高龄髋部骨折合并脑卒中后遗症患者的治疗对策

Treatment therapy comparison of older patients with stroke sequela combined hip fracture in the elderly

目的探讨高龄髋部骨折合并脑卒中后遗症患者的治疗方案，探讨其预后的影响因素。方法回顾性分析62例高龄髋部骨折合并脑卒中后遗症患者的临床资料，根据治疗方法分为保守治疗组（12例）、关节置换组（18例）、内固定组（32例）。综合分析比较美国麻醉师协会（ASA）评分、日常生活活动能力指数（Barthel生活指数）、合并症、简易精神状态量表（MMSE）、股骨近端骨小梁类型指数（Singh指数）、骨折后并发症（感染、再发脑卒中、褥疮、深静脉血栓、心力衰竭）等指标。结果3组患者年龄及性别、ASA评分、合并症比较差异均无统计学意义。保守治疗组、关节置换组、内固定组Barthel生活指数分别为52．1±11．4、74．5±21．3、63．84-15．7；骨折后并发症分别为10、3、13例。3组患者组间Barthel生活指数、并发症比较差异均有统计学意义（F=2．45，P〈0．05；X2=9．32，P〈0．05）。保守治疗组与手术治疗的两组Singh指数（X2=11．10，P〈0．05）及MMSE量表（X2=7．40，P〈0．05）比较差异均有统计学意义，而手术治疗的两组间比较差异均无统计学意义（P均〉0．05）。ASA评分、合并症、MMSE量表、治疗策略、骨折前Barthel生活指数均与骨折后Barthel生活指数存在相关性（OR值分别为5．726、7．152、0．047、1．221、5．312，P均〈0．05）。结论对于高龄髋部骨折合并脑卒中后遗症患者应首选关节置换术治疗，预后受患者身心整体状态的影响较大，完整的评估是选择治疗方案前必不可少的步骤。

Objective To investigate therapeutic effect for oIder patients suffering from stroke sequela combined hip fracture anddiscuss the influence factors of prognosis. Methods The clinical data of 62 older patients suffering from stroke sequela combined with hip fracture were retrospectively analyzed. The therapy approach included the conservative treatment group （12 cases） ,the joint replacement group （18 cases） and the internal fixation group （32 cases）. The data of the American association of anaesthetists （ASA） score, daily life activities ability index （Barthel life index）, complications, mini-mental state examination （MMSE） scale score, proximal femur trabecular bone type index （ Singh index） , complications after fracture （ infection, recurrent stroke,bedsore, deep vein thrombosis, heart failure ） were collected and analyzed. Results There was no statistical significance in terms of age, gender, ASA grade, and complications among three groups. In the conservative treatment group, the joint replacement group, and the internal fixation group, the Bart index were （52. 1 ±11.4）, （74. 5±21.3 ） and （63.8 ± 15.7 ） respectively, and the cases of postoperative complications were 10,3 and 13. There were significant difference in terms of Bart index and complication rate among the three groups （ F = 2.45, P 〈 O. 05 ; X2 = 9. 32, P 〈 0.05 ）. The differences of Singh index （ X2 = 11.05, P 〈 O. 05 ） and MMSE scale score （X2 = 7. 40,P 〈 0. 05 ） were statistically significant between the conservative treatment group and the two surgical treatment groups. No significant difference were found regarding of Singh index and MMSE scale score between the two surgical treatment groups. The relationship between ASA score, complication, MMSE scale score, treatment strategies and Bart index after fracture were found （OR = 5. 726,7. 152,0. 047,1. 221, and 5.312 respectively;P 〈 0. 05）. Conclusion Joint replacement treatment is a preferred choice for older patients suffering from stroke sequela combined hip fracture. The prognosis is strongly influenced by the physical and mental state of patients. Comorehensive evaluation is an indispensable step to choose treatment strategies.