乌司他丁对老年患者髋部骨折术后谵妄的影响

目的评价围术期静脉输注乌司他丁对老年患者髋部骨折术后谵妄(POD)的影响。方法选择择期行髋部骨折手术的老年患者96例,男38例,女58例,年龄70~93岁,ASAⅡ或Ⅲ级,采用随机数字表法分为两组:乌司他丁组(U组)和对照组(C组),每组48例。麻醉方式均采用腰-硬联合麻醉+髂筋膜间隙阻滞。U组于切皮前、术后第1天和第2天静脉泵入乌司他丁5 000U/kg;C组给予等容积生理盐水。术后1~3d采用意识错乱评估法(CAM)评定POD的发生情况。分别于麻醉前(T0)、术毕(T_1)和术后第3天(T2)采集外周静脉血5ml,采用ELISA法检测血清IL-6和S100β的水平。结果 C组POD发生13例(28.2%),U组POD发生2例(4.3%),U组POD发生率明显低于C组(P0.05);与T0时比较,T_1、T_2时C组血清IL-6和IL-10水平明显升高(P0.05);T_1、T_2时U组血清IL-6水平明显低于C组(P0.05)。与T_0时比较,T_1时C组S100β水平明显升高(P0.05);T_1时U组血清S100β水平明显低于C组(P0.05)。结论乌司他丁降低老年髋部骨折患者POD发生率,机制可能与抑制血清促炎症因子IL-6和S100β的过度释放相关。     

Predictors of bone loss after hip fracture

Although accelerated bone mineral density (BMD) loss follows hip fracture, little is known about factors associated with this loss. We examined potential predictors of BMD loss in a cohort of community-dwelling women who had sustained hip fracture and who were followed for 1 year after fracture. BMD was measured at the femoral neck, intertrochanteric region, and total body, during hospitalization and 2, 6, and 12 months later. Demographic, health, lifestyle, clinical, surgical, and functional characteristics at baseline, and postfracture activity were evaluated for associations with baseline BMD and BMD 1 year later. To examine possible BMD-dependent effects, high and low baseline BMD groups were defined. None of the studied factors consistently predicted either baseline BMD or BMD at 1 year after fracture, among women with either high or low baseline BMD. Baseline BMD was the only factor that substantially and consistently predicted change, explaining 70% to 90% of variation. These results suggest that BMD will not be preserved by general rehabilitative measures and that prompt, specific intervention to minimize bone loss after hip fracture is an essential element of clinical management of the hip fracture patient.     

Predictors of functional outcome following intracapsular hip fracture in elderly women. A one-year prospective cohort study

OBJECTIVES: To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty. PARTICIPANTS AND METHODS: Eighty-four women aged > or =50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice. The main outcome measure was the rapid disability rating scale version-2 (RDRS-2) applied at hospital discharge and one year later. RESULTS: At hospital discharge, the total hip arthroplasty group was younger and had a better functional status than the internal fixation or hemiarthroplasty groups. One year later, the best function was still observed in the total arthroplasty group, but the differences were small and failed to achieve the level of statistical significance. During that one-year period, walking ability or mobility did not change significantly after total hip arthroplasty, but a significant proportion of the women developed cognitive impairment, including mental confusion, uncooperativeness, and depression. Overall, the most significant predictors of poor functional status one year after fracture were increasing age, living in an institution at time of injury, and poor functional status at discharge. CONCLUSIONS: In elderly women with a displaced intracapsular hip fracture, total hip arthroplasty is associated with a functional benefit within the first months after surgery. However, the extent to which this functional benefit is maintained over time, is less clear. These results support the need for randomised studies to quantify the extent to which, in elderly women, the early functional benefit of total hip arthroplasty is maintained in the long run or compromised by progressive cognitive impairment and other negative determinants of functional outcome.     

