González Marcos Enrique, González García Enrique, González-Santos Josefa, González-Bernal Jerónimo J, Del Pilar Martín-Rodríguez Adoración, Santamaría-Peláez Mirian
RACA 11 Artillery Regiment, Cid Campeador Military Base, 09193 Burgos, Spain.
Traumatology and Orthopedic Surgery Department, Burgos University Hospital (HUBU), 09006 Burgos, Spain.
J Clin Med. 2022 Jul 31;11(15):4467. doi: 10.3390/jcm11154467.
Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture.
Retrospective study of 537 patients aged ≥65 years who survived at the sixth month after fracturing their hip, of which the age, sex, type of fracture, surgical risk, independence (BI), walking ability, cognitive level (PS), comorbidities, indicated drugs, complications, surgical delay, hospital stay, and surgical technique are known. Using Pearson's χ test, all the variables were contrasted with respect to the limitation or not, at the sixth month of the recovery of both independence and pre-admission walking ability. Multivariate analysis provides the necessary adjustment to the previous contrast.
We have found that age and PS ≥ 5 at admission limit recovery from both dependency and walking ability. Surgical risk, independence (BI) upon admission, anemia, and constipation during the hospital stay limit the recovery of the BI. Worsening of walking ability during the hospital stay and the type of extra-articular fracture, which was surgically treated by osteosynthesis, limit the recovery of walking ability.
The factors previously exposed, and perhaps the fact that patients with hip fractures are not routinely referred to rehabilitation, explain the high proportion of patients who do not recover their previous independency (36%) or walking ability (45%) to the fact of fracturing.
根据文献,老年髋部骨折意味着四分之一到一半的患者在骨折后无法恢复到之前的独立水平和行走能力。
对537例年龄≥65岁且在髋部骨折后存活至第六个月的患者进行回顾性研究,已知其年龄、性别、骨折类型、手术风险、独立性(巴氏指数)、行走能力、认知水平(简易精神状态检查表)、合并症、所用药物、并发症、手术延迟、住院时间和手术技术。使用Pearson卡方检验,将所有变量与恢复独立和入院前行走能力的第六个月时是否存在限制进行对比。多变量分析对之前的对比进行了必要的调整。
我们发现,年龄和入院时简易精神状态检查表评分≥5限制了从依赖状态和行走能力的恢复。手术风险、入院时的独立性(巴氏指数)、贫血和住院期间的便秘限制了巴氏指数的恢复。住院期间行走能力的恶化以及通过骨合成手术治疗的关节外骨折类型限制了行走能力的恢复。
上述因素,以及髋部骨折患者未常规转诊至康复治疗这一事实,解释了未恢复到骨折前独立水平(36%)或行走能力(45%)的患者比例较高的原因。