多学科联合诊疗模式在老年髋关节置换术患者中的应用

Application of multidisciplinary diagnosis and treatment model in elderly patients undergoing hip arthroplasty

目的探讨多学科联合诊疗模式在老年髋关节置换术患者中的应用效果。方法选择2017年9月至2021年10月解放军联勤保障部队第九〇八医院骨科收治的366例老年髋部骨折患者进行回顾性研究。其中197例老年髋关节置换术患者(联合组)采用多学科联合诊疗模式进行治疗。多学科诊疗计划由骨科医生、内科医生、麻醉师、康复理疗师和营养师共同制订。169例老年髋关节置换术患者(传统组)采用单一骨科为主的传统治疗模式。比较两组骨折类型、入路、假体类型、术前Harris评分、年龄和性别差异。比较两组患者术前等待时间、手术时间、术后第一次下床活动时间。比较两组术后1、3、6个月早期并发症发生率、髋关节功能Harris评分和Barthel评分。结果联合组术前等待时间、手术时间和术后第一次下床活动时间均短于传统组(P<0.05)。联合组术后早期并发症发生率低于传统组(P<0.05)。联合组术后1、3、6个月髋关节功能Harris评分和Barthel评分高于传统组(P<0.05)。结论对接受髋关节置换术的老年患者进行多学科治疗,不仅可以加快术前检查的效率,减少术前不必要的等待时间,还可以缩短手术时间,缩短术后下床时间,降低术后并发症的发生率,促进患者术后髋关节功能的恢复。

Objective To explore the application effect of a multidisciplinary diagnosis and treatment model in the treatment of elderly patients undergoing hip arthroplasty.Methods A retrospective study was conducted on 366 elderly patients with hip fractures admitted to the Department of Orthopedics of No.908 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from September 2017 to October 2021.Among them,a multidisciplinary diagnosis and treatment model was adopted for 197 elderly patients undergoing hip arthroplasty for treatment.The multidisciplinary diagnosis and treatment plan was jointly developed by orthopedists,internists,anesthesiologists,rehabilitation therapists,and nutritionists.A traditional treatment model primarily focused on orthopedics was adopted for 169 elderly patients undergoing hip arthroplasty.The differences in fracture type,approach,prosthesis type,preoperative Harris score,age,and gender between the two groups were compared.The differences in preoperative waiting time,operation time,and postoperative offbed activity time between the two groups of patients were compared.The incidence of early complications,and Harris score and Barthel score of hip joint function between the two groups at 1,3,and 6 months were compared after surgery.Results The preoperative waiting time,operation time,and postoperative off-bed activity time of the combined group were shorter than those of the traditional group(P<0.05).The incidence of early postoperative complications in the combined group is lower than that in the traditional group(P<0.05).The Harris and Barthel scores of hip joint function in the combined group were significantly higher than those in the traditional group at 1,3,and 6 months after surgery(P<0.05).Conclusion Multidisciplinary treatment for elderly patients undergoing hip arthroplasty can not only accelerate the efficiency of preoperative examination,and reduce unnecessary waiting time before surgery,but also shorten the total operation time,shorten postoperative off-bed time,reduce the incidence of postoperative complications,and promote the recovery of hip joint function in patients after su rgery.