老年患者髋部骨折术后肺部并发症的危险因素

目的采用巢式病例-对照研究分析老年髋部骨折患者术后肺部并发症的危险因素。方法回顾性分析我院2005年1月至2014年12月诊治的老年髋部骨折患者的临床资料,对其中术后新发生肺部并发症的56例患者(研究组),采用巢式病例-对照研究的方法,按照1∶6匹配同期同类未发生肺部并发症的336例患者(对照组),探讨性别、年龄、术前并存疾病(心脏疾病、高血压、肺部疾病、糖尿病、脑血管疾病和慢性肾脏疾病)、术前卧床时间、手术方式、麻醉方法、失血量和手术时间对术后肺部并发症的影响。结果 572例老年髋部骨折患者中,56例术后新发肺部并发症,单因素分析显示,研究组年龄明显大于对照组(P0.05),术前合并肺部疾病、髓外固定术、全身麻醉比例明显高于对照组(P0.05),术前卧床时间明显长于对照组(P0.05)。多因素Logistic回归分析显示,高龄(OR=1.12,95%CI 1.07～1.18,P0.001)、术前合并肺部疾病(OR=3.30,95%CI 1.34～8.15,P=0.010)、术前卧床时间延长(OR=1.29,95%CI 1.15～1.44,P0.001)、髓外固定术(OR=5.69,95%CI 2.10～15.39,P=0.001)和全身麻醉(OR=2.15,95%CI 1.05～4.40,P=0.036)是老年髋部骨折患者术后新发肺部并发症的独立危险因素。结论高龄、术前合并肺部疾病、术前卧床时间延长、髓外固定术和全身麻醉可以作为老年髋部骨折患者术后新发肺部并发症的独立危险因素,针对危险因素进行干预或可降低术后肺部并发症的发生。     

Safety of endoscopy in the immediate postoperative period following gastric anastomosis

Summary The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period.     

Predictors of 5 year survival following hip fracture

Background

This study aims to assess the mortality associated with hip fracture at 5 years in a geriatric population, and evaluate the influence of age, cognitive state, mobility and residential status on long term survival after hip fracture.

Methods

A prospective audit was carried out of all patients with a hip fracture admitted to a university hospital over a 4 year period. Data from 2640 patients were analysed and multivariate analysis used to indicate the important variables predicting mortality. Patients fulfilling the criteria of age < 80 years, Abbreviated Mental Test Score (AMT) ≥ 7/10, independently mobile and admitted from own home were put into group A (low risk group). Patients not meeting the criteria were placed into group B (high risk group).

Results

2640 patients fitted the inclusion criteria, 482 in group A and 2158 in group B. 850 patients (43.1%) died in their first year following hip fracture. 302 patients (63%) of group A were still alive at 5 years in comparison with only 367 (17%) of group B. Overall, 669 (25%) patients survived for 5 years. Increased survival was shown for the following variables: age < 80 years RR 5.27 (p < 0.01), AMT ≥ 7/10 RR 6.03 (p < 0.01), independent mobility RR 2.63 (p < 0.01) and admitted from own home RR 4.52 (p < 0.01).

Conclusions

These findings will allow for early recognition of those patients with an increased chance of long-term survival following hip fracture. Such patients may be suitable for surgical treatment, such as total hip replacement, which has a good long-term outcome.     

Predictive nomogram for postoperative delirium in elderly patients with a hip fracture

To evaluate the risk factors for the development of postoperative delirium and design a predictive nomogram for the prevention of delirium in elderly patients with a hip fracture, we retrospectively studied 825 patients who sustained a femoral neck fracture from January 2005 to December 2015. Independent risk factors for developing delirium within 6 months of surgery were identified using multivariable logistic regression analyses. A predictive nomogram model was built based on the results, and the discrimination and calibration were determined by C-index and calibration plot. Of the 825 patients who met inclusion criteria, 118 (14.3%) developed postoperative delirium. According to the results, preoperative cognitive impairment (OR, 4.132, 95% CI, 1.831 to 9.324, P＜0.001), multiple medical comorbidities (OR, 1.452, 95% CI, 0.958–2.202, P?=?0.079), ASA classification (OR, 1.655, 95% CI, 1.073–2.553, P?=?0.023), transfusion exceeding 2 units of red blood cell (OR, 1.599, 95% CI, 1.043–2.451, P?=?0.035), and intensive care (OR, 1.817, 95% CI, 1.127–2.930, P?=?0.014) were identified to be the independent predictors of the development of postoperative delirium. The risk of postoperative delirium increased with the increasing risk score of predictive nomogram, and the C-index was 0.67 (0.62 - 0.72). The calibration showed that the predicted probabilities of delirium in the predictive nomogram were close to the observed frequency of delirium, and the decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 8% and 35% due to the net benefit.     

