Division of Orthopaedic Surgery, Oslo University Hospital.
Institute of Clinical Medicine, University of Oslo.
Acta Orthop. 2020 Apr;91(2):139-145. doi: 10.1080/17453674.2019.1710804. Epub 2020 Jan 13.
Background and purpose - We established a care pathway for hip fracture patients, a "Hip Fracture Unit" (HFU), aiming to provide better in-hospital care and thus improve outcome. We compared the results after introduction of the HFU with a historical control group.Patients and methods - The HFU consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. 276 patients admitted from May 2014 to May 2015 constituted the HFU group and 167 patients admitted from September 2009 to January 2012 constituted the historical control group. Patients were followed prospectively up to 12 months post fracture.Results - Mean preoperative waiting time was 24 hours in the HFU group and 29 hours in the control group (p = 0.003). 123 patients (47%) in the HFU were started on anti-osteoporosis treatment while in hospital. "Short Physical Performance Battery" score (SPPB) was mean 5.5 in the HFU group and 3.8 in the control group at 4 months (p < 0.001), and 5.7 vs. 3.6 at 12 months (p < 0.001). The mortality rate at 4 months was 15% in both groups. No statistically significant differences were found in readmissions, complications, new nursing home admissions, in Barthel ADL index or a mental capacity test at the follow-ups.
背景与目的 - 我们建立了髋部骨折患者的护理路径，即“髋部骨折单元”（HFU），旨在提供更好的院内护理，从而改善预后。我们将引入 HFU 前后的结果与历史对照组进行比较。
患者与方法 - HFU 包括骨科病房内的一系列措施，如缩短术前等待时间、增加神经阻滞的使用、早期活动和骨质疏松症治疗。2014 年 5 月至 2015 年 5 月收治的 276 例患者为 HFU 组，2009 年 9 月至 2012 年 1 月收治的 167 例患者为历史对照组。患者前瞻性随访至骨折后 12 个月。
结果 - HFU 组术前平均等待时间为 24 小时，对照组为 29 小时（p = 0.003）。HFU 组 123 例（47%）患者在住院期间开始接受抗骨质疏松治疗。4 个月时 HFU 组的“短体适能表现测试”（SPPB）评分为 5.5，对照组为 3.8（p < 0.001），12 个月时分别为 5.7 和 3.6（p < 0.001）。两组 4 个月时的死亡率均为 15%。在随访中，两组在再入院率、并发症、新入住养老院、巴氏 ADL 指数或精神能力测试方面无统计学差异。
