The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures.
The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures.
复制标题
头下骨折老年人手术过程的预测因素及其对功能恢复的影响。
DOI：
10.1093/gerona/51a.4.m158
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Magaziner,J
中科院分区：
文献类型：
--
作者：
Young,Y;German,P;Brant,L;Kenzora,J;Magaziner,J
背景已经证明，大多数髋部骨折患者不能恢复其骨折前的功能水平，并且通常在骨折后功能下降。对于头下骨折患者进行手术治疗（半髋关节置换术与内固定术）对功能恢复的有效性知之甚少。本研究探讨了手术方式选择的相关因素以及手术方式选择对日常生活活动能力（PADL）和工具性日常生活活动能力（IADL）的影响。样本包括1984年至1986年期间在巴尔的摩地区七家医院之一的社区收治的年龄在65岁及以上的312例头下骨折患者。基线信息是在住院期间通过与患者及其重要他人（代理人）的结构化访谈获得的。在出院后两个月、六个月和一年对代理人进行随访。疾病诊断、骨折严重程度和手术操作的信息从病历中获得。移位性骨折患者接受半髋关节置换术的可能性高7倍（OR = 7.0，95% CI 3.7-13.I）。在术后2个月的短期恢复中，接受半髋关节置换术的患者在转移、膳食准备和购物方面优于接受内固定术的患者。对于长期功能恢复（1年），两种手术方法之间的总体PADL和IADL功能无统计学显著差异。骨折的严重程度被认为是外科手术的最重要的决定因素。接受半髋关节置换术的头下骨折患者在短期内往往有更好的功能恢复。需要进一步研究使用半关节置换术的其他益处。
Background. It has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning and usually decline in function following fracture. Little is known about the effectiveness of surgical procedure performed (hemiarthroplasty vs internal fixation) on functional recovery of subcapital fracture patients. This study examines the factors related to the type of the surgical procedure chosen and the effect of this selection on physical activities of daily living (PADL) and instrumental activities of daily living (IADL).Methods. The sample consists of 312 patents with subcapital fractures age 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986. Baseline information was obtained during hospitalization through structured interviews with both patients and their significant others (proxy). The follow-up interviews were administered to proxies at two months, six months, and one year after discharge from hospital. Information on disease diagnoses, fracture severity, and surgical procedures performed was obtained from medical charts.Results. Patients with a displaced fracture were seven times more likely to receive a hemiarthroplasty (OR = 7.0, 95% CI 3.7–13.I). During the short-term recovery (2 months after surgery), patients who received hemiarthroplasty were doing better in transferring, meal preparation, and shopping than those who received internal fixation. For the long-term functional recovery (one year), the overall PADL and IADL functions were not statistically significantly different between the two surgical procedures performed.Conclusions. The severity of fracture was found to be the most important determinant of surgical procedure. Patients with a subcapital fracture who received hemiarthroplasty tended to have a better functional recovery in the short term. Further study of other benefits of using a hemiarthroplasty is needed.