Bischoff-Ferrari Heike A, Dawson-Hughes Bess, Platz Andreas, Orav Endel J, Stähelin Hannes B, Willett Walter C, Can Uenal, Egli Andreas, Mueller Nicolas J, Looser Silvan, Bretscher Beat, Minder Elisabeth, Vergopoulos Athanasios, Theiler Robert
Centre on Aging and Mobility, University of Zurich, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland.
Arch Intern Med. 2010 May 10;170(9):813-20. doi: 10.1001/archinternmed.2010.67.
Care of elderly patients after hip fracture is not well established.
We enrolled 173 patients with acute hip fracture who were 65 years or older (79.2% women; mean age, 84 years; 77.4% living at home). Using a factorial design, we randomly allocated patients to extended physiotherapy (PT) (supervised 60 min/d during acute care plus an unsupervised home program) vs standard PT (supervised 30 min/d during acute care plus no home program; single-blinded), and to cholecalciferol therapy, 2000 vs 800 IU/d (double-blinded). Primary outcome was rate of falls; secondary outcome was rate of hospital readmissions during the 12-month follow-up. All analyses included 173 individuals and used multivariate Poisson regression analyses.
At baseline, 50.9% of participants had 25-hydroxyvitamin D levels of less than 12 ng/mL and 97.7% of less than 30 ng/mL. We documented 212 falls and 74 hospital readmissions. Because this was a factorial design trial, all analyses tested the main effect of each treatment while controlling for the other in 173 participants. Extended vs standard PT reduced the rate of falls by 25% (95% confidence interval [CI], -44% to -1%). Cholecalciferol treatment, 2000 vs 800 IU/d, did not reduce falls (28%; 95% CI, -4% to 68%), but reduced the rate of hospital readmissions by 39% (95% CI, -62% to -1%).
Extended PT was successful in reducing falls but not hospital readmissions, whereas cholecalciferol treatment, 2000 IU/d, was successful in reducing hospital readmission but not falls. Thus, the 2 strategies may be useful together because they address 2 different and important complications after hip fracture.
老年髋部骨折患者的护理方案尚未完全确立。
我们纳入了173例65岁及以上的急性髋部骨折患者（女性占79.2%；平均年龄84岁；77.4%居家生活）。采用析因设计，我们将患者随机分配至强化物理治疗（PT）组（急性护理期间每天监督60分钟，加上无监督的家庭计划）与标准PT组（急性护理期间每天监督30分钟，无家庭计划；单盲），以及胆钙化醇治疗组，剂量分别为2000 IU/d和800 IU/d（双盲）。主要结局是跌倒发生率；次要结局是12个月随访期间的再入院率。所有分析纳入了173名个体，并采用多变量泊松回归分析。
基线时，50.9%的参与者25-羟维生素D水平低于12 ng/mL，97.7%低于30 ng/mL。我们记录到212次跌倒和74次再入院。由于这是一项析因设计试验，所有分析在173名参与者中检验了每种治疗的主要效应，同时控制另一种治疗。强化PT与标准PT相比，跌倒发生率降低了25%（95%置信区间[CI]，-44%至-1%）。胆钙化醇治疗，2000 IU/d与800 IU/d相比，并未降低跌倒发生率（28%；95% CI，-4%至68%），但再入院率降低了39%（95% CI，-62%至-1%）。
强化PT成功降低了跌倒发生率，但未降低再入院率，而2000 IU/d的胆钙化醇治疗成功降低了再入院率，但未降低跌倒发生率。因此，这两种策略可能联合使用有效，因为它们解决了髋部骨折后两种不同且重要的并发症。
