护理干预减少老年髋部骨折术后再骨折的随机对照研究

Effect of nursing intervention on secondary contralateral fractures after hip fracture surgery:A randomized controlled trial

目的探讨老年人防跌倒指南推荐的综合护理干预对预防老年髋部骨折术后对侧再骨折的效果。方法选择2012年1-12月我院收治的60岁以上髋部骨折患者,排除双侧骨折、既往骨折、病理性骨折及多发伤患者。按照简单随机方法分为防跌倒综合干预组及无干预对照组。比较两组患者术后1年内对侧再次骨折发生率及功能康复情况。结果总共386例符合人组条件并随机分配至干预组及对照组,每组各193例。两组患者年龄、性别、体质量指数、并存疾病、手术类型等差异均无统计学意义。干预组及对照组分别有12例(6.2%)、20例(10.4%)失访。随访结果显示,干预组6例(3.1%)发生对侧再次骨折,对照组有巧例(8.7%),防跌倒综合干预明显降低老年髋部骨折术后对侧再次骨折发生率(P=0.033)。干预组术后1年功能康复较对照组更佳(75.1 vs 69.4,P=0.000)(功能恢复评分)。多因素分析发现,老年髋部骨折患者对侧再骨折的原因有重度骨质疏松,合并神经系统疾病、呼吸系统疾病、心血管系统疾病。结论经综合护理干预可有效降低髋部骨折术后对侧再次骨折发生率。

Objective To discuss the risk factors of secondary contralateral fractures among elderly hip fracture patient, and compare the effect of nursing intervention on secondary contralateral fractures after hip fracture surgery. Methods Patients with fracture over 60 years from January 2012 to December 2012 in our hospital, excluding patients with bilateral fractures, previous fractures, pathologic fractures and multiple trauma, were enrolled in this study. They were randomly divided into intervention group and control group. After 1 year of surgery, the differences of the rate of secondary contralateral hip fractures and physical functional between two groups were compared. Results A total of 386 patients met the inclusion criteria, and they were randomly assigned to the intervention group （n=193） and control group （n=193）. There were no significant differences in age, gender, body mass index, comorbidities, type of surgery between two groups. 12 cases （6.2%） in intervention group and 20 cases （10.4%） in control group lost follow-up. Follow-up results showed that 6 cases （3.1%） had secondary contratateral hip fractures in the intervention group, 15 cages （8.7%） in the control group. Anti-fall comprehensive intervention significantly reduced the rate of the secondary contralateral hip fractures （P=0.033）. Simultaneously, one year after the surgery, the function rehabilitation in intervention group were significantly better than the control group （75.1 vs 69.4, P=0.000）. Multivariate analysis showed that severe osteoporosis, nervous system diseases, respiratory diseases, cardiovascular diseases were the main risk factors for secondary contralaterat fractures among elderly hip fracture patient. Conclusion Comprehensive nursing intervention can effectively reduce rate of secondary eontralateral fractures after hip fracture surgery.