老年髋部骨折术后功能恢复多因素分析

发布时间：2018-03-02 07:05

本文关键词： 髋部骨折绿色通道相关因素功能恢复　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:研究影响老年髋部骨折患者术后功能恢复的相关因素,为临床工作中治疗老年髋部骨折提高其术后功能恢复提供相关资料,同时为提高其远期生存质量、生存率提供相关意见。方法:回顾性分析2005年3月至2015年1月之间在我院住院治疗的435例老年髋部骨折术后患者临床资料,其中305例随访成功并纳入研究,对老年髋部骨折患者术后功能恢复的相关因素进行分析,其中涵盖年龄、性别、伤前基础病、骨折类型、手术的时机、术后并发症等因素。采用SPSS16.0软件数据,分别采用?2检验或校正的?2检验、秩和检验的统计学分析,以P0.05为差异有显著性,先进行单因素分析,剔除无统计学意义的变量,再对结果中存在统计学意义的变量再次进行多因素logistic回归分析,判断该因素是否为影响老年髋部骨折术后功能恢复的独立因素。结果:采用统计学分析,患者的年龄、性别、骨折类型对于老年髋部骨折患者术后功能恢复非危险因素,而伤前基础病、手术时机、术后并发症三种因素对于老年髋部骨折患者术后功能恢复有较明显影响(P0.05),其术后功能恢复相对越差。经过多因素二分类Logistic回归分析则发现患者的伤前基础病是老年髋部骨折患者术后功能恢复的独立因素,老年髋部骨折患者伤前基础病种类越多,严重性越大的患者,术后功能恢复相对越差。结论:1临床工作当中要高度重视对于伤前基础病的治疗及评估,经讨论发现伤前基础病中心脑血管疾病又做为其首要影响因素直接影响其术后功能恢复程度。2年龄并不是决定髋部骨折术后功能恢复的最主要因素,不应因单纯的高龄来迁延或放弃手术治疗。3老年髋部骨折患者进行手术的时机选择上应因人而异。4骨折的严重程度在一定程度上影响了术后功能恢复,临床工作当中应重视骨折分型详细评估骨质质量来指导手术方案及内固定材料的选择。5骨折复位良好与否在髋部骨折治疗过程中有至关重要的作用,因而术中应尽量解剖复位。6术后护理及康复锻炼也应予以充分的重视,密切关注围手术期并发症和手术相关并发症,一旦出现,应当及时处理。7随着我国人口老龄化进程的不断加快,建议远期在基层医院能够普及建立“老年髋部骨折绿色通道模式治疗病房”,为降低术后病死率及提高术后功能恢复程度提供积极意义。
[Abstract]:Objective: to study the related factors affecting the postoperative functional recovery of elderly hip fracture patients, and to provide relevant data for the treatment of elderly hip fractures and improve their long-term quality of life. Methods: the clinical data of 435 elderly patients with hip fracture who were hospitalized in our hospital between March 2005 and January 2015 were analyzed retrospectively. 305 of them were followed up successfully and included in the study. The related factors of postoperative functional recovery in elderly patients with hip fracture were analyzed, including age, sex, pretraumatic basic disease, fracture type, timing of operation, postoperative complications and so on. (2) checked or corrected? 2 the statistical analysis of test, rank sum test, taking P0.05 as the significant difference, first carries on the single factor analysis, removes the variable which has no statistical significance, then carries on the multivariate logistic regression analysis again to the variable which has the statistical significance in the result. Results: using statistical analysis, age, sex and type of fracture were used as non-risk factors for functional recovery in elderly patients with hip fracture. And the basic diseases before injury, the timing of surgery, Three factors of postoperative complications have significant influence on postoperative functional recovery in elderly patients with hip fracture, and the worse the postoperative functional recovery is, the worse the postoperative functional recovery is. After multivariate two-classification Logistic regression analysis, it is found that the patients with pretraumatic basic diseases are old. Independent factors of postoperative functional recovery in hip fracture patients, In elderly patients with hip fracture, the more kinds of basic diseases before injury and the greater the severity, the worse the functional recovery after operation. Conclusion in the clinical work of 1 / 1, we should attach great importance to the treatment and evaluation of pretraumatic basic diseases. After discussion, it was found that cardio-cerebrovascular disease in pretraumatic basic diseases was not the most important factor to determine the functional recovery after hip fracture, as the primary influencing factor, the degree of functional recovery was not directly affected by the age of .2 years. The timing of operation for elderly hip fracture patients should not be delayed or abandoned because of simple old age. The severity of the fracture of .4 should be different from person to person, and the recovery of postoperative function should be affected to a certain extent. In clinical work, attention should be paid to the detailed evaluation of bone quality by fracture classification to guide the selection of surgical schemes and internal fixation materials. The reduction of 5 fractures is of vital importance in the treatment of hip fractures. Therefore, we should pay more attention to the nursing care and rehabilitation exercise after anatomic reduction as much as possible, pay close attention to the perioperative complications and operative related complications, once they appear, As the ageing process of our population continues to accelerate, it should be addressed in a timely manner, It is suggested that the establishment of "Green Channel treatment Ward for Old Hip fracture" can be popularized in grass-roots hospitals in the long term, which provides a positive significance for reducing the postoperative mortality and improving the degree of postoperative functional recovery.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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