Peterborough Hip Fracture Unit, Peterborough and Stamford Hospitals NHS Trust, Thorpe Road, Peterborough, UK PE3 6DA.
Injury. 2011 Nov;42(11):1313-6. doi: 10.1016/j.injury.2011.03.021. Epub 2011 Apr 13.
Diabetes mellitus, and especially type II diabetes, is a widespread and increasing problem in the western world due to the high rates of obesity. It has also been shown in previous studies that diabetics have impaired fracture healing. The aim of this study was to see exactly what role diabetes plays in hip fracture because it is a partially modifiable disease, and to see whether there are any changes that we could make to our practice to improve patient outcome.
We analysed the characteristics and outcomes for 477 hip fracture patients who were known to be diabetic at the time of admission, against 5489 non-diabetic hip fracture patients.
At the time of admission the diabetic patients were more likely to be using walking aids [268/477 (56%) versus 2455/5489 (45%), p<0.0001], have a more restricted walking ability and a higher mean ASA grade (2.9 versus 2.6, p<0.0001). Diabetics patients were more likely to develop cardiac post-operative complications [26/477 (5.5%) versus 146/5489 (2.7%), p=0.0008] and to develop pressure ulcers [34/477 (7.1%) versus 171/5489 (3.1%), p<0.0001]. Hospital stay was increased for those with diabetes (25 days versus 21 days, p 0.006). No difference in surgical complications was seen between groups. At one year, recovery of function was similar for diabetic patients compared to those without diabetes.
These findings show diabetics are at an increased risk of specific complications and have a longer length of hospital stay but generally make a normal recovery thereafter.
由于肥胖率高，糖尿病（尤其是 2 型糖尿病）在西方世界是一个普遍且日益严重的问题。之前的研究表明，糖尿病患者的骨折愈合能力受损。本研究旨在明确糖尿病在髋部骨折中扮演的角色，因为这是一种部分可改变的疾病，并探讨我们是否可以对治疗方案进行调整，以改善患者的预后。
我们分析了 477 名入院时患有糖尿病的髋部骨折患者的特征和结局，与 5489 名非糖尿病髋部骨折患者进行对比。
入院时，糖尿病患者更有可能使用助行器[477 例患者中有 268 例（56%），而非糖尿病患者中有 5489 例中有 2455 例（45%），p<0.0001]，活动能力受限且美国麻醉医师协会（ASA）分级更高（2.9 级比 2.6 级，p<0.0001）。糖尿病患者更有可能发生术后心脏并发症[477 例患者中有 26 例（5.5%），而非糖尿病患者中有 5489 例中有 146 例（2.7%），p=0.0008]和压疮[477 例患者中有 34 例（7.1%），而非糖尿病患者中有 5489 例中有 171 例（3.1%），p<0.0001]。糖尿病患者的住院时间延长（25 天比 21 天，p<0.006）。两组患者的手术并发症无差异。1 年后，糖尿病患者的功能恢复与无糖尿病患者相似。
这些发现表明，糖尿病患者发生特定并发症的风险增加，住院时间延长，但总体预后正常。
