Ramírez-Pérez Esperanza, Clark Patricia, Carlos Fernando, Camacho Araceli, Franco-Marina Francisco
Medwave. 2014 Jun 18;14(5):e5972. doi: 10.5867/medwave.2014.05.5972.
Hip fractures are an important cause of morbidity and mortality and one of the main causes of disability in the older population. The lifetime risk for any type of osteoporotic fracture is very high and falls within the range of 40-50% in women and 13-22% for men. In Mexico, the lifetime likelihood of having a hip fracture at 50 years of age is 8.5% in Mexican women and 3.8% in Mexican men, but this is expected to rise in upcoming years.
This study aims to report the Health-Related Quality of Life over the first six months after a hip fracture in two public and two private tertiary care hospitals in Mexico City.
Changes over time were evaluated through visual observation of each patients development trajectory using the graphic representation of the EQ-5D global score. The trajectories were grouped by affinity into five levels of progress according to clinical course. The identified descriptive options were analyzed using the multinomial logistic regression model (LR).
One-hundred-and-thirty-six (136) patients with a hip fracture were followed after surgery. Their mean age was 77 ± 10 years. During the first month, mobility, daily activities, and self-care were the most affected. The group aged between 80 and 84 years reported extreme problems regarding anxiety and depression (21%), and those aged between 50 and 74 years described having issues concerning pain and discomfort (27%). At the 6-month follow-up, only those aged > 85 years of age showed worsening of their condition, a high proportion of these ranking at level 3 in mobility, self-care, and anxiety/depression. Toward the end of the follow-up period, this last group reported having extreme problems (being unable to carry out everyday activities) and worsening of their mobility (9.2%) (inability to walk about) (LR test, p = 0.06).
Patients with hip fracture showed difficulties in different areas during the first month after surgery, with steady recuperation up to month six. Age was an important factor in the recovery of all evaluated domains. This graphical tool facilitates classification, identification, and monitoring Health-Related Quality of Life in patients with hip fractures.
髋部骨折是导致发病和死亡的重要原因，也是老年人群残疾的主要原因之一。任何类型骨质疏松性骨折的终生风险都非常高，女性在40%-50%范围内，男性在13%-22%范围内。在墨西哥，50岁时发生髋部骨折的终生可能性在墨西哥女性中为8.5%，在墨西哥男性中为3.8%，但预计在未来几年会上升。
本研究旨在报告墨西哥城两家公立和两家私立三级护理医院髋部骨折后前六个月的健康相关生活质量。
通过使用EQ-5D总体评分的图形表示对每位患者的发展轨迹进行视觉观察来评估随时间的变化。根据临床病程，将轨迹按相似性分组为五个进展水平。使用多项逻辑回归模型（LR）分析确定的描述性选项。
136例髋部骨折患者术后接受随访。他们的平均年龄为77±10岁。在第一个月，活动能力、日常活动和自我护理受影响最大。80至84岁的人群报告焦虑和抑郁方面存在极端问题（21%），50至74岁的人群描述存在疼痛和不适问题（27%）。在6个月随访时，只有85岁以上的人群病情恶化，其中很大一部分在活动能力、自我护理和焦虑/抑郁方面处于3级。在随访期结束时，最后一组报告存在极端问题（无法进行日常活动）且活动能力恶化（9.2%）（无法行走）（LR检验，p = 0.06）。
髋部骨折患者在术后第一个月在不同方面存在困难，直至第六个月病情稳步恢复。年龄是所有评估领域恢复的重要因素。这种图形工具便于对髋部骨折患者的健康相关生活质量进行分类、识别和监测。
