Department of Geriatric Medicine and Rehabilitation The Orthogeriatric Hip Fracture Unit, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
Geriatr Gerontol Int. 2012 Oct;12(4):688-94. doi: 10.1111/j.1447-0594.2012.00845.x. Epub 2012 Apr 2.
To study possible differences in rehabilitation outcomes of patients with hip fracture, with and without atrial fibrillation.
A retrospective cohort study comprising 1114 patients, divided into three groups: patients with sinus rhythm, paroxysmal atrial fibrillation or chronic atrial fibrillation. All patients underwent a standard orthogeriatric care comprising surgical hip repair and a rehabilitation course. Main outcome measures included functional status at discharge by the Functional Independence Measure, post-fracture functional status category and type of postdischarge living arrangement.
Patients with atrial fibrillation differed from patients in sinus rhythm by female sex (P = 0.018), older age (P = 0.008) and higher rates of heart failure (P < 0.001), ischemic heart disease (P < 0.001), previous stroke (P < 0.001), and American Society of Anesthesiologists score (P < 0.001). No differences were observed among the three groups regarding Functional Independence Measure motor and total scores. In regression analysis, Mini-Mental State Examination (P < 0.001), prefracture status (P < 0.001), postsurgery motor Functional Independence Measure (P < 0.0001) and Parkinson's disease (P = 0.009) were predictive of higher motor Functional Independence Measure at discharge, whereas atrial fibrillation had no predictive value whatsoever. There were no differences among groups in magnitude of postfracture change of functional status category or type of postdischarge living arrangement.
Discharge motor Functional Independence Measure scores, postfracture changes in functional status and in discharge placement are similar in hip fracture patients with sinus rhythm, compared with those with atrial fibrillation. Atrial fibrillation should not be considered to adversely affect the rehabilitation outcome of these patients.
研究伴有和不伴有心房颤动的髋部骨折患者康复结果的可能差异。
回顾性队列研究纳入 1114 例患者，分为三组：窦性心律组、阵发性心房颤动组和慢性心房颤动组。所有患者均接受标准的矫形骨科治疗，包括手术髋关节修复和康复疗程。主要观察指标包括功能独立性测量法（FIM）出院时的功能状态、骨折后功能状态类别和出院后居住安排类型。
与窦性心律患者相比，心房颤动患者的女性比例（P=0.018）、年龄更大（P=0.008）、心力衰竭（P＜0.001）、缺血性心脏病（P＜0.001）、既往中风（P＜0.001）和美国麻醉医师协会评分（P＜0.001）更高。三组之间 FIM 运动和总分无差异。在回归分析中，简易精神状态检查（P＜0.001）、骨折前状态（P＜0.001）、手术后 FIM 运动（P＜0.0001）和帕金森病（P=0.009）是出院时 FIM 运动评分较高的预测因素，而心房颤动无任何预测价值。三组间功能状态类别的骨折后变化或出院后居住安排类型无差异。
与窦性心律患者相比，髋部骨折伴心房颤动患者的出院时 FIM 运动评分、骨折后功能状态变化和出院时安置情况相似。心房颤动不应被认为会对这些患者的康复结果产生不利影响。
