Leung K S, Yuen W F, Ngai W K, Lam C Y, Lau T W, Lee K B, Siu K M, Tang N, Wong S H, Cheung W H
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong.
Hong Kong Med J. 2017 Jun;23(3):264-71. doi: 10.12809/hkmj166124. Epub 2017 May 5.
In setting up a disease registry for fragility fractures in Hong Kong, we conducted a retrospective systematic study on the management of fragility hip fractures. Patient outcomes were compared with the standards from our orthopaedic working group and those from the British Orthopaedic Association that runs a mature fracture registry in the United Kingdom.
Clinical data on fragility hip fracture patients admitted to six acute major hospitals in Hong Kong in 2012 were captured. These included demographics, pre- and post-operative assessments, discharge details, complications, and 1-year follow-up information. Analysis was performed according to the local standards with reference to those from the British Orthopaedic Association.
Overall, 91.0% of patients received orthopaedic care within 4 hours of admission and 60.5% received surgery within 48 hours. Preoperative geri-orthopaedic co-management was received by 3.5% of patients and was one of the reasons for the delayed surgery in 22% of patients. Only 22.9% were discharged with medication that would promote bone health. Institutionalisation on discharge significantly increased by 16.2% (P<0.001). Only 35.1% of patients attended out-patient follow-up 1 year following fracture, and mobility had deteriorated in 69.9% compared with the premorbid state. Death occurred in 17.3% of patients within a year of surgery compared with 1.6% mortality rate in a Hong Kong age-matched population.
The efficiency and quality of acute care for fragility hip fracture patients was documented. Regular geri-orthopaedic co-management can enhance acute care. Much effort is needed to improve functional recovery, prescription of bone health medications, attendance for follow-up, and to decrease institutionalisation. A Fracture Liaison Service is vital to improve long-term care and prevent secondary fractures.
在香港建立脆性骨折疾病登记系统时，我们对脆性髋部骨折的治疗进行了一项回顾性系统研究。将患者的治疗结果与我们骨科工作组制定的标准以及在英国运营成熟骨折登记系统的英国骨科协会制定的标准进行了比较。
收集了2012年香港六家急性大型医院收治的脆性髋部骨折患者的临床数据。这些数据包括人口统计学信息、术前和术后评估、出院细节、并发症以及1年随访信息。分析是根据当地标准并参考英国骨科协会的标准进行的。
总体而言，91.0%的患者在入院后4小时内接受了骨科治疗，60.5%的患者在48小时内接受了手术。3.5%的患者接受了术前老年骨科联合管理，这是22%的患者手术延迟的原因之一。只有22.9%的患者出院时带了促进骨骼健康的药物。出院时入住养老院的比例显著增加了16.2%（P<0.001）。骨折后1年只有35.1%的患者进行了门诊随访，与病前状态相比，69.9%的患者活动能力下降。术后1年内17.3%的患者死亡，而香港年龄匹配人群的死亡率为1.6%。
记录了脆性髋部骨折患者急性护理的效率和质量。定期的老年骨科联合管理可以加强急性护理。需要付出很大努力来改善功能恢复、骨骼健康药物的处方、随访率，并减少入住养老院的比例。骨折联络服务对于改善长期护理和预防二次骨折至关重要。
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