Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado M T, Escalante E, Lumbreras C, Tarrida A
Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 Jan-Feb;64(1):57-63. doi: 10.1016/j.recot.2019.06.007. Epub 2019 Jul 31.
Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months.
From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors.
271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001).
Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
髋部骨折通常发生在体弱的老年患者中，且在第一年与重要的发病死亡率相关。本研究的目的是描述能够使患者在12个月时维持功能的预后因素。
纳入2010年6月1日至2013年5月31日期间因骨质脆弱导致髋部骨折而入住我院老年急性病房的所有69岁以上患者。我们将那些在Barthel指数中相对于骨折前丧失0 - 15分的患者定义为功能维持。对相关的双变量数据分析以及预测性预测因子的多变量预后因素进行前瞻性研究。
共纳入271例患者，其中146例（54.8%）在12个月时维持功能，122例（45.2%）未维持。维持功能状态的患者更年轻：平均年龄83.4岁 vs 85.80岁（P = 0.002）；在以下指标中得分更高：骨折前Lawton指数4.42 vs 2.40（P < 0.001）以及出院时Barthel指数34.2 vs 27.1（P = 0.002）。在“老年痴呆量表”得分上也存在差异，分别为2.59 vs 3.13（P = 0.009），在“美国麻醉医师协会”评分上，<II级分别为62.2% vs 37.8%（P = 0.006），且住院期间谵妄发生率更低，分别为4.7% vs 35.3%（P = 0.002）。在多变量分析中，它们保持了统计学意义，年龄OR：1.044（95%CI：1.002 - 1.088）（P = 0.04）以及Lawton指数OR：0.869（95%CI：0.804 - 0.940）（P < 0.001）。
12个月时功能维持的预后因素是年龄和进行日常生活工具性活动的能力。