疼痛管理对老年髋部骨折患者术后的影响

目的探讨老年髋部骨折患者规范化疼痛管理的效果。方法将年龄≥60岁、髋部骨折已行手术的40例患者随机分为干预组和对照组各20例。对照组采用常规护理,观察组在此基础上对患者进行规范化疼痛管理,包括健康教育、合理评估、合理应用镇痛药物、个体化管理等措施。结果两组术后第3天及出院时疼痛程度、出院时日常生活能力、住院时间比较,差异有统计学意义(P<0.05,P<0.01)。结论对老年髋部骨折患者实施疼痛管理,能够减轻术后疼痛,提高患者的生活能力,促进其早日康复。     

老年髋部骨折患者术后对侧髋部骨折发生因素的Meta分析

目的通过Meta分析评价影响老年髋部骨折患者术后对侧髋部骨折的相关因素。方法检索Pubmed、Cochrane、中国生物医学文献数据库、CNKI中国期刊全文数据库、万方数据库自2005年1月至2018年4月国内外正式刊物上公开发表的有关老年髋部骨折术后对侧髋部骨折相关因素的文献,严格评价质量及提取相关资料,获取患者的性别、年龄(>65岁)、吸烟、初次髋部骨折类型、骨质疏松症(Singh指数≥4为骨质疏松)、伴有原发性高血压、伴有帕金森病、伴有脑卒中、伴有老年痴呆症、伴有白内障、伴有类风湿关节炎、伴有糖尿病、初次骨折内固定种类、患者治疗配合的依从性。运用RevMan5.0软件进行统计分析,评估各项指标的优势比(OR)和95%可信区间(CI)。结果共纳入17项研究13717例老年髋部骨折患者,发生对侧髋部骨折1504例。影响老年髋部骨折术后对侧髋部骨折的相关因素有患者年龄(OR=-3.55,95%CI:-5.60^-1.50,P<0.001)、骨质疏松症(OR=2.38,95%CI:1.36~4.17,P=0.002)、伴有帕金森病(OR=4.54,95%CI:2.74~7.53,P<0.001)、脑卒中(OR=0.33,95%CI:0.18~0.59,P<0.001)、老年痴呆症(OR=0.43,95%CI:0.29~0.62,P<0.001)、白内障(OR=0.37,95%CI:0.22~0.63,P<0.001)、类风湿关节炎(OR=0.32,95%CI:0.21~0.50,P<0.001)、糖尿病(OR=0.65,95%CI:0.47~0.91,P=0.01)、初次骨折内固定种类(OR=0.51,95%CI:0.30~0.85,P=0.01)、治疗配合依从性(OR=0.36,95%CI:0.21~0.64,P<0.001),而与性别(OR=1.07,95%CI:0.45~2.56,P=0.88)、吸烟(OR=0.86,95%CI:0.40~1.86,P=0.70)、初次髋部骨折类型(OR=0.97,95%CI:0.60~1.57,P=0.90)、伴有原发性高血压(OR=0.70,95%CI:0.41~1.21,P=0.20)无关。结论影响老年髋部骨折患者术后对侧髋部骨折的相关因素有年龄偏大、伴有骨质疏松症、帕金森病、脑卒中、老年痴呆症、白内障、类风湿关节炎、糖尿病、初次骨折内固定种类、治疗配合依从性差。而患者性别、吸烟、骨折类型、伴有原发性高血压目前尚无足够的证据与对侧髋部骨折有关。     

