多学科协作诊疗模式提高老年股骨转子间骨折的诊疗效率  

Multidisciplinary team improves the efficiency of diagnosis and treatment of intertrochanteric fractures in the elderly

作　　者：郝永壮[1] 任俊明[2] 韩小花[3] 王佳佳 孔瑜 刘云忠[4] 董建亮 尉志刚 Hao Yongzhuang;Ren Junming;Han Xiaohua;Wang Jiajia;Kong Yu;Liu Yunzhong;Dong Jianliang;Yu Zhigang(The Orthopedics Department,Shanxi Provincial People Hospital,Taiyuan 030001,China;The Anesthesiology Department,Shanxi Provincial People Hospital,Taiyuan 030001,China;The Geriatrics Department,Shanxi Provincial People Hospital,Taiyuan 030001,China;The Emergency Department,Shanxi Provincial People Hospital,Taiyuan 030001,China;The Rehabilitation Department,Shanxi Provincial People Hospital,Taiyuan 030001,China;The Medical Affairs Department,Shanxi Provincial People Hospital,Taiyuan 030001,China)

机构地区：[1]山西省人民医院骨科,太原030001 [2]山西省人民医院麻醉科,太原030001 [3]山西省人民医院老年医学科,太原030001 [4]山西省人民医院急诊科,太原030001 [5]山西省人民医院康复科,太原030001 [6]山西省人民医院医务处,太原030001

出　　处：《中华实验外科杂志》2024年第12期2877-2879,共3页Chinese Journal of Experimental Surgery

基　　金：山西省大健康产业高质量发展科研专项课题(重点项目)(DJKZXKT2023030)。

摘　　要：目的探讨多学科协作(MDT)诊疗模式能否提高老年股骨转子间骨折的诊疗效率。方法选取山西省人民医院2023年6月至2024年5月MDT模式治疗的92例老年股骨转子间骨折患者和山西省人民医院2022年6月至2023年5月传统模式治疗的84例该类患者, 分别作为MDT组和对照组。统计其一般资料, 比较两组患者的术前等待时间、手术时间、术中出血量、术后住院时间、住院费用、术后并发症发生率、48 h内手术率及术后1、3个月死亡率等。计量资料采用独立样本t检验, 计数资料采用χ^(2)检验。结果两组患者一般资料比较差异无统计学意义。MDT组术前等待时间低于对照组[(32.2±4.4) h比(98.6±11.2) h, t=8.311, P<0.01];MDT组术后住院时间低于对照组[(3.2±0.8) d比(5.8±1.8) d, t=13.054, P<0.05];两组的手术时间[(50.5±11.2)分比(56.0±15.5)分]、术中出血量[(140.3±21.5) ml比(134.5±18.4) ml]差异无统计学意义(t=2.261、1.114, P>0.05)。MDT组住院费用低于对照组[(25 266.8±1 325.6)元比(32 107.5±3 122.8)元, t=6.115, P<0.05]。MDT组的术后并发症发生率明显低于对照组[13%(12/92)比51.2%(43/84), χ^(2)=11.712, P<0.01];MDT组肺部感染[4.3%(4/92)比13.1%(11/84)]、深静脉血栓[3.3%(3/92)比13.1%(11/84)]、褥疮[1.1%(1/92)比8.3%(7/84)]、谵妄[3.3%(3/92)比9.5%(8/84)]发生率低于对照组(χ^(2)=3.172、4.225、5.302、2.317、P<0.05);MDT组与对照组间猝死[0%(0/92)比1.2%(1/84), χ^(2)=1.026]、心衰[1.1%(1/92)比2.4%(2/84), χ^(2)=0.244]、呼衰[0%(0/92)比2.4%(2/84), χ^(2)=2.703]、肺栓塞[0%(0/92)比1.2%(1/84), χ^(2)=1.236]的发生率比较, 差异无统计学意义(P>0.05)。MDT组48 h内手术率高于对照组[48.9%(45/92)比11.9%(10/84), χ^(2)=9.652, P<0.05];MDT组与对照组术后1个月[2.2%(2/92)比3.6%(3/84), χ^(2)=0.813, P>0.05]、术后3个月[3.3%(3/92)比4.8%(4/84), χ^(2)=0.172, P>0.05]死亡率比较, 差异无统计学意义。结论 MDT诊疗模式可显著提高老年股骨转ObjectiveTo investigate whether multidisciplinary team(MDT)can improve the efficiency of diagnosis and treatment of intertrochanteric fractures in elderly patients.MethodsA total of 92 elderly patients with intertrochanteric fractures treated with MDT mode in Shanxi Provincial People’s Hospital from June 2023 to May 2024 and 84 such patients treated with traditional mode in Shanxi Provincial People’s Hospital from June 2022 to May 2023 were selected as the MDT group and the control group,respectively.General data were collected.The preoperative waiting time,operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost,postoperative complications incidence,48 h operation rate and 1,3 months postoperative mortality were compared between the two groups.Independent sample t test was used for measurement data,χ^(2) test was used for count data.ResultsThere was no difference in general data between the two groups.The preoperative waiting time in the MDT group was significantly lower than that in the control group[(32.2±4.4)h vs.(98.6±11.2)h,t=8.311,P<0.01].The postoperative hospital stay in the MDT group was significantly lower than that in the control group[(3.2±0.8)d vs.(5.8±1.8)d,t=13.054,P<0.05].There was no significant difference in operation time[(50.5±11.2)min vs.(56.0±15.5)min]and intraoperative blood loss[(140.3±21.5)ml vs.(134.5±18.4)ml]between the two groups(t=2.261,1.114,P>0.05).The hospitalization cost of MDT group was lower than that of control group[(25266.8±1325.6)yuan vs.(32107.5±3122.8)yuan,t=6.115,P<0.05].The incidence of postoperative complications in MDT group was significantly lower than that in control group[13%(12/92)vs.51.2%(43/84),χ^(2)=11.712,P<0.01].The incidence of pulmonary infection[4.3%(4/92)vs.13.1%(11/84)],deep vein thrombosis[3.3%(3/92)vs.13.1%(11/84)],bedsore[1.1%(1/92)vs.8.3%(7/84)]and delirium[3.3%(3/92)vs.9.5%(8/84)]in MDT group were lower In the control group(χ^(2)=3.172,4.225,5.302,2.317,P<0.05);Sudden death[0%(0/92)vs.1.2%(1/84),χ^(

关 键 词：多学科协作 诊疗模式 老年 股骨转子间骨折 

分 类 号：R687.3[医药卫生—骨科学]