Youm T, Aharonoff G, Zuckerman J D, Koval K J
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York 10003, USA.
J Orthop Trauma. 2000 Jun-Jul;14(5):329-34. doi: 10.1097/00005131-200006000-00004.
To evaluate the effect of previous cerebrovascular accident on outcome after hip fracture.
Prospective, consecutive.
From July 1987 to March 1997, 862 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed.
All patients had operative fracture treatment.
Postoperative complications, in-hospital mortality, hospital length of stay, hospital discharge status, one-year mortality and place of residence, and return to preinjury ambulatory level, basic and instrumental activities of daily living status.
Sixty-three patients (7.3 percent) had a history of cerebrovascular accident; the fracture was on the hemiplegic side in forty-six (86.8 percent) of the fifty-three patients with hemiplegia. Patients who had a history of cerebrovascular accident were more likely to be male and have an American Society of Anesthesiologists (ASA) rating of III or IV. They were also more likely to have three or more comorbidities, be a home ambulator, and be dependent on basic and instrumental activities of daily living before hip fracture. Hospital length of stay was significantly higher for patients who had a history of cerebrovascular accident. There were no differences in the incidence of hospital mortality or one-year mortality between patients who did and did not have a history of cerebrovascular accident before hip fracture. In addition, at one-year follow-up, when controlling for prefracture level of function, there were no differences in the rate of functional recovery between the two groups of patients.
The functional recovery of elderly hip fracture patients who had a prior cerebrovascular accident was similar to that of patients who had no history of a prior cerebrovascular accident.
评估既往脑血管意外对髋部骨折预后的影响。
前瞻性、连续性研究。
1987年7月至1997年3月，对862例65岁及以上接受手术治疗的股骨颈或转子间骨折的社区居住患者进行前瞻性随访。
所有患者均接受骨折手术治疗。
术后并发症、住院死亡率、住院时间、出院状态、1年死亡率及居住地点，以及恢复至伤前行走水平、基本和工具性日常生活活动状态。
63例患者（7.3%）有脑血管意外病史；在53例偏瘫患者中，46例（86.8%）骨折位于偏瘫侧。有脑血管意外病史的患者更可能为男性，美国麻醉医师协会（ASA）分级为Ⅲ或Ⅳ级。他们也更可能有三种或更多合并症，为家庭行走者，且在髋部骨折前依赖基本和工具性日常生活活动。有脑血管意外病史的患者住院时间显著更长。髋部骨折前有和没有脑血管意外病史的患者在住院死亡率或1年死亡率发生率上无差异。此外，在1年随访时，在控制骨折前功能水平后，两组患者的功能恢复率无差异。
既往有脑血管意外的老年髋部骨折患者的功能恢复与无既往脑血管意外病史的患者相似。