高龄髋部骨折患者术后谵妄危险因素调查

目的明确年龄≥75岁高龄髋部骨折术后谵妄的发病率,筛选导致术后谵妄的危险因素。方法自2012-06—2015-06诊治年龄≥75岁的髋部骨折435例,统计术后谵妄发生率,并根据术后3 d内是否发生谵妄分为谵妄组和非谵妄组。可疑危险因素进行组间比较后,将差异有统计学意义的因素进行Logistic回归分析,筛选发生术后谵妄的危险因素。结果 102例发生术后谵妄,发生率23.45%。谵妄组与非谵妄组间年龄、术前白蛋白、术后血红蛋白、术后红细胞压积、简易精神状态评价量表评分(MMSE评分)、术前老年痴呆病史、视力障碍、听力障碍、留置导尿、居住状态的差异有统计学意义(P0.05)。Logistic回归分析结果显示视力障碍、留置导尿、低MMSE评分、低白蛋白是发生术后谵妄的独立危险因素(P0.05)。结论髋部骨折手术是术后谵妄发生的重要原因;年龄不是高龄髋部骨折患者术后谵妄的独立危险因素;术前认知功能与感觉功能障碍及低营养状态是高龄髋部骨折患者出现术后谵妄的主要危险因素。     

Early postoperative hypoalbuminemia is a risk factor for postoperative acute kidney injury following hip fracture surgery

IntroductionAcute kidney injury (AKI) is a common and serious complication after hip fracture surgery in older adults. Hypoalbuminemia is a known independent risk factor for AKI. However, few studies have investigated the relationship between early postoperative hypoalbuminemia and AKI after hip fracture surgery. Therefore, we sought to determine the incidence of and risk factors for AKI and the effects of early postoperative hypoalbuminemia on AKI incidence after surgery for hip fractures, especially intertrochanteric fractures of the proximal femur.Patients and methodsIn this retrospective cohort study from a single center, we reviewed the medical records of 481 consecutive patients (>60 years) who underwent surgery for intertrochanteric fracture of the proximal femur. Multiple logistic regression was performed to identify independent risk factors for AKI. After determining the cut-off value of the minimal level of postoperative serum albumin during the first two postoperative days, we divided the patients into two groups: group 1 included 251 patients whose minimal early postoperative serum albumin level was <2.9 g/dL during the first two postoperative days; and group 2 included 230 patients whose minimal early postoperative serum albumin level was ≥2.9 g/dL. The incidence of AKI was analyzed using inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and propensity score matching weighting (PSMW) analyses.ResultsThe incidence of AKI, defined based on the Kidney Disease Improving Global Outcomes criteria, was 11.8% (n = 57). Chronic kidney disease and the minimal early postoperative serum albumin level <2.9 g/dL at any point during the first two postoperative days were independent risk factors for AKI. The IPTW, PSM, and PSMW analyses comparing the incidence of AKI between the two groups revealed that the minimal early postoperative serum albumin level <2.9 g/dL was significantly associated with AKI development (P < 0.001, P = 0.025, and P = 0.011, respectively).ConclusionThe incidence of postoperative AKI was 11.8%. Our findings demonstrate that early postoperative hypoalbuminemia is an independent risk factor for AKI in patients undergoing surgery for intertrochanteric fracture of the proximal femur.     

Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture

Introduction

Contra-lateral hip fractures in elderly patients with a previous hip fracture increase the incidence of complications and socioeconomic burden. The purpose of this study was to identify the risk factors that contribute to the occurrence of contra-lateral hip fracture in elderly patients.

Materials and methods

Among 1093 patients treated for a hip fracture, 47 patients sustained a contra-lateral hip fracture. These patients were compared with 141 patients with a unilateral hip fracture (controls).

