多学科协作在老年人髋部骨折治疗中的作用

Clinical significance of multidisciplinary team collaboration for the treatment of hip fractures in the elderly

目的探讨多学科团队协作的治疗模式在老年人髋部骨折治疗过程中的作用。方法收集2015年9月1日至2017年12月31日我院骨科收治的符合入组条件的老年髋部骨折患者157例,采取随机分组方法分为传统治疗组和多学科协作(MDT)治疗组,比较两组患者治疗时间、费用、术后转归及术后Harris髋关节功能评分等方面的差异。结果MDT治疗组患者的术前待床日、总住院时间、术后抗生素使用时间较传统治疗组均明显缩短(均P<0.05),治疗总费用、床位费、化验费、护理费较传统治疗组低(均P<0.05)。MDT治疗组患者术后下床活动时间较传统治疗组患者明显提前,股骨颈骨折患者平均为(5.36±1.56)d,优于传统治疗组(10.07±2.26)d;股骨粗隆间骨折患者平均为(30.26±3.01)d,优于传统治疗组(42.28±3.52)d(t=2.86、2.25,P=0.002、0.017)。MDT治疗组患者术后3个月和6个月Harris髋关节功能评分均较传统治疗组高(均P<0.05)。结论MDT治疗模式能缩短老年髋部骨折患者的术前待床日、总住院时间、术后下床活动时间,以及减少住院费用及术后并发症的发生,较传统模式更有利于患者髋关节功能的恢复。

Objective To investigate the clinical value of multidisciplinary team collaboration(MDT)for the treatment of hip fractures in elderly patients. Methods A total of 157 elderly patients with hip fractures meeting inclusion and exclusion criteria were admitted into our department from 1st September 2015 to 31st December 2017.The patients were randomly divided into the traditional treatment group and the MDT group.The differences in treatment time, cost, postoperative outcomes and postoperative Harris hip function score were compared between the two groups. Results The preoperative length of stay, total hospitalization time and the time of antibiotic use after operation were shorter in the MDT treatment group than in the traditional treatment group(all P<0.05). Total costs of treatment and costs for bed, laboratory examinations, and nursing were lower in the MDT treatment group than in the traditional treatment group(all P<0.05). The off-bed activity time after operation was earlier in the MDT treatment group with femoral neck fractures [(5.36±1.56)d vs.(10.07±2.26)d, P=0.002]than in the traditional treatment group with intertrochanteric fracture patients [(30.26±3.01)d vs.(42.28±3.52)d, P=0.017]. Harris hip function score was higher in the MDT treatment group than in the traditional treatment group at 3 and 6 months after surgery (P<0.05). Conclusions As compared with the traditional treatment mode, MDT treatment mode can shorten the preoperative stay in bed, the length of hospital stay after surgery and the off-bed activity time after operation, reduce hospitalization costs and postoperative complications, and can promote the recovery of hip joint function in elderly hip fracture patients.