承重状态对老年髋部骨折术后活动能力和结局的影响。

The influence of weight-bearing status on post-operative mobility and outcomes in geriatric hip fracture.

机构信息

Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia.

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.

出版信息

Eur J Trauma Emerg Surg. 2022 Oct;48(5):4093-4103. doi: 10.1007/s00068-022-01939-6. Epub 2022 Mar 15.

DOI:10.1007/s00068-022-01939-6

PMID:35290469

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9532285/

Abstract

PURPOSE

We hypothesized that unrestricted or full weight-bearing (FWB) in hip fracture would increase the opportunity to mobilize on post-operative day 1 (POD1mob) and be associated with better outcomes compared with restricted weight-bearing (RWB).

METHODS

Over 4 years, 1514 geriatric hip fracture patients aged 65 and above were prospectively recruited. Outcomes were compared between FWB and RWB patients. The primary outcome was 30-day mortality. Secondary outcomes were immobility-related adverse events, length of stay (LOS), and reoperation for failure. Causal effect modelling and multivariate regression with mediation analyses were performed to examine the relation between weight-bearing status (WBS), POD1mob, and known mortality predictors.

RESULTS

FWB was allowed in 1421 (96%) of 1479 surgically treated patients and RWB enforced in 58 (4%) patients. Mortality within 30 days occurred in 141 (9.9%) of FWB and 3 (5.2%) of RWB patients. In adjusted analysis, RWB did not influence 30-day mortality (OR 0.42, 95% CI 0.15-01.13, p = 0.293), with the WBS accounting for 91% of the total effect on mortality and 9% contributed from how WBS influenced the POD1mob. RWB was significantly related to increased DVT (OR 7.81, 95% CI: 1.81-33.71 p = 0.002) but no other secondary outcomes. Patients that did not have the opportunity to mobilize had increased 30-day mortality (OR 2.31, 95% CI 1.53-3.48 p < 0.001).

CONCLUSION

Restricted weight-bearing was not associated with increased 30-day mortality. Only a small proportion of this effect was mediated by POD1mob. Whilst post-surgical WBS may be difficult to influence for cultural reasons, POD1mob is an easily modifiable target that is likely to have a greater effect on 30-day mortality.

LEVEL OF EVIDENCE

Level III, observational study.

摘要

目的

我们假设髋部骨折患者采用非限制或完全负重（FWB），相较于限制负重（RWB），在术后第 1 天（POD1mob）有更多机会活动，且具有更好的预后。

方法

在 4 年多的时间里，前瞻性招募了 1514 名 65 岁及以上的老年髋部骨折患者。比较了 FWB 和 RWB 患者的预后。主要结局是 30 天死亡率。次要结局是与活动受限相关的不良事件、住院时间（LOS）和因失败而再次手术。采用因果效应模型和多变量回归中介分析，来检验负重状态（WBS）、POD1mob 与已知死亡率预测因素之间的关系。

结果

1479 名接受手术治疗的患者中，1421 名（96%）允许 FWB，58 名（4%）采用 RWB。30 天内死亡的患者有 141 名（9.9%）在 FWB 组，3 名（5.2%）在 RWB 组。在调整分析中，RWB 对 30 天死亡率没有影响（OR 0.42，95%CI 0.15-01.13，p=0.293），WBS 对死亡率的总效应占 91%，而 WBS 对 POD1mob 的影响占 9%。RWB 与增加的深静脉血栓形成（DVT）显著相关（OR 7.81，95%CI：1.81-33.71，p=0.002），但与其他次要结局无关。没有机会活动的患者 30 天死亡率增加（OR 2.31，95%CI 1.53-3.48，p<0.001）。