Results

The incidence of contra-lateral hip fracture was 4.3% among the 1093 patients treated for a hip fracture at our institute. A contra-lateral hip fracture occurred within 2 years of initial fracture in 66%, and subsequently, the annual incidence rate decreased. A similar fracture pattern was noted in 70% of patients who sustained an intertrochanteric fracture. In terms of preoperative factors, respiratory disease (OR 2.57, P = 0.032) and visual impairment (OR 2.51, P = 0.012) were higher in patients with a contra-lateral hip fracture than in controls, and for postoperative factors, the proportions of patients with postoperative delirium (OR 2.91, P = 0.022), late onset of rehabilitation (OR 1.05, P = 0.023), and poor ambulatory status at 3 months (OR 1.34, P = 0.002) were also significantly higher in patients than in controls.

Conclusions

Postoperative delirium and underlying visual impairment and respiratory disease could be risk factors of contra-lateral fracture in elderly patients. Early and active rehabilitation after surgery is important to prevent the occurrence of contra-lateral hip fracture in the elderly.     

卒中后偏瘫的老年髋部骨折患者术后一年内死亡相关因素分析

目的 探讨卒中后偏瘫的老年髋部骨折患者的一般特征及术后1年内死亡的相关影响因素.方法 回顾性分析2000年1月至2007年5月手术治疗的老年髓部骨折患者资料.比较偏瘫组与非偏瘫组患者的一般特点,分析偏瘫组患者1年内死亡的相关影响因素.分析的变量包括:年龄、性别、美国麻醉医师协会(ASA)分级、术前合并疾病数量及种类、骨折类型、骨折前活动能力、认知能力、住院时间、受伤至手术时间、麻醉方式及手术方式等.结果 共有1379例患者符合纳入标准,平均年龄为(76.4±7 0)岁(65 ～99岁);其中101例患者髋部骨折前患有卒中后偏瘫.偏瘫组与非偏瘫组患者的ASA分级、术前合并疾病数量、骨折前活动能力、认知能力、住院时间及术后1年存活情况差异均有统计学意义(P＜0.05).偏瘫组患者术后1年髓访,25例患者死亡,病死率为24.8％.多因素Logistic回归分析结果显示:性别(P=0.017)、ASA分级(P=0.009)、术前合并疾病数量(P=0.048)、骨折前活动能力(P=0.000)及慢性呼吸系统疾病(P=0.022)是偏瘫患者术后1年死亡的危险因素. 结论 偏瘫组患者较非偏瘫组患者住院时间长,死亡率高.男性患者、ASA分级为Ⅲ或Ⅳ级、术前合并疾病≥3种、慢性呼吸系统疾病及弱的骨折前活动能力是影响卒中后偏瘫的老年髋部骨折患者术后1年内死亡的危险因素.     

术后使用右美托咪定对老年髋部手术患者发生谵妄的临床研究

目的探讨术后使用右美托咪定对老年髋部手术患者发生谵妄的影响。 方法前瞻性收集2016年1月至2018年1月在海门市人民医院骨科行髋部手术的老年患者50例,采用随机数字表法将患者分为两组：右美托咪定组25例,术后在骨科常规治疗基础上给予右美托咪定静脉泵入注射用于术后镇痛,维持量0.5 μg/kg/hr;对照组25例,仅给予骨科常规治疗。比较两组谵妄的发生率、发生时间、持续时间。 结果全部患者均获得随访,随访时间为7~15 d,平均（10.0±1.4）d。右美托咪定组谵妄的发生率（6%）与对照组（13%）比较,差异无统计学意义（P>0.05）。右美托咪定组谵妄的发生时间为术后（26±6）h,晚于对照组的（7±3）h,差异有统计学意义（t=2.370,P<0.05）。右美托咪定组谵妄的持续时间为（2.4±0.8）d,短于对照组的（6.2±1.5）d,差异有统计学意义（t=-1.942,P<0.05）。 结论右美托咪定能延缓谵妄的发生,缩短谵妄的持续时间,但不能显著降低谵妄的发生率。     

