Jarnlo G B
Department of Orthopedics, University of Lund, Sweden.
Scand J Rehabil Med Suppl. 1991;24:1-31.
The incidence of hip fractures increased from 3.3 per 1,000 inhabitants in 1966 to 5.1 in 1986 for persons more than 50 years old. The incidence almost doubled in persons more than 80 years old, from 13.3 to 25.6 per 1,000. The proportional increase was largest in men with cervical fractures. A higher incidence was found in the city compared to the rural area. The city of Lund had a lower incidence in comparison with larger cities, such as Stockholm, Göteborg and Uppsala. The early rehabilitation at home of hip fracture patients in cooperation with primary health care, rendered good results and a low consumption of resources, compared to continued care at the Orthopedic Department or in a nursing home. About 60 per cent of the patients returned directly to their own home. Most of them regained, within four months, their former capacity of daily life, in spite of their hip fracture and high age. Patients with hip fractures reported more signs of diseases, lower capacity for managing their daily life and were more often afraid of falling than the controls. Most falls, 75 per cent, preceding the fracture, occurred during walking or when rising from or sitting down on a chair. Two thirds of the hip fracture patients had fallen sideways. A test battery for assessing standing balance on a computerized force platform was evaluated. Postural sway in healthy subjects indicated that age and sex were important, when analysing the results. Men and older subjects had larger postural sway than women and younger subjects, respectively. Middle-aged patients with a previous hip fracture showed larger postural sway (= lower balance capacity), lower perceived balance and a lower walking speed than healthy controls. Eighteen 70-year-old women trained their postural control for five weeks. They had significantly better results in the tests after the training period than the controls. These balance tests are simple and applicable in clinical practice. Training of postural control might prevent some hip fractures, which is of the utmost importance both for the elderly person and society.
1966年至1986年期间，50岁以上人群髋部骨折的发病率从每1000名居民中的3.3例增至5.1例。80岁以上人群的发病率几乎翻了一番，从每1000人中的13.3例增至25.6例。颈椎骨折男性的发病率增长比例最大。与农村地区相比，城市的发病率更高。与斯德哥尔摩、哥德堡和乌普萨拉等大城市相比，隆德市的发病率较低。与在骨科或疗养院继续接受护理相比，髋部骨折患者与初级卫生保健机构合作在家中进行早期康复，取得了良好的效果且资源消耗较低。约60%的患者直接回到了自己家中。尽管他们髋部骨折且年事已高，但大多数患者在四个月内恢复了以前的日常生活能力。与对照组相比，髋部骨折患者报告的疾病症状更多，日常生活自理能力更低，且更常害怕跌倒。骨折前发生的跌倒中，75%发生在行走时或从椅子上起身或坐下时。三分之二的髋部骨折患者是侧身摔倒的。对一种用于在计算机化测力平台上评估站立平衡的测试组合进行了评估。健康受试者的姿势摆动表明，在分析结果时，年龄和性别很重要。男性和老年受试者的姿势摆动分别比女性和年轻受试者更大。有过髋部骨折病史的中年患者与健康对照组相比，表现出更大的姿势摆动（即平衡能力更低）、更低的平衡感和更低的步行速度。18名70岁的女性进行了为期五周的姿势控制训练。训练期结束后，她们在测试中的结果明显优于对照组。这些平衡测试简单且适用于临床实践。姿势控制训练可能预防一些髋部骨折，这对老年人和社会都至关重要。
