[1]李宁,杨明辉,朱仕文,等.多学科协作构建老年髋部骨折“绿色通道”[J].中华老年骨科与康复电子杂志,2022,(05):290-295.[doi:10.3877/cma.j.issn.2096-0263.2022.05.007]
　Li Ning,Yang Minghui,Zhu Shiwen,et al.“Green Pathway” with a multidisciplinary approach in geriatric hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2022,(05):290-295.[doi:10.3877/cma.j.issn.2096-0263.2022.05.007]
点击复制

多学科协作构建老年髋部骨折“绿色通道”()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2022年05期
页码:
290-295
栏目:
髋部骨折
出版日期:
2022-10-05

文章信息/Info

Title:
“Green Pathway” with a multidisciplinary approach in geriatric hip fractures
作者:
李宁1; 杨明辉1; 朱仕文1; 张萍2; 吴新宝1; 蒋协远1
100035 北京积水潭医院创伤骨科1，老年医学科2
Author(s):
Li Ning1;  Yang Minghui1;  Zhu Shiwen1;  Zhang Ping2;  Wu Xinbao1;  Jiang Xieyuan1.
1Department of Orthopaedics and Traumatology, 2Department of Geriatrics, Beijing Jishuitan Hospital, Beijing 100035, China
关键词:
髋部骨折;  老年人;  多学科协作;  并发症髋部骨折;  老年人;  多学科协作;  并发症
Keywords:
Hip fractures;  Aged;  Multidisciplinary;  Complications
DOI:
10.3877/cma.j.issn.2096-0263.2022.05.007
文献标志码:
A
摘要:
目的 评价新型冠状病毒肺炎疫情前后多学科协作模式治疗老年髋部骨折的效果，探索常态化疫情防控形势下进一步完善临床诊疗路径的突破点。方法 回顾性收集自2019年1月至2020年12月间北京积水潭医院老年创伤骨科以多学科协作模式治疗的老年髋部骨折患者的相关信息进行分析比较，包括年龄、性别、骨折类型、美国麻醉医师协会（ASA）评分、手术治疗率、受伤至急诊时间、急诊至入院时间、入院至手术时间、入院48 h内手术率、住院时间、围手术期并发症发生率及院内死亡率等。结果 本研究共纳入老年髋部骨折患者2 275例，平均年龄79.7岁（65～105岁）；男性663例（29.1%），女性1 612例（70.9%）；股骨颈骨折1 219例（53.6%），股骨粗隆间骨折1 016例（44.7%），股骨粗隆下骨折40例（1.8%）；ASA评分高分级占比49.6%；手术治疗率为97.7%；院内死亡率为0.2%（4例）。相较于2019年，2020年所收治患者受伤至急诊平均时间明显延长（1.7 d VS. 3.4 d，P=0.000），急诊至入院平均时间无明显变化（23.4 h VS. 24.0 h，P=0.109），入院至手术平均时间略有增长（30.7 h VS. 38.3 h，P=0.000），入院48 h内手术率有所下降（82.1% VS. 72.4%，P=0.000），平均住院时间略有延长（4.1 d VS. 4.3 d，P=0.005）；围手术期并发症发生率明显增加（16.9% VS. 22.5%，P=0.001），主要体现在压疮、肺部感染及泌尿系感染的发生率明显上升。结论 基于多学科协作的老年髋部骨折“绿色通道”诊疗模式院内死亡率极低；有效地缩短术前等待时间，可能降低围手术期并发症发生率。
Abstract:
Objective This research aims to evaluate the efficacy of multidisciplinary care model in the management of geriatric hip fractures before and after COVID-19 pandemic and explore the breakthrough of the clinical pathway optimization in the situation of routine epidemic prevention and control. Methods The elderly patients with hip fracture treated with a multidisciplinary approach in the Department of Geriatric Orthopaedics and Traumatology of Beijing Jishuitan Hospital from January 2019 to December 2020 were included. The clinical data including age, gender, fracture type, ASA score, surgical treatment rate, time from injury to emergency, time from emergency to admission, time from admission to operation, operation rate within 48 hours of admission, length of stay, incidence of perioperative complications and in-hospital mortality were collected retrospectively and analyzed. Results A total of 2275 elderly patients with hip fracture were enrolled, in which 663 males (29.1%) and 1612 females (70.9%). The average age was 79.7 y (65-105 y). There were 1219 cases of femoral neck fracture (53.6%), 1016 cases of trochanteric fracture (44.7%), and 40 cases of subtrochanteric fracture (1.8%). High ASA score accounted for 49.6%. The surgical treatment rate was 97.7%. The in-hospital mortality rate was 0.2% (4 cases). Compared with 2019, in 2020, the average time from injury to emergency was significantly longer (1.7 d VS. 3.4 d, P=0.000); the average time from emergency to admission was unchanged (23.4 h VS. 24.0 h, P=0.109); the average time from admission to operation increased slightly (30.7 h VS. 38.3 h, P=0.000); the operation rate within 48 hours of admission decreased (82.1% VS. 72.4%, P=0.000); the average length of stay was slightly longer (4.1 d VS. 4.3 d, P=0.005); the incidence of perioperative complications increased significantly (16.9% VS. 22.5%, P=0.001), mainly reflected in the increased incidence of bedsore, pneumonia and urinary tract infection. Conclusions "Green Pathway" with a multidisciplinary approach is efficient in the management of geriatric hip fractures with an extremely low in-hospital mortality. Effective shortening the waiting time before operation might reduce the incidence of perioperative complications.

