老年髋部脆性骨折病人二次骨折预防与管理最佳证据总结

Summary of the best evidence on the prevention and management of secondary fractures in elderly patients with hip fragility fractures

目的:总结老年髋部脆性骨折病人二次骨折预防与管理的最佳证据。方法:检索UpToDate、BMJ Best Practice、国际指南网、英国国家卫生临床优化研究所指南网、新西兰指南小组网站、苏格兰校际指南网络、加拿大医学临床实践指南信息库、加拿大安大略注册护士协会指南网、the Cochrane Library、澳大利亚Joanna Briggs Institute(JBI)网、医脉通、PubMed、Web of Science、EMbase、CINAHL、中国生物医学文献服务系统、中国知网、万方数据库中老年髋部脆性骨折病人二次骨折预防与管理相关的指南、专家共识、临床决策、证据总结、系统评价等,检索时限为建库至2022年3月31日。由2名研究人员对文献质量进行独立评价,对符合标准的文献进行证据提取,并依据JBI证据预分级系统(2014版)进行证据分级。结果:共纳入10篇文献,包括指南2篇、专家共识4篇、临床决策2篇、证据总结1篇、系统评价1篇。结合专业人员判断,围绕风险评估与筛查、跌倒预防、骨质疏松防治、二次骨折管理、健康教育5个方面进行证据总结,形成25条证据。结论:总结的老年髋部脆性骨折病人二次骨折预防与管理的最佳证据较为全面、科学、严谨,可为老年髋部脆性骨折病人二次骨折风险预防的精准性及二次骨折管理的规范性提供循证证据。

Objective:To summarise the best evidence on preventing and managing secondary fractures in elderly patients with hip fragility fractures.Methods:Guidelines,expert consensus,clinical decision-making,evidence summaries,systematic reviews,et,related to prevention and management of secondary fractures in middle-aged and elderly patients with hip fragility fractures were retrieved from UpToDate,BMJ Best Practice,International Guidelines Network,National Institute for Health Clinical Excellence Guidelines Network,New Zealand Guidelines Group website,Scottish Intercollegiate Guidelines Network,Canadian Medical Clinical Practice Guidelines Information Database,Ontario Registered Nurses Association Guidelines Network,the Cochrane Library,the Australian Joanna Brigg Institute(JBI)website,Yimaitong,PubMed,Web of Science,EMbase,CINAHL,SinoMed,CNKI,and WanFang Database from the establishment of the databases to March 31,2022.Two researchers independently evaluated the quality of the literature,extracted evidence from the literature that met the standards,and graded the evidence according to the Australian JBI evidence pre-grading system(2014 version).Results:A total of 10 documents were included,including 2 guidelines,4 expert consensus articles,2 clinical decision-making articles,1 evidence summary,and 1 systematic review.Based on the judgment of professionals,25 pieces of evidence were summarised around five aspects:risk assessment and screening,fall prevention,osteoporosis prevention and treatment,secondary fracture management,and health education.Conclusions:The summarised best evidence on the prevention and management of secondary fractures in elderly patients with hip fragility fractures was comprehensive,scientific,and rigorous,which could provide evidence-based evidence for the accuracy of secondary fracture risk prevention and the standardization of secondary fracture management in elderly patients with hip fragility fractures.