Bliemel Christopher, Lechler Philipp, Oberkircher Ludwig, Colcuc Christian, Balzer-Geldsetzer Monika, Dodel Richard, Ruchholtz Steffen, Buecking Benjamin
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
Dement Geriatr Cogn Disord. 2015;40(1-2):33-43. doi: 10.1159/000381334. Epub 2015 Apr 21.
To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment.
A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors.
33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001).
Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.
探讨认知障碍对髋部骨折患者住院治疗期间功能结局及并发症发生率的影响。
在一家单一创伤中心连续纳入402例行髋部骨折手术治疗的患者。根据简易精神状态检查表（MMSE）结果将患者分组，即≥20分（I组）和≤19分（II组）。比较两组之间的并发症、院内死亡率以及根据Barthel指数（BI）得出的术后功能结局。进行多因素回归分析以控制其他因素。
33%的患者MMSE评分≤19分。两组之间的并发症发生率相似（p>0.05）。同样，I组患者（4.5%）和II组患者（9.8%；β=0.218，p<0.740）的总体院内死亡率相似。根据BI评估，II组的功能结局较差（β=-0.266，p<0.001）。II组患者转入康复诊所的频率较低（52.3%对76.0%，p<0.001）。
MMSE评分较低的患者功能结局较差的风险较高。围手术期护理应侧重于保留功能能力，以保护这些患者避免进一步丧失独立性和不利的临床病程。
