Chanthanapodi Praphan, Tammata Netnapha, Laoruengthana Artit, Jarusriwanna Atthakorn
Department of Orthopaedics, Somdejphrajaotaksin Maharaj Hospital, Tak, Thailand.
Department of Rehabilitation Medicine and Physical Therapy, Somdejphrajaotaksin Maharaj Hospital, Tak, Thailand.
Geriatr Orthop Surg Rehabil. 2024 Aug 23;15:21514593241278963. doi: 10.1177/21514593241278963. eCollection 2024.
Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures.
This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery.
110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks.
Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures.
多达三分之一的脆性髋部骨折患者在受伤后的一年内完全依赖他人，这会导致后期的发病率和死亡率。了解影响患者行走能力的相关因素有助于医护人员制定治疗计划，以改善其功能结局。本研究旨在评估脆性髋部骨折术后早期独立行走障碍的相关因素。
这项回顾性队列研究纳入了2018年1月至2023年6月期间394例患有转子间、转子下或股骨颈脆性髋部骨折的患者。收集并分析了包括术前人口统计学、围手术期和术后因素在内的相关因素。终点指标是患者术后6周时的独立行走障碍情况。
110例患者（27.9%）存在行走障碍，而284例患者（72.1%）在术后6周时能够独立行走。多变量风险比回归分析显示，年龄≥80岁的患者（RR 1.65；95% CI 1.21 - 2.25；P = 0.001）、骨折前需借助助行器行走的患者（RR 2.03；95% CI 1.53 - 2.69；P < 0.001）、患有≥2种基础合并症的患者（RR 1.63；95% CI 1.19 - 2.23；P = 0.002）、术前低白蛋白血症患者（RR 1.74；95% CI 1.32 - 2.29；P < 0.001）以及术后出现医疗并发症的患者（RR 2.04；95% CI 1.37 - 3.02；P < 0.001）在术后6周早期与独立行走障碍显著相关。
髋部骨折手术后出现术后医疗并发症的患者独立行走障碍风险最高。医护人员应关注高危患者，纠正可改变的因素，并尽量减少任何术后并发症，以改善功能恢复并降低脆性髋部骨折后与非行走相关的发病率。
