Uezono Sae, Ishibashi Yusuke, Kuramochi Shouichi, Kaganoi Seiji, Ikeda Takuhiro, Shimohira Takahiro, Katoh Munenori
Hirakawa Hospital, Tokyo, Japan.
Akitsu Kounoike Hospital, Nara, Japan.
Prog Rehabil Med. 2020 Aug 26;5:20200019. doi: 10.2490/prm.20200019. eCollection 2020.
A total of 183 patients admitted to five hospitals for proximal femoral fractures and psychiatric disorders were examined to determine whether their physical function could be improved by rehabilitation and to identify factors that affected home discharge.
We conducted surveys to collect data regarding patients' age, sex, type of mental illness, location at time of injury, complications, Charlson Comorbidity Index, Global Assessment of Functioning scale scores, surgical technique, time from surgery to the start of rehabilitation at the target hospital, rehabilitation duration, results of cognitive function tests (e.g., the Mini Mental Status Examination), walking ability before the injury, final walking ability, functional independence measure (FIM) of the patient's activities of daily living at the start and end of treatments, and discharge destinations.
The motor function index showed a significant improvement from an average of 36.0 points at admission to an average of 53.0 points at discharge. Overall, 47.9% of patients who were able to walk before injury could regain gait ability. The discharge rate to the patient's home was 15.8%.
The gait reacquisition rate for patients with femoral neck fractures and mental illness admitted to a psychiatric ward was 47.9%, which was lower than that reported in previous studies, but higher than that for dementia patients. Binomial logistic regression analysis identified the following predictive items for home discharge: whether the fracture occurred at home, FIM cognition item scores at admission, and total and motor item scores at discharge. The derived equation had a high hit rate of 80.9%.
对五家医院收治的183例股骨近端骨折合并精神疾病患者进行检查，以确定康复是否能改善其身体功能，并找出影响出院回家的因素。
我们进行了调查，收集有关患者的年龄、性别、精神疾病类型、受伤时的位置、并发症、查尔森合并症指数、功能总体评定量表评分、手术技术、从手术到目标医院开始康复的时间、康复持续时间、认知功能测试结果（如简易精神状态检查表）、受伤前的行走能力、最终行走能力、治疗开始和结束时患者日常生活活动的功能独立性测量（FIM）以及出院去向等数据。
运动功能指数从入院时的平均36.0分显著提高到出院时的平均53.0分。总体而言，受伤前能够行走的患者中有47.9%能够恢复步态能力。患者出院回家的比例为15.8%。
入住精神科病房的股骨颈骨折合并精神疾病患者的步态恢复率为47.9%，低于先前研究报告的水平，但高于痴呆患者。二项逻辑回归分析确定了以下出院回家的预测指标：骨折是否在家中发生、入院时FIM认知项目评分以及出院时的总分和运动项目评分。推导方程的命中率高达80.9%。
