帕金森病对中国老年股骨转子间骨折患者的影响：倾向评分匹配分析。
The effect of Parkinson's disease on Chinese geriatric patients with intertrochanteric fracture: A propensity score-matched analysis.
机构信息
Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue lane, 610041 Chengdu, Sichuan, China.
Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue lane, 610041 Chengdu, Sichuan, China.
出版信息
Orthop Traumatol Surg Res. 2020 Jun;106(4):627-632. doi: 10.1016/j.otsr.2019.11.022. Epub 2020 Feb 3.
BACKGROUND
Currently, few studies focus on the treatment of Parkinson's disease (PD) patients after a fracture. The effect of PD on geriatric patients with intertrochanteric fracture remains unclear. Therefore, we performed a study to focus on two questions as follow: (1) would PD increase the operation difficulty and perioperative complications in Chinese elderly patients with intertrochanteric fracture? (2) is there any difference between the clinical outcome of patients with and without PD?
HYPOTHESIS
PD would increase perioperative complications and influence the postoperative rehabilitation in elderly patients with intertrochanteric fracture.
MATERIALS AND METHODS
There were 445 elderly intertrochanteric fracture patients treated with proximal femoral nail anti-rotation during January 2010 and December 2017. After propensity score matching, twenty-four geriatric intertrochanteric fracture patients with PD and forty-eight geriatric intertrochanteric fracture patients without PD were enrolled in this retrospective study. Intraoperative and postoperative comparison were conducted between patients with and without PD.
RESULTS
Compared with 63 months for geriatric intertrochanteric fracture patients without PD, patients with PD had a median survival time of 31 months. The Harris Hip Score and Barthel Index of patients with PD were significantly lower than that of patients without PD. In addition, the Depression subscale score of patients with PD were significantly higher that of patients without PD.
DISCUSSION
The effect of PD on geriatric patients with intertrochanteric fracture is not the operation itself, but the postoperative rehabilitation. In addition, multi-disciplinary treatment, personal rehabilitation training, more intensive outpatient care, and meticulous nursing were recommended in treatment for elderly patients with intertrochanteric fracture and PD.
LEVEL OF EVIDENCE
III, Cohort comparative study.
背景
目前，很少有研究关注帕金森病（PD）患者骨折后的治疗。PD 对老年股骨转子间骨折患者的影响尚不清楚。因此，我们进行了一项研究，重点关注以下两个问题：（1）PD 是否会增加中国老年股骨转子间骨折患者的手术难度和围手术期并发症？（2）PD 患者与非 PD 患者的临床结果是否存在差异？
假设
PD 会增加老年股骨转子间骨折患者围手术期并发症，并影响术后康复。
材料和方法
2010 年 1 月至 2017 年 12 月，共有 445 例老年股骨转子间骨折患者接受股骨近端防旋髓内钉治疗。通过倾向评分匹配，纳入 24 例合并 PD 的老年股骨转子间骨折患者和 48 例无 PD 的老年股骨转子间骨折患者进行回顾性研究。比较 PD 患者和非 PD 患者的术中及术后情况。
结果
与无 PD 的老年股骨转子间骨折患者的 63 个月相比，PD 患者的中位生存时间为 31 个月。PD 患者的 Harris 髋关节评分和 Barthel 指数明显低于无 PD 患者。此外，PD 患者的抑郁亚量表评分明显高于无 PD 患者。
讨论
PD 对老年股骨转子间骨折患者的影响不是手术本身，而是术后康复。此外，建议对老年股骨转子间骨折合并 PD 的患者进行多学科治疗、个体化康复训练、更密集的门诊护理和细致的护理。
证据等级
III 级，队列比较研究。
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