Röder Frank, Schwab Matthias, Aleker Thomas, Mörike Klaus, Thon Klaus-Peter, Klotz Ulrich
Department of Geriatric Rehabilitation, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.
Age Ageing. 2003 Jan;32(1):74-80. doi: 10.1093/ageing/32.1.74.
hip fracture is a major cause of morbidity and mortality in older people; optimal post-surgical treatment is a matter of controversy.
to examine the effects of rehabilitation on the clinical outcome following surgical treatment of hip fracture.
prospective longitudinal study in three groups of patients with different post-surgical care.
initial screening of 283 elderly patients with proximal femur fracture; documentation of medical and social history and clinical data; geriatric assessments (Activities of Daily Living and Instrumental Activities of Daily Living) during hospital stay and follow-up for 12 months. One hundred and forty-five patients (>or=65 years) of normal mental status were eligible for the study. Successful follow-up could be monitored in 120 and 117 patients for 6 and 12 months, respectively. Sixty-nine and 39 patients underwent supervised inpatient rehabilitation in an orthopaedic or geriatric hospital, respectively (intervention groups A and B, respectively) whereas 34 patients received no special rehabilitation as they were directly discharged home (control group C).
initially a fall-/surgical-induced reduction (P<0.001) of the main outcome measure (Activities of Daily Living) was observed in all patients. Within 6 months of rehabilitation there was an improvement (P<0.01) in Activities of Daily Living; however the pre-fracture scores were not reached. The same time pattern was seen in group C. Therefore no significant differences between the three groups of patients in approaching the baseline status was visible. Moreover, the one-year total mortality in the studied population with normal mental status averaged 11.7% and did not differ between the three groups.
based on our measured outcome variables institutional rehabilitation after surgical treatment of hip fracture apparently had no significant impact on mortality and morbidity in older patients of normal mental status.
髋部骨折是老年人发病和死亡的主要原因；最佳的术后治疗存在争议。
探讨康复治疗对髋部骨折手术治疗后临床结局的影响。
对三组接受不同术后护理的患者进行前瞻性纵向研究。
初步筛查283例老年股骨近端骨折患者；记录医疗和社会史以及临床资料；在住院期间和随访12个月期间进行老年评估（日常生活活动和工具性日常生活活动）。145例精神状态正常（≥65岁）的患者符合研究条件。分别有120例和117例患者成功随访6个月和12个月。69例和39例患者分别在骨科或老年医院接受了有监督的住院康复治疗（分别为干预组A和B），而34例患者因直接出院回家未接受特殊康复治疗（对照组C）。
最初，所有患者的主要结局指标（日常生活活动）均因跌倒/手术而降低（P<0.001）。康复治疗6个月内，日常生活活动有改善（P<0.01）；然而，未达到骨折前评分。C组也出现了相同的时间模式。因此，三组患者在接近基线状态方面没有显著差异。此外，研究人群中精神状态正常者的一年总死亡率平均为11.7%，三组之间无差异。
基于我们测量的结局变量，髋部骨折手术治疗后机构康复对精神状态正常的老年患者的死亡率和发病率显然没有显著影响。
