浙江省温州地区老年脑卒中后患者髋部骨折发病率调查及危险因素分析  

Incidence rate and risk factors of hip fractures in older adult patients with stroke in Wenzhou,Zhejiang Province

作　　者：李峰 尤炯鸣 王锋 杨吉和 Li Feng;You Jiongming;Wang Feng;Yang Jihe(Department of Traumatology and Orthopedics,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang Province,China;Department of Emergency,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市中西医结合医院创伤骨科,温州325000 [2]温州市中心医院急诊科,温州325000

出　　处：《中国基层医药》2024年第5期675-680,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市基础性科研项目(Y2020404)。

摘　　要：目的分析浙江省温州地区老年脑卒中后患者髋部骨折发病率及相关的危险因素。方法采用回顾性研究方式,以2016年1月至2021年1月温州市中心医院和温州市中西医结合医院收治的老年脑卒中患者4500例为研究对象,年龄≥65岁,男2245例,女2255例;以患者病历资料为数据来源,统计髋部骨折发病率,并通过单因素分析及多因素logistic回归分析导致老年脑卒中后患者发生髋部骨折的危险因素。结果所有患者脑卒中后2年内髋部骨折发生率为6.58%(296/4500),且髋部骨折发生于偏瘫患侧比例高达82.77%(245/296)。骨密度(BMD)(T值)≤-1、脑卒中后3个月内身体质量指数下降率>5%、视力受损、Berg平衡量表评分<45分、下肢Fugl-Meyer量表评分<20分、肢改良Ashworth量表(MAS)分级≥Ⅱ级、下肢肌群(髋伸肌群、膝伸肌群)徒手肌力检查(MMT)分级髋伸肌群MMT<3级和膝伸肌群MMT<3级等均为老年脑卒中后患者发生髋部骨折的独立危险因素(OR=6.765、6.772、4.726、5.491、4.582、6.294、3.763、4.236,均P<0.05)。结论老年脑卒中后患者骨密度下降、体质量丢失、视力受损、下肢平衡及运动功能下降、下肢肌痉挛及肌力减弱等是发生髋部骨折的危险因素,应制定针对性预防措施。Objective To analyze the incidence rate and risk factors of hip fracture in older adult patients with stroke in Wenzhou,Zhejiang Province.Methods A total of 4500 older adult patients with stroke,aged≥65 years,who received treatment at the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2016 and January 2021 were included in this study.There were 2245 males and 2255 females.Patient case data were used as the primary data source and the incidence rate of hip fracture was calculated.Furthermore,risk factors for hip fracture in older adult patients with stroke were analyzed using univariate analysis and multivariate logistic regression analysis.Results The incidence rate of hip fractures within 2 years of stroke was 6.58%(296/4500)among all patients,with a high proportion of 82.77%(245/296)of hip fractures occurring on the paralyzed side.Independent risk factors for hip fractures in older adult patients with stroke included bone mineral density(T-score)≤-1,a decrease in body mass index>5%within 3 months of stroke,visual impairment,a Berg Balance Scale score<45 points,a lower extremity Fugl-Meyer Scale score<20 points,Modified Ashworth Scale(MAS)grade≥II for limb spasticity,and Manual Muscle Testing(MMT)grades for hip extensor muscle groups and knee extensor muscle groups<3(OR=6.765,6.772,4.726,5.491,4.582,6.294,3.763,4.236,all P<0.05).Conclusion Factors such as decreased bone density,weight loss,visual impairment,decreased lower extremity balance and motor function,lower extremity muscle spasticity,and weakened muscle strength are risk factors for hip fractures in older adult patients with stroke.Targeted preventive measures should be developed accordingly.

关 键 词：脑血管障碍 髋骨折 危险因素 因素分析 统计学 老年人 

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