Willig R, Luukinen H, Jalovaara P
Department of Surgery, Central Hospital of Länsi-Pohja, Kemi, University of Oulu, Oulu, Finland.
Public Health. 2003 Jan;117(1):25-30. doi: 10.1016/S0033-3506(02)00005-7.
Recently, it has been shown that hip fractures can be effectively prevented by use of hip protectors. To determine who would gain most benefit from use of hip protectors, we conducted a study with the aim to clarify factors that contribute to the occurrence of fracture in individuals who fall on their hip. Hip fracture patients were compared with individuals who had fallen on their hip without sustaining a fracture. The study group consisted of 123 consecutive hip fracture patients aged 70 years or over (mean age 82 years, female 82 years and male 80 years). The control group comprised 132 individuals (mean age 81 years, female 81 years and male 80 years) obtained from a prospective study on falls, who had experienced a fall that caused a visible soft tissue injury (bruise or wound) at the hip or gluteal region without sustaining a fracture. Patients were questioned about associated diseases, medications, place of residence, walking ability, need for locomotor aids and some activities in daily living (ADL). Patients who sustained a hip fracture were more likely to be women, living in long-term institutional care, using neuroleptics, dependent in ADL and had more history of previous stroke with hemiparesis, more Parkinsonism and lower body mass indexes (BMI) than those who did not sustain a fracture on fall on the hip. According to a logistical regression model, institutional residence, low BMI and history of stroke with hemiplegic status differed between fracture cases and controls. Institutional residence, low BMI and history of hemiplegic stroke discriminate hip fracture patients from fallers who sustain a soft tissue injury on the hip region. In clinical practice, patients who have these characteristics would be potential candidates to use hip protectors and other preventive measures.
最近的研究表明，使用髋部保护器可以有效预防髋部骨折。为了确定哪些人能从使用髋部保护器中获益最大，我们开展了一项研究，旨在明确导致髋部着地的个体发生骨折的相关因素。将髋部骨折患者与髋部着地但未发生骨折的个体进行比较。研究组由123例连续的70岁及以上髋部骨折患者组成（平均年龄82岁，女性82岁，男性80岁）。对照组包括132名个体（平均年龄81岁，女性81岁，男性80岁），这些个体来自一项关于跌倒的前瞻性研究，他们经历了一次跌倒，导致髋部或臀部区域出现明显的软组织损伤（瘀伤或伤口）但未发生骨折。对患者询问了相关疾病、用药情况、居住地点、行走能力、是否需要助行器以及一些日常生活活动（ADL）。与髋部着地未发生骨折的患者相比，发生髋部骨折的患者更可能为女性，居住在长期机构护理机构，使用抗精神病药物，日常生活活动依赖他人，既往有更多中风伴偏瘫病史、帕金森病病史且体重指数（BMI）更低。根据逻辑回归模型，骨折病例与对照组在机构居住、低BMI和中风伴偏瘫状态方面存在差异。机构居住、低BMI和偏瘫性中风病史可将髋部骨折患者与髋部区域发生软组织损伤的跌倒者区分开来。在临床实践中，具有这些特征的患者可能是使用髋部保护器和其他预防措施的潜在人选。
