University of Nottingham, Nottingham, UK.
NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK.
Age Ageing. 2021 Jun 28;50(4):1129-1136. doi: 10.1093/ageing/afab071.
Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group.
MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term 'non-weight bearing'. All study types were included. Analysis was by narrative synthesis.
No papers were identified from a search using the key phrase 'non-weight bearing'. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing.
These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process.
下肢骨折患者需要非负重，这会增加与固定和残疾相关的并发症风险，尤其是身体虚弱的患者，但对于此类患者的最佳护理方法还存在很多不清楚的地方。我们进行了一次范围性文献综述，旨在探讨针对该患者群体的管理方法，目前有哪些证据。
我们对已发表文献的 MEDLINE（PubMed）、CINAHL、EMBASE 和 Cochrane 数据库以及 HMIC 和 SIGLE 灰色文献数据库进行了检索，查找原始研究和专家报告，最初使用“非负重”这一关键词进行了反复搜索。所有研究类型都被纳入。分析采用叙述性综合法。
使用关键词“非负重”进行搜索后，没有发现相关文献。删除该关键词后，从电子数据库的搜索中检索到 11 篇与下肢骨折相关的间接相关文章，包括三项观察性研究、五篇非系统性综述文章、一篇系统综述、一篇观点文章和一项专家意见调查，这些文章与限制负重患者相关。观察性研究表明，抑郁、认知和营养会影响结果，因此与管理具有间接相关性。非系统性综述文章强调了在固定期间保持力量和运动范围的重要性，并建议采用骨科老年病护理模式。在灰色文献中发现了 14 份英国和 97 份非英国与脆性骨折、跌倒和骨质疏松症管理相关的指南，但没有一份指南针对任何非负重期的管理提出具体建议。
这些发现总结了可用于为这些患者制定临床指南的证据基础，但还不够充分。我们建议使用专家共识流程为这些患者制定指南。