超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者围术期镇痛的研究

目的:研究超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期疼痛控制及术后并发症的影响。方法:选择2021年1月至2021年9月收治的老年髋部骨折手术患者127例,按照镇痛方法不同分为连续髂筋膜间隙阻滞组(F组)和静脉镇痛对照组(C组)。其中F组62例,男19例,女43例;年龄66~95(82.4±7.2)岁;股骨颈骨折25例,股骨转子间骨折37例。C组65例,男18例,女47例;年龄65~94(81.4±8.7)岁;股骨颈骨折29例,股骨转子间骨折36例。观察两组患者围术期不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS)、简易精神状态评价量表(minimental state examination,MMSE)评分、警觉-镇静评分(observer''s assessment of alertness/sedation,OAA/S)、改良Bromage评分、术后并发症及患者住院期间情况。结果:F组实施阻滞后30 min、麻醉摆放体位时,术后6、24、48 h的静息及运动VAS低于C组(P<0.05)。F组术前12 h,术后1、3 d的MMSE评分及术后3 d的OAA/S评分高于C组(P<0.05)。F组不良反应发生率、需要额外镇痛人数低于C组(P<0.05)。F组围术期镇痛满意度及住院时间均优于C组(P<0.05)。两组患者在各时间点患肢Bromage评分及术后30 d死亡率比较,差异无统计学意义(P>0.05)。结论:超声引导下连续髂筋膜间隙阻滞可为老年髋部骨折患者提供安全、有效的围术期镇痛效果,改善术后认知功能,减少术后并发症,从而缩短住院时间,提高住院期间生活质量。     

Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients

Background

In April 2004 the Israeli Ministry of Health decided to condition DRG payment for hip surgery by time between hospitalisation and operation, giving a fine for every day's delay beyond 48 h. An evaluation study performed 2 years after the reform has shown the positive influence of the reform on patient's survival in the hospital. This study evaluates the impact of the reform on the longer-term mortality of patients.

Methods

A retrospective study based on data from nine hospitals of the national trauma registry available for the years 2001–2007, with surveillance on 2-year survival through data of Ministry of the Interior. The study population includes patients aged 65 and above with an isolated hip fracture following trauma. Mortality curves and Cox regression were utilised to compare the influence of different parameters on long-term mortality.

Results

Earlier surgery had a significant positive impact on survival through the whole length of the study period. In the period after the introduction of the new reimbursement system for hip fracture surgeries, a significant decrease in the longer-term mortality was observed up to 6 months of follow-up, even when adjusted by patients’ age, gender and the receiving hospital. After 6 months there was no further decrease in relative risk, though the survival advantage remained with patients hospitalised after the reform.

Conclusions

The reform appears successful in decreasing the longer-term patient mortality after hip fracture through influencing surgical practice.     

