合并脑卒中史的老年髋部骨折患者的临床特征及治疗效果分析  

Analysis of clinical characteristics and surgical efficacy of geriatric hip fracture combined with stroke history

作　　者：谭哲伦 刘刚[1] 葛宇峰 高峰 姚东晨 陈依民 彭卫东 张京 张馨艺 朱仕文[1] 杨明辉[1] 吴新宝[1] Tan Zhelun;Liu Gang;Ge Yufeng;Gao feng;Yao Dongchen;Chen Yimin;Peng Weidong;Zhang Jing;Zhang Xinyi;Zhu Shiwen;Yang Minghui;Wu Xinbao(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;School of Population Health,University of New South Wales,Sydney 2052,Australia;the George Institute for Global Health at Peking University Health Science Centre,Beijing 100191,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]澳大利亚新南威尔士大学人群健康学院,悉尼2052 [3]北京大学医学部乔治全球健康研究院,北京100191

出　　处：《中华解剖与临床杂志》2023年第1期7-13,共7页Chinese Journal of Anatomy and Clinics

基　　金：首都卫生发展科研专项(首发2022-1-2071);北京积水潭医院高层次人才“学科骨干”培养计划(XKGG201807)。

摘　　要：目的探讨合并脑卒中病史的老年髋部骨折患者的临床特征,以及在老年髋部骨折共管模式下的治疗效果。方法回顾性队列分析。纳入2018年11月—2019年11月在北京积水潭医院手术治疗的1092例老年髋部骨折患者的临床资料,其中男306例,女786例,年龄65~95岁(平均79.6岁)。根据既往是否有脑卒中病史分为脑卒中组155例和非脑卒中组937例。脑卒中组患者发生脑卒中至髋部骨折手术时间均大于30 d。观察指标:(1)分析脑卒中组患者的临床特征(脑卒中类型、发病史、后遗症发生率、遗留肢体不利情况,以及肢体不利侧与肢体利侧发生骨折的占比)。(2)比较2组患者的年龄、性别、骨折类型、骨折侧别、伤前能否户外活动、伤前行走是否需要辅具等临床特征的差异。(3)比较2组患者的入院48 h内手术率、术前等待时间、住院时间,比较不同观察时间的死亡率、再手术率,以及并发症发生率、活动恢复情况、健康相关生活质量等结果的差异。结果(1)脑卒中组155例患者的临床特征:其中,脑梗死141例(91.0%),脑出血14例(9.0%);1次脑卒中发病史148例(95.4%),≥2次发病史7例(4.5%);有脑卒中后遗症60例(38.7%);遗留肢体不利的患者43例(27.7%),其中81.4%(35/43)骨折发生在肢体不利侧,18.6%(8/43)发生在利侧。(2)2组患者的性别、骨折侧别比较差异均无统计学差异(P值均>0.05);脑卒中组患者较非脑卒中组患者的中位年龄小(79岁与81岁),脑卒中组患者股骨颈骨折发生率(58.7%,91/155)、辅具帮助行走的比例(43.9%,68/155)及无法户外活动的比例(11.6%,18/155)均较非脑卒中患者高(49.6%,465/937;23.5%,276/937;5.7%,53/937),差异均有统计学意义(P值均<0.05)。(2)2组患者的入院48 h内手术率、术前等待时间、住院时间、再手术率及并发症发生率比较差异均无统计学意义(P值均>0.05);院内死亡率及入院后30 d、120 d、1年死亡率差异均无统计学�Objective A study was conducted to explore the clinical characteristics of elderly hip fracture patients with stroke history and the treatment effect under the common tube mode of elderly hip fracture.Method A retrospective cohort study was conducted.The clinical data of 1092 elderly cases with surgical treatment of hip fracture aged 65-95 years old,hospitalized in Beijing Jishuitan Hospital from November 2018 to November 2019 were included.The patients included 306 males and 786 females with an average age of 79.6 years old.According to whether they had a history of stroke,they were divided into the stroke group(155 cases)and the non-stroke group(937 cases).More than 30 days had passed since the stroke occurred.Observation indicators included the following.(1)The clinical characteristics(stroke type,history,incidence of sequelae and type of sequelae were analyzed,and the differences between both sides of the limbs were compared.(2)The difference between the patients with stroke and those without stroke in age,sex,fracture type,fracture side,whether they can exercise outdoors,and whether they need assistive devices before injury was determined.(3)The treatment effects of the two groups of patients were compared,as follows:operation rate within 48 h after admission,preoperative waiting time,hospitalization time,and differences in mortality,reoperation rate,complication rate,mortality,activity recovery,health-related quality of life,and other outcomes.Result(1)The clinical characteristics of 155 patients in the stroke group were as follows.A total of 141 patients(91.0%)had cerebral infarction,and 14 patients(9.0%)had cerebral hemorrhage.A total of 148 cases(95.4%)suffered stroke once,and 7 cases(4.5%)suffered more than once.Sixty cases(38.7%)had sequelae of stroke.Forty-three patients(27.7%)had poor limb activity,of which 81.4%(35/43)of fractures occurred on the affected side of the limb,which was statistically significant compared with 18.6%(8/43)on the healthy side.(2)There was no significant difference in the ge

关 键 词：髋骨折 脑卒中 老年人 共管模式 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R683.3[医药卫生—临床医学]