From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette).
J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 22;7(8). doi: 10.5435/JAAOSGlobal-D-23-00079. eCollection 2023 Aug 1.
The inability to mobilize after surgical intervention for hip fractures in the elderly is established as a risk factor for greater morbidity and mortality. Previous studies have evaluated the association between the timing and distance of ambulation in the postoperative acute care phase with postoperative complications. The purpose of this study was to evaluate the association between ambulatory distance in the acute postoperative setting and ambulatory capacity at 3 months.
Patients aged 65 and older who were ambulatory at baseline and underwent surgical intervention for hip fractures from 2014 to 2019 were retrospectively reviewed. Consistent with previous literature, patients were divided into two groups: those who were able to ambulate 5 feet within 72 hours after surgical fixation (early ambulatory) and those who were not (minimally ambulatory).
One hundred seventy patients (84 early ambulatory and 86 minimally ambulatory) were available for analysis. Using a multivariable ordinal logistic regression model, variables found to be statistically significant predictors of ambulatory status at 3 months were the ability to ambulate five feet in 72 hours (P < 0.0001), ambulatory distance at discharge (P = 0.012), and time from presentation to surgery (P = 0.039). Patients who were able to ambulate 5 feet within 72 hours had 9 times the odds of being independent ambulators rather than a lower ambulatory class (cane, walker, and nonambulatory). Pertrochanteric fractures were less likely than femoral neck fractures to independently ambulate at 3 months (17.2% vs. 42.3%; P = 0.0006).
Ambulating 5 feet within 72 hours after hip fracture surgery is associated with an increased likelihood of independent ambulation at 3 months postoperatively. This simple and clear goal may be used to help enhance postoperative mobility and independence while providing a metric to guide therapy and help counsel patients and families.
老年人髋部骨折手术后无法活动已被确定为发病率和死亡率增加的危险因素。先前的研究已经评估了术后急性护理阶段的活动时间和距离与术后并发症之间的关联。本研究旨在评估术后急性环境中步行距离与术后 3 个月步行能力之间的关联。
回顾性分析了 2014 年至 2019 年期间基线时可活动且接受髋部骨折手术的年龄在 65 岁及以上的患者。与先前的文献一致，患者分为两组：术后 72 小时内能够行走 5 英尺的患者（早期活动组）和无法行走的患者（最小活动组）。
共有 170 例患者（84 例早期活动组和 86 例最小活动组）可进行分析。使用多变量有序逻辑回归模型，发现对 3 个月时步行状态有统计学意义的预测变量包括术后 72 小时内能够行走 5 英尺（P < 0.0001）、出院时的步行距离（P = 0.012）和从就诊到手术的时间（P = 0.039）。术后 72 小时内能够行走 5 英尺的患者独立行走的可能性是行走能力较低的患者的 9 倍（拐杖、助行器和无法行走）。转子间骨折比股骨颈骨折更有可能在 3 个月时独立行走（17.2%比 42.3%；P = 0.0006）。
髋部骨折手术后 72 小时内行走 5 英尺与术后 3 个月独立行走的可能性增加相关。这个简单明确的目标可用于帮助提高术后活动能力和独立性，并提供一个衡量标准来指导治疗，帮助患者和家属。
