Ekström Henrik, Elmståhl Sölve
Department of Health Sciences, Division of Geriatric Medicine, Lund University and Malmö University Hospital, Malmö, Sweden.
Acta Orthop. 2006 Dec;77(6):902-11. doi: 10.1080/17453670610013204.
Earlier reports on reduced physical performance and osteoporosis-related fractures have mostly been short-term studies. The aim of this investigation was to examine the effects of fractures on physical functioning 3 years after trauma, the latter being stratified for pain.
The study consisted of a population-based case-control study including 289 subjects from the "Good Ageing in Skåne" project. Men and women with fractures, aged 60-93 years, were divided into one group with pain (FP, n = 71) and one without pain (FnP, n = 53). Fractures included vertebrae, hip, pelvis or ankle according to the national medical register. A third group of subjects without fractures or pain (CnP, n = 165) was used as control. Pain during the previous month, health variables, lifestyle, medication, use of a walking aid, and sociodemographic variables were self-reported. Walking 15 m, 2 x 15 m, and timed get-up-and-go (TUG)--all at self-selected and maximum speed--and maximum handgrip strength were assessed objectively.
Among the FP patients, almost half of the group suffered pain on a daily basis. The subjects in the CnP and FnP groups performed significantly better than the FP patient group in all functional tests. Median time for walking a distance of 15 m at self-selected speed was 16, 13 and 12 sec for the CnP, FnP and FP groups, respectively. Both fracture and pain independently explained lower walking speed (self-selected and maximum) as well as TUG, adjusted for age, sex and co-morbidity in a multiple regression model. Those who had sustained fractures more than 3 years previously performed significantly better in walking 15 m and 2 x 15 m at both self-elected and maximum speed than those with a more recent fracture, irrespective of pain.
After 3 years, patients who had sustained a fracture but who experienced no pain performed almost as well as control subjects. Pain and fracture were independently influenced by physical function.
早期关于身体机能下降和骨质疏松相关骨折的报告大多是短期研究。本调查的目的是研究创伤3年后骨折对身体功能的影响，并根据疼痛情况进行分层分析。
本研究为基于人群的病例对照研究，纳入了来自“斯科讷地区健康老龄化”项目的289名受试者。年龄在60 - 93岁的骨折患者分为有疼痛组（FP，n = 71）和无疼痛组（FnP，n = 53）。根据国家医疗记录，骨折部位包括椎骨、髋部、骨盆或脚踝。第三组为无骨折且无疼痛的受试者（CnP，n = 165）作为对照组。通过自我报告获取前一个月的疼痛情况、健康变量、生活方式、用药情况、助行器使用情况以及社会人口学变量。客观评估了15米步行、2次15米步行以及定时起立行走测试（TUG）（均以自我选择速度和最大速度进行）和最大握力。
在FP组患者中，近一半的人每天都遭受疼痛。CnP组和FnP组受试者在所有功能测试中的表现均显著优于FP患者组。以自我选择速度步行15米的中位时间，CnP组、FnP组和FP组分别为16秒、13秒和12秒。在多元回归模型中，调整年龄、性别和合并症后，骨折和疼痛均独立解释了较低的步行速度（自我选择速度和最大速度）以及TUG。那些骨折超过3年的受试者在以自我选择速度和最大速度步行15米和2次15米时的表现明显优于近期骨折的受试者，无论是否疼痛。
3年后，骨折但无疼痛的患者表现几乎与对照组受试者一样好。疼痛和骨折均独立影响身体功能。
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