中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
1期
15-18
,共4页
张文波%胡达奇%徐生产%李克鹏
張文波%鬍達奇%徐生產%李剋鵬
장문파%호체기%서생산%리극붕
髋部骨折%脑卒中后遗症%高龄%ASA评分%Barthel生活指数%MMSE量表
髖部骨摺%腦卒中後遺癥%高齡%ASA評分%Barthel生活指數%MMSE量錶
관부골절%뇌졸중후유증%고령%ASA평분%Barthel생활지수%MMSE량표
Hip fracture%Stroke sequela%Older patients%ASA score%Barthel life index%MMSE scale
目的 探讨高龄髋部骨折合并脑卒中后遗症患者的治疗方案,探讨其预后的影响因素.方法 回顾性分析62例高龄髋部骨折合并脑卒中后遗症患者的临床资料,根据治疗方法分为保守治疗组(12例)、关节置换组(18例)、内固定组(32例).综合分析比较美国麻醉师协会(ASA)评分、日常生活活动能力指数(Barthel生活指数)、合并症、简易精神状态量表(MMSE)、股骨近端骨小梁类型指数(Singh指数)、骨折后并发症(感染、再发脑卒中、褥疮、深静脉血栓、心力衰竭)等指标.结果 3组患者年龄及性别、ASA评分、合并症比较差异均无统计学意义.保守治疗组、关节置换组、内固定组Barthel生活指数分别为52.1±11.4、74.5±21.3、63.8±15.7;骨折后并发症分别为10、3、13例.3组患者组间Barthel生活指数、并发症比较差异均有统计学意义(F=2.45,P＜0.05;x2 =9.32,P＜0.05).保守治疗组与手术治疗的两组Singh指数(x2=11.10,P＜0.05)及MMSE量表(x2 =7.40,P＜0.05)比较差异均有统计学意义,而手术治疗的两组间比较差异均无统计学意义(P均＞0.05).ASA评分、合并症、MMSE量表、治疗策略、骨折前Barthel生活指数均与骨折后Barthel生活指数存在相关性(OR值分别为5.726、7.152、0.047、1.221、5.312,P均＜0.05).结论 对于高龄髋部骨折合并脑卒中后遗症患者应首选关节置换术治疗,预后受患者身心整体状态的影响较大,完整的评估是选择治疗方案前必不可少的步骤.
目的 探討高齡髖部骨摺閤併腦卒中後遺癥患者的治療方案,探討其預後的影響因素.方法 迴顧性分析62例高齡髖部骨摺閤併腦卒中後遺癥患者的臨床資料,根據治療方法分為保守治療組(12例)、關節置換組(18例)、內固定組(32例).綜閤分析比較美國痳醉師協會(ASA)評分、日常生活活動能力指數(Barthel生活指數)、閤併癥、簡易精神狀態量錶(MMSE)、股骨近耑骨小樑類型指數(Singh指數)、骨摺後併髮癥(感染、再髮腦卒中、褥瘡、深靜脈血栓、心力衰竭)等指標.結果 3組患者年齡及性彆、ASA評分、閤併癥比較差異均無統計學意義.保守治療組、關節置換組、內固定組Barthel生活指數分彆為52.1±11.4、74.5±21.3、63.8±15.7;骨摺後併髮癥分彆為10、3、13例.3組患者組間Barthel生活指數、併髮癥比較差異均有統計學意義(F=2.45,P＜0.05;x2 =9.32,P＜0.05).保守治療組與手術治療的兩組Singh指數(x2=11.10,P＜0.05)及MMSE量錶(x2 =7.40,P＜0.05)比較差異均有統計學意義,而手術治療的兩組間比較差異均無統計學意義(P均＞0.05).ASA評分、閤併癥、MMSE量錶、治療策略、骨摺前Barthel生活指數均與骨摺後Barthel生活指數存在相關性(OR值分彆為5.726、7.152、0.047、1.221、5.312,P均＜0.05).結論 對于高齡髖部骨摺閤併腦卒中後遺癥患者應首選關節置換術治療,預後受患者身心整體狀態的影響較大,完整的評估是選擇治療方案前必不可少的步驟.
목적 탐토고령관부골절합병뇌졸중후유증환자적치료방안,탐토기예후적영향인소.방법 회고성분석62례고령관부골절합병뇌졸중후유증환자적림상자료,근거치료방법분위보수치료조(12례)、관절치환조(18례)、내고정조(32례).종합분석비교미국마취사협회(ASA)평분、일상생활활동능력지수(Barthel생활지수)、합병증、간역정신상태량표(MMSE)、고골근단골소량류형지수(Singh지수)、골절후병발증(감염、재발뇌졸중、욕창、심정맥혈전、심력쇠갈)등지표.결과 3조환자년령급성별、ASA평분、합병증비교차이균무통계학의의.보수치료조、관절치환조、내고정조Barthel생활지수분별위52.1±11.4、74.5±21.3、63.8±15.7;골절후병발증분별위10、3、13례.3조환자조간Barthel생활지수、병발증비교차이균유통계학의의(F=2.45,P＜0.05;x2 =9.32,P＜0.05).보수치료조여수술치료적량조Singh지수(x2=11.10,P＜0.05)급MMSE량표(x2 =7.40,P＜0.05)비교차이균유통계학의의,이수술치료적량조간비교차이균무통계학의의(P균＞0.05).ASA평분、합병증、MMSE량표、치료책략、골절전Barthel생활지수균여골절후Barthel생활지수존재상관성(OR치분별위5.726、7.152、0.047、1.221、5.312,P균＜0.05).결론 대우고령관부골절합병뇌졸중후유증환자응수선관절치환술치료,예후수환자신심정체상태적영향교대,완정적평고시선택치료방안전필불가소적보취.
Objective To investigate therapeutic effect for older patients suffering from stroke sequela combined hip fracture and discuss the influence factors of prognosis.Methods The clinical data of 62 older patients suffering from stroke sequela combined with hip fracture were retrospectively analyzed.The therapy approach included the conservative treatment group (12 cases),the joint replacement group (18 cases) and the internal fixation group (32 cases).The data of the American association of anaesthetists (ASA) score,daily life activities ability index (Barthel life index),complications,mini-mental state examination (MMSE) scale score,proximal femur trabecular bone type index (Singh index),complications after fracture (infection,recurrent stroke,bedsore,deep vein thrombosis,heart failure) were collected and analyzed.Results There was no statistical significance in terms of age,gender,ASA grade,and complications among three groups.In the conservative treatment group,the joint replacement group,and the internal fixation group,the Bart index were (52.1 ± 11.4),(74.5 ± 21.3) and (63.8 ± 15.7) respectively,and the cases of postoperative complications were 10,3 and 13.There were significant difference in terms of Bart index and complication rate among the three groups (F =2.45,P ＜ 0.05 ; x2 =9.32,P ＜ 0.05).The differences of Singh index (x2 =11.05,P ＜ 0.05) and MMSE scale score (x2 =7.40,P ＜ 0.05) were statistically significant between the conservative treatment group and the two surgical treatment groups.No significant difference were found regarding of Singh index and MMSE scale score between the two surgical treatment groups.The relationship between ASA score,complication,MMSE scale score,treatment strategies and Bart index after fracture were found (OR =5.726,7.152,0.047,1.221,and 5.312 respectively ;P ＜ 0.05).Conclusion Joint replacement treatment is a preferred choice for older patients suffering from stroke sequela combined hip fracture.The prognosis is strongly influenced by the physical and mental state of patients.Comprehensive evaluation is an indispensable step to choose treatment strategies.
