Clinical Research Center, National Hospital Organization Sagamihara Hospital, Sagamihara, Japan.
J Orthop Trauma. 2012 Mar;26(3):163-71. doi: 10.1097/BOT.0b013e31821e1261.
To investigate the predictors of functional outcome and changes in the basic activities of daily living in older adults who sustained hip fractures, considering the level of ambulatory ability before injury.
A prospective observational cohort study.
One university hospital and 13 community teaching hospitals.
A consecutive cohort of 650 patients who underwent surgery for a hip fracture between December 2004 and January 2006.
Recovery of ambulatory ability and independence in activities of daily living 6 and 12 months after surgery.
Ambulatory ability recovered to the prefracture level in approximately half of the patients 6 months after surgery, and those ratios changed little in the next 6 months. In patients who were community ambulators before fractures, the independence in bathing before fractures was a strong predictor of ambulatory ability after surgery, but this was not the case in the former household ambulator group. The attainment of assisted ambulation with a walking cane at hospital discharge was a reliable predictor of ambulatory ability in both former community ambulator and household ambulator groups.
Ambulatory ability after hip fractures was considered to be determined within 6 months after surgery. There was some difference in prognostic factors for ambulatory ability according to the level of mobility before fractures. The attainment of single cane (T-cane) gait at hospital discharge can serve as a reliable predictor of ambulatory ability after fractures, irrespective of the level of mobility before the injury.
Prognostic Level I. See page 128 for a complete description of levels of evidence.
探讨髋部骨折老年患者功能预后的预测因素，以及受伤前步行能力水平对日常生活基本活动能力变化的影响。
前瞻性观察队列研究。
一家大学医院和 13 家社区教学医院。
2004 年 12 月至 2006 年 1 月期间接受髋关节骨折手术的连续队列 650 例患者。
术后 6 个月和 12 个月时步行能力和日常生活活动独立能力的恢复情况。
约一半的患者在术后 6 个月时恢复到骨折前的步行能力水平，此后的 6 个月内这一比例变化不大。在骨折前为社区步行者的患者中，骨折前洗澡的独立性是术后步行能力的一个强有力的预测因素，但在前家庭步行者组中并非如此。出院时使用手杖辅助行走达到辅助步行的能力是前社区步行者和家庭步行者两组患者步行能力的可靠预测因素。
髋部骨折后步行能力被认为在术后 6 个月内确定。根据骨折前的活动能力水平，步行能力的预后因素存在一定差异。出院时达到单拐（T 型拐）步态可以作为骨折后步行能力的可靠预测因素，而与受伤前的活动能力水平无关。
预后Ⅰ级。详见第 128 页，了解证据水平的完整描述。
