中国修复重建外科杂志

中国修复重建外科杂志

术前早期下地活动对老年髋部骨折的疗效影响分析

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目的 探讨术前早期下地活动对老年髋部骨折疗效的影响。 方法 回顾分析 2017 年 2 月—2018 年 4 月收治并符合选择标准的 16 例老年髋部骨折患者临床资料。男 8 例,女 8 例;年龄 69~90 岁,平均 80.3 岁。骨折类型:股骨转子间骨折 8 例,股骨颈骨折 8 例。术前美国麻醉医师协会(ASA)评分为(2.94±0.43)分。合并心脑血管疾病 3 例,原发性高血压 6 例,呼吸系统疾病 5 例,糖尿病 3 例,其他系统疾病 2 例。受伤至入院时间为 4 h~14 d,平均 39.5 h。 入院当天或入院后第 1 天患者在充分镇痛治疗下开始下地活动,采用闭合复位内固定(9 例)或人工髋关节置换术(7 例)。入院至手术时间 4~25 d,平均 7.4 d。患者入院时、术前第 1 次下地活动后、术后第 2 天、末次随访时,按照 Barthel 量表评分评估患者生活自理能力,计算入院后各时间点 Barthel 生活自理能力恢复有效性(Barthel effectiveness,BE)。观察随访期间患者并发症发生情况。 结果 16 例患者手术均顺利完成。住院时间 8~24 d,平均 14.1 d。患者均获随访,随访时间 2.5~16.0 个月,平均 6.5 个月。1 例患者术后发生肺部感染;其余患者均无手术相关并发症发生。随访期间无患者死亡。入院时 Barthel 量表评分为(30.63±5.56)分、术前第 1 次下地活动后为(53.13±9.50)分、术后第 2 天为(60.63±6.09)分、末次随访时为(96.25±4.84)分,各时间点 Barthel 量表评分比较差异均有统计学意义(P<0.05)。术前第 1 次下地活动后、术后第 2 天、末次随访时 BE 分别为 0.23±0.06、0.30±0.04、0.66±0.06,各时间点 BE 比较,差异均有统计学意义(P<0.05)。 结论 对于术前等待时间较长的老年髋部骨折患者,术前早期下地活动对术后患者恢复自理能力有积极影响。

Objective To evaluate the effect of early preoperative mobilization on the rehabilitation of older patients with hip fracture after operation. Methods The clinical data of 16 elderly patients with hip fracture between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed anastomosis (9 cases) or artificial hip arthroplasty (7 case). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, the second day after operation, and last follow-up, the Barthel Index was used to assess the patients’ self-care ability, and Barthel effectiveness (BE) was calculated. Patients were observed for complications during follow-up. Results All 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up period. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points (P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 at the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points (P<0.05). Conclusion For elderly patients with hip fracture who have long waiting time before operation, early preoperative mobilization has a positive impact on patients’ activities of daily living.

关键词: 髋部骨折; 术前下地活动; Barthel 量表评分; 老年患者

Key words: Hip fracture; preoperative mobilization; Barthel Index; elderly patients

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