老年髋部骨折病人二次骨折预防管理的最佳证据总结

Management of secondary fracture prevention in elderly hip fracture patients:a summary of the best evidence

目的:检索、评价并整合国内外关于老年髋部骨折病人二次骨折预防管理的相关证据,并进行最佳证据总结。方法:系统检索英国国家健康与临床优化研究网站、国际指南网、加拿大安大略注册护士协会网站、苏格兰学院间指南网、乔安娜布里格斯研究所循证卫生保健中心数据库和医脉通等指南网以及中国生物医学文献数据库、万方数据库、中国知网、PubMed等中英文数据库中关于老年髋部骨折病人二次骨折预防管理的相关证据,检索时限为建库至2022年12月24日。由2名研究者独立完成文献评价,对符合标准的文献进行证据提取及总结。结果:共纳入16篇文献,包括5篇指南、5篇专家共识、5篇系统评价和1篇最佳实践,总结确定了6个主题、22条最佳证据,包括多学科合作团队、评估、营养饮食、功能锻炼、用药指导、健康宣教6个方面。结论:汇总的老年髋部骨折二次骨折预防管理的最佳证据可为医护人员临床实践提供参考,医护人员应结合科室实际、病人意愿选择应用,以科学、个性化的管理为病人提供帮助和护理,提高病人的生存质量。

Objective:To summarize the best evidence on the management of preventing secondary fractures in elderly patients with hip fractures by retrieving,evaluating,and integrating relevant domestic and foreign evidence.Methods:Relevant evidence on secondary fracture prevention and management of elderly hip fracture patients were retrieved from the website of National Health and Clinical Excellence Research in the United Kingdom,the International Guidelines Network,the website of the Registered Nurses Association of Ontario,the Scottish College Guidelines Network,the Joanna Briggs Research Center for Evidence-Based Health Care Database,Yimaitong website,China Biomedical Literature Database,PubMed,WanFang Database,and China National Knowledge Infrastructure(CNKI).The search time limit was from the establishment to December 24,2022.Two researchers independently completed the literature evaluation and extracted and summarized evidence from the literature that met the criteria.Results:A total of 16 articles were included,including 5 guidelines,5 expert consensuses,5 systematic reviews,and 1 best practice.6 topics were summarized,and 22 pieces of best evidence were identified,including 6 aspects:multidisciplinary cooperation teams,evaluation,nutrition and diet,functional exercise,medication guidance,and health education.Conclusions:The best evidence of secondary fractures prevention management in elderly hip fracture patients could provide a reference for the clinical practice of medical staff.Medical staff should choose the application in combination with departmental conditions and patients′wishes and provide help and care for patients with scientific and personalized management to improve patients′quality of life.