Specht-Leible N, Schultz U, Kraus B, Meeder P J, Quentmeier A, Ewerbeck V, Voss E, Martin M, Oster P
Bethanien Krankenhaus,Geriatrisches Zentrum am Klinikum der Universität Heidelberg.
Unfallchirurg. 2003 Mar;106(3):207-14. doi: 10.1007/s00113-002-0545-x.
The goal of the investigation was to study case management and functional outcome in older patients with hip fracture. A prospective observational survey was performed, including all patients aged 65 years and over presenting with hip fracture in Heidelberg, from 1 July 1999 to 30 June 2000. All patients were reassessed by telephone calls 6 months post-fracture. A total of 331 patients were included (mean age 81.5 years, 81% female,23.8% nursing home residents). Hip fracture incidence per 1,000 was 7.8/year, and nursing home residents had a six times higher incidence rate than those living at home. Prior to the fracture, half of the patients were dependent in ambulation and a third needed support in basic activities. With substantial comorbidity (42% cognitive impairment), complications were common. Geriatric care was needed for 82% of the survivors. In-hospital treatment costs were about 10,000 Euro per fracture. Mortality at 6 months was 19.9%. The majority of survivors showed loss of competence and mobility. Functional outcome in older patients with hip fracture is disappointing. As the majority of the patients are frail, clinical treatment is complicated by "geriatric" problems. Thus, improved interdisciplinary care, with close cooperation between geriatricians and surgeons might result in a better functional outcome.
该调查的目的是研究老年髋部骨折患者的病例管理和功能转归。进行了一项前瞻性观察性调查，纳入了1999年7月1日至2000年6月30日期间在海德堡出现髋部骨折的所有65岁及以上患者。所有患者在骨折后6个月通过电话进行重新评估。共纳入331例患者（平均年龄81.5岁，81%为女性，23.8%为养老院居民）。每1000人的髋部骨折发病率为每年7.8例，养老院居民的发病率比居家者高6倍。骨折前，一半的患者行走依赖他人，三分之一的患者在基本活动方面需要帮助。合并症严重（42%有认知障碍），并发症很常见。82%的幸存者需要老年护理。每次骨折的住院治疗费用约为10000欧元。6个月时的死亡率为19.9%。大多数幸存者出现了能力和活动能力丧失。老年髋部骨折患者的功能转归令人失望。由于大多数患者身体虚弱，临床治疗因“老年”问题而变得复杂。因此，老年科医生和外科医生密切合作，改善多学科护理，可能会带来更好的功能转归。
