老年人髋部骨折康复时间和危险因素对法医鉴定的影响

Effects of recovery time and risk factors on disability identification of elderly patients with hip fracture

目的分析老年人髋部骨折后康复时间及康复影响因素,为髋部损伤法医相关鉴定提供依据。方法对2017年1月4日至2018年1月3日市立医院骨科收治的60岁以上髋部骨折且行手术治疗的136例患者,进行前瞻性队列研究1年。每隔3个月收集1次患者的人口学数据以及髋部骨折后的表现和功能活动评分。结果136例髋部骨折患者经1年的随访,57例(41.91%)患者术后6个月内完全康复,81例(61.03%)患者术后12个月内康复。年龄、骨质疏松症、骨折后新发抑郁症和经济收入低是影响髋部骨折后患者康复的重要影响因素;且在1年内康复率存在时间变化趋势,术后6个月的康复率与3个月、9个月和12个月的比较,差异有统计学意义(P﹤0.001);股骨颈骨折患者6个月的康复率(29.31%)明显低于髋臼骨折(50.50%)和股骨粗隆骨折(52.27%)的康复率。结论在对老年人髋部骨折法医学鉴定时应考虑骨折类型、骨质疏松症、骨折后新发抑郁症、社会经济状况、年龄、术前脑梗等影响功能康复的因素,鉴定时限至少延长至骨折后9个月。

Objective To study the recovery time and influencing factors of hip fracture in the elderly in order to provide the basis for the time limit of disability identification of hip injury.Methods Prospective cohort studies for 1 year were conducted on 136 cases elderly(over 60 years old)patients with hip fracture.Their clinical data were collected from orthopedic department in Suzhou municipal hospital from 4 January 2017 to 3 January 2018.demographic data and information on the surgery and functional activity score of patients with hip fractures were collected every three months.Results Among 136 patients with hip fracture,57 patients(41.91%)fully recovered within 6 months after surgery,and 81 patients(61.03%)fully recovered within 12 months after surgery.Age,osteoporosis,depression after fractures,and low income were important influencing factors of the recovery and there were time-dependent trends on recovery rate during one year.The recovery rate within 6 months was significant different(P﹤0.001)from that of 3 months,9 months and 12 months after surgery.The 6-month recovery rate of patients with femoral neck fracture(29.31%)was significantly lower than that of acetabular fracture(50.50%)and femoral trochanteric fracture(52.27%).Conclusions The important factors such as fracture types,osteoporosis,depression after fracture,socioeconomic condition,age and cerebral infarction after hip fractures in the elderly should be considered in forensic identification of injury.The assessment time should be extended to at least 9 months after fracture.