Department for Orthopaedics and Trauma Surgery, Muscuoskeletal University Center Munich (MUM), University Hospital LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
AUVA Trauma Hospital Styria, Graz, Austria.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2867-2872. doi: 10.1007/s00068-021-01856-0. Epub 2021 Dec 21.
Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns.
Thirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up.
During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level.
Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the "fast track" concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice.
Prospective cohort study, 2.
体力活动是矫形外科的一个重要结果参数，可以进行客观评估。到目前为止，关于老年骨科患者的客观步态参数的信息很少。本研究重点关注术后康复的前 6 周，并提供典型老年骨科骨折模式的步态速度和步长的客观数据。
31 名老年骨科骨折患者[股骨粗隆间骨折（PFF）、股骨颈（FN）和肱骨近端骨折（PHF）]连续纳入一家最大护理医院的前瞻性研究设计。所有患者在术后住院期间（24 小时/天）和 6 周随访时佩戴放置在腰部的加速度计，以测量真实的步态速度和步长。此外，在基线、住院期间和 6 周随访时收集移动能力（帕克移动评分）和日常生活活动（巴氏指数）的自我评估。
在术后住院期间，PHF 组的步态速度（m/s）明显高于 FN 组（0.36±0.28）和 PFF 组（0.19±0.28）（p<0.05）。所有组在术后 6 周时的步态速度均显著改善（PHF：0.90±0.41；FN：0.72±0.13；PFF：0.60±0.23）。同样，术后各组的步长（m）也存在差异[FN：0.16±0.13；PFF：0.12±0.15；PHF：0.31±0.05（p<0.005）]，并且随着时间的推移显著改善（FN：0.47±0.01；0.39±0.19；0.50±0.18）。自我评估分数表明，大多数患者在骨折前移动能力受限较小。这些值在术后立即下降，并在前 6 周内改善，但未达到初始水平。
在老年骨科骨折患者中，术后 6 周内步态速度、步长以及移动能力和日常生活活动的自我评估均显著改善。由于在住院期间观察到术后活动能力非常低，因此无论骨折类型如何，该组患者在术后康复方面都具有很大的潜力。出于这个原因，特定的术后护理概念类似于初级关节置换术的“快速通道”概念，对老年骨科患者在临床实践中至关重要。
前瞻性队列研究，2 级。
