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老年髋部骨折作为一种全身性疾病:关于多系统影响及管理的叙述性综述

Hip Fracture as a Systemic Disease in Older Adults: A Narrative Review on Multisystem Implications and Management.

作者信息

Andaloro Silvia, Cacciatore Stefano, Risoli Antonella, Comodo Rocco Maria, Brancaccio Vincenzo, Calvani Riccardo, Giusti Simone, Schlögl Mathias, D'Angelo Emanuela, Tosato Matteo, Landi Francesco, Marzetti Emanuele

机构信息

Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.

Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.

出版信息

Med Sci (Basel). 2025 Jul 11;13(3):89. doi: 10.3390/medsci13030089.


DOI:10.3390/medsci13030089
PMID:40700118
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12285999/
Abstract

Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of 681 per 100,000. Despite improved surgical care, one-year mortality remains high (15-30%), and fewer than half of survivors regain their pre-fracture functional status. Traditionally regarded as mechanical injuries, hip fractures are now increasingly recognized as systemic events reflecting and accelerating biological vulnerability and frailty progression. We synthesize evidence across biological, clinical, and social domains to explore the systemic implications of hip fracture, from the acute catabolic response and immune dysfunction to long-term functional decline. The concept of intrinsic capacity, introduced by the World Health Organization, offers a resilience-based framework to assess the multidimensional impact of hip fracture on physical, cognitive, and psychological function. We highlight the importance of orthogeriatric co-management, early surgical intervention, and integrated rehabilitation strategies tailored to the individual's functional reserves and personal goals. Innovations such as digital health tools, biological aging biomarkers, and personalized surgical approaches represent promising avenues to enhance recovery and autonomy. Ultimately, we advocate for a shift toward interdisciplinary, capacity-oriented models of care that align with the goals of healthy aging and enable recovery that transcends survival, focusing instead on restoring function and quality of life.

摘要

髋部骨折是老年人最严重的健康问题之一,常常导致残疾、失去独立生活能力以及死亡率上升。2019年,全球估计有960万≥55岁的成年人出现新发病例,发病率为每10万人中有681例。尽管手术治疗有所改善,但一年死亡率仍然很高(15%-30%),而且幸存者中不到一半能恢复到骨折前的功能状态。髋部骨折传统上被视为机械性损伤,现在越来越被认为是反映并加速生物脆弱性和衰弱进程的全身性事件。我们综合生物学、临床和社会领域的证据,探讨髋部骨折的全身性影响,从急性分解代谢反应和免疫功能障碍到长期功能衰退。世界卫生组织提出的内在能力概念提供了一个基于恢复力的框架,以评估髋部骨折对身体、认知和心理功能的多维度影响。我们强调老年骨科联合管理、早期手术干预以及根据个人功能储备和个人目标量身定制的综合康复策略的重要性。数字健康工具、生物衰老生物标志物和个性化手术方法等创新代表了增强康复和自主性的有前景的途径。最终,我们主张转向跨学科、以能力为导向的护理模式,这种模式符合健康老龄化的目标,实现超越生存的康复,而是专注于恢复功能和生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fce8/12285999/a3fc63ec5fcd/medsci-13-00089-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fce8/12285999/a3fc63ec5fcd/medsci-13-00089-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fce8/12285999/a3fc63ec5fcd/medsci-13-00089-g001.jpg

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本文引用的文献

[1]
Frailty as a determinant of mortality, surgical timing and hospital stay in proximal femur fractures: a retrospective cohort study.

Eur J Orthop Surg Traumatol. 2025-5-14

[2]
Risk Factors for Readmission Within 30 Days After Discharge Following Hip Fracture Surgery: A Systematic Review and Meta-Analysis.

J Clin Med. 2025-4-17

[3]
Association between markers of inflammation and outcomes after hip fracture surgery: analysis of routinely collected electronic healthcare data.

BMC Geriatr. 2025-4-24

[4]
The Current Status of Frailty and Influencing Factors in Elderly Patients With Hip Fractures: A Meta-Analysis.

Biomed Res Int. 2025-4-13

[5]
The effects of in-hospital orthogeriatric care on health-related quality of life: a systematic review and meta-analysis.

Age Ageing. 2025-3-28

[6]
Current Care and Barriers to Optimal Care of People With Hip Fracture: A Survey of Hospitals in New South Wales, Australia.

Geriatr Orthop Surg Rehabil. 2025-3-20

[7]
The association between cognitive frailty and the risk of fall occurrence in older adults: a meta-analysis of cohort studies.

Front Med (Lausanne). 2025-2-12

[8]
Clinical efficacy of THA with dual mobility cup vs. hemiarthroplasty in elderly patients with femoral neck fracture: a retrospective study.

Front Surg. 2025-2-5

[9]
The vulnerability of hip fracture patients with cognitive impairment: an analysis of health conditions, hospital care, and outcomes.

BMC Geriatr. 2025-2-14

[10]
A two-year longitudinal study of the impact of cognitive status and depression on frailty status in older adults following hip fracture.

Geriatr Nurs. 2025

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