加速康复外科理念在高龄髋部骨折围术期的应用效果

目的探讨加速康复外科（ERAS）理念在高龄髋部骨折患者围术期应用的临床效果。 方法回顾性分析2013年7月至2016年10月，上海中医药大学附属普陀医院接受手术的高龄（年龄≥75岁）髋部骨折患者149例，男62例，女87例，年龄（82±5）岁。分别采用加速康复外科组及传统处理模式组进行围手术期处理。分析两组患者术后住院时间、疼痛视觉模拟评分（VAS）评分、术后并发症发生情况、髋关节Harris评分并进行对比。 结果149例患者均成功获得随访，随访时间（16.0±2.3）个月。男62例，女87例，平均年龄（82±5）岁。加速康复外科组患者术后住院时间为（7.2±1.2）d，少于传统处理模式组术后住院时间[（12.1±1.9）d，t=2.513，P<0.05]。术后24 h及48 h，加速康复外科组VAS评分与传统处理模式组比较，差异无统计学意义（t=1.761，t=1.598；均P>0.05）。术后12 h及72 h，加速康复外科组VAS评分为（2.5±1.3）分、（1.2±0.8）分，低于传统处理模式组[（3.9±1.6）分、（2.7±1.5）分，t=2.379，t=2.165；均P<0.05]。加速康复外科组术后精神异常以及恶心呕吐发生率（6.4%及9.0%）低于传统处理模式组（23.9%及29.6%，χ²=9.079，χ²=10.339；均P<0.05）。肺部感染、下肢深静脉血栓、脑血管意外、尿路感染、褥疮发生率差异无统计学意义（χ²=1.665，χ²=1.232，χ²=0.444，χ²=2.170及χ²=1.091；均P>0.05）。术后1 w，加速康复外科组Harris评分为（63.2±4.8）分，高于传统处理模式组[（49.2±3.9）分，t=2.221，P<0.05]，术后3、6及12个月，两组Harris评分差异无统计学意义（t=1.187，t=1.098，t=0.813，均P>0.05）。 结论高龄髋部骨折患者围手术期应用加速康复外科理念安全有效，可以减少术后精神异常以及恶心呕吐发生率，加速患者术后早期髋关节功能恢复，缩短术后住院时间，值得临床推广应用。     

Post-discharge complications in postoperative patients with hip fracture

Hip fractures often occur in elderly people and are a major global health challenge causing many consequences, both in health and socioeconomic costs. This review aimed to identify complications that occur in patients with postoperative hip fracture between 30 days and 60 months after discharge. This review was conducted on articles published from 2005 to 2017 obtained from the EBSCO, PubMed, ProQuest and Google Scholar databases. The literature search followed PRISMA Guidelines. Key search words included the terms: hip fracture, complication, postoperative, community, and nursing. Articles were considered eligible if discussed the complications of hip fracture with surgical treatment, occurring post hospital discharge and the patient was in the community. In this review, 23 articles were included that met the inclusion criteria. There were 16 articles that cohort studies, 3 were retrospective studies, 3 were randomized control trials and 1 article was an observational study. The time of observation varied from 30 days to the longest of 5 years. Quality assessment of the levels of evidence used the Oxford CEBM recommendations. The review results found that postoperative hip fracture patients after discharge still experienced various complications after 30 days and up to 1–3 years post-operation.     

衰弱量表与衰弱表型评估对老年髋部骨折患者术后转归的预测作用

目的 比较衰弱量表与衰弱表型评估对老年髋部骨折患者术后转归的预测作用。
方法 2019年9月至2020年1月髋部骨折患者120例,男65例,女55例,年龄≥65岁,术前1 d分别采用衰弱量表和衰弱表型完成衰弱评估,依据两个量表各自评估的结果将患者分为：非衰弱期、衰弱前期和衰弱期,通过κ检验比较两种方法的一致性,并通过χ2检验确定衰弱与术后转归各项指标之间的关系。
结果 采用衰弱量表和衰弱表型检出老年髋部骨折患者术前衰弱期的比例分别为15.0%、22.5%,一致性检验κ值为0.55（95%CI 0.42～0.67）。根据衰弱量表评估结果,衰弱期患者术后总并发症（RR=4.5,95%CI 0.9～21.5）、术后住院时间超过5 d（RR=3.5,95%CI 1.0～12.2）和PACU停留时间超过60 min（RR=6.9,95%CI 1.2～40.1）的发生风险明显高于非衰弱期患者,衰弱前期患者术后住院时间超过5 d的发生风险明显高于非衰弱期患者（RR=2.7,95%CI 1.0～7.0）。根据衰弱表型评估结果,衰弱前期患者术后总并发症的发生风险明显高于非衰弱期患者（RR=4.7,95%CI 1.0～22.9）,衰弱期患者PACU停留时间超过60 min的发生风险明显高于非衰弱期患者（RR=5.3,95%CI 1.0～28.6）。
结论 衰弱量表和衰弱表型作为老年髋部骨折术前衰弱评估工具,两者评估一致性中等,其中衰弱量表在预测术后转归方面更具优势。