Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
Injury. 2021 Aug;52(8):2373-2378. doi: 10.1016/j.injury.2021.04.001. Epub 2021 Apr 7.
Hip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF).
A retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline.
Age (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced.
The type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.
髋部骨折不应被视为单一的、同质的病症。人们提出了各种影响髋部骨折患者功能恢复的决定因素，例如年龄或骨折类型。本研究旨在确定股骨颈骨折（FNF）与转子间骨折（ITF）患者的功能恢复特征是否存在差异。
对 2014 年 12 月 1 日至 2017 年 12 月 31 日期间在康复机构接受手术治疗的 531 名髋部骨折老年患者进行了回顾性研究。患者接受了个性化的康复计划，以改善其身体功能。本研究的结果衡量指标包括康复机构的住院时间（LOS）、功能独立性测量（FIM）增益，即出院时和入院时 FIM 评分的差异，以及 FIM 效率，代表日常增益。患者还根据年龄类别和基线时的不同功能独立性水平进行分层，用 FIM 总分评估。
FNF 与 ITF 患者的年龄（p<0.05）、 LOS（p<0.005）和康复结果（FIM 评分和效率；p<0.05）存在显著差异。特别是，ITF 患者的年龄更大，基线时的依赖性更高。此外，与 FNF 患者相比，他们的 FIM 效率较低（p<0.05），FIM 总分的改善程度相似，但平均提前 3 天出院。随着年龄的增长，FIM 效率下降，而 LOS 增加。基线依赖性高（FIM 总分<40）的患者的 FIM 增益和效率最低， LOS 最长，与独立性更高的患者相比。此外，在年龄较大（85 岁以上）和依赖性较高的患者中，ITF 和 FNF 之间的结果测量差异减小。
髋部骨折的类型可能会影响年轻且独立性更高的髋部骨折患者在住院康复期间的 LOS 和 FIM 效率。特别是，ITF 患者需要更长的康复时间才能达到与 FNF 患者相似的功能增益。