相似文献/References:

[1]沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林.锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析[J].中华老年骨科与康复电子杂志,2015,(02):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
　Shen Pengcheng,Zhu Lifan,Jiang Fugui,et al.Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
[2]刘文宣　张宇宸　刘文聪　高霞　李涛　张晓琳.CTR 基因多态性与老年男性骨质疏松的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
　Liu Wenxuan,Zhang Yuchen,Liu Wencong,et al.Association between calcitonin receptor gene polymorphism and osteoporosis in elderly men[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
[3]董仁卫　郭琪　王家仲　王连成.老年人群肌力水平与心血管疾病 三大危险因素的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
　Dong Renwei,Guo Qi,Wang Jiazhong,et al.The association between muscle strength level and three major risk factors of cardiovascular disease in elderly population[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
[4]李森磊,孙立,杨先腾,等.老年髋关节置换术后认知功能障碍的危险因素分析[J].中华老年骨科与康复电子杂志,2016,(02):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
　Li Senlei,Sun Li,Yang Xianteng,et al.Risk factors analysis for postoperative cognitive dysfunction in 　elderly patients undergoing hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
[5]钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J].中华老年骨科与康复电子杂志,2016,(02):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
　Zhong Junqing,Wang Liancheng..Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
[6]赵德伟,马志杰,杨磊,等.多孔钽金属涂层髋关节假体置换治疗老年股骨颈骨折的临床疗效观察[J].中华老年骨科与康复电子杂志,2016,(02):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
　Zhao Dewei,Ma Zhijie,Yang Lei,et al.Clinical investigation of hip implants by using porous tantalum coating in the treatment of elderly femoral neck fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
[7]吴啸波,裴宝瑞.老年髋部骨折围手术期相关问题的研究进展[J].中华老年骨科与康复电子杂志,2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
　Wu Xiaobo,Pei Baorui..Perioperative related problems of surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
[8]宋会平,张柳.阿仑膦酸钠治疗老年女性严重骨质疏松症患者的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
　Song Huiping,Zhang Liu.Effcacy analysis of alendronate in the treatment of severe osteoporosis in senile women[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
[9]柴仪,田伟明,温志刚.经皮椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
　Chai Yi,Tian Weiming,Wen Zhigang.Curative effective analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fracture in senile patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
[10]陈旭光,张天燕,单新１,等.围术期抑郁对老年骨科手术患者单核细胞组织因子表达及血小板功能的影响[J].中华老年骨科与康复电子杂志,2016,(03):155.[doi:10.3877//cma.j.issn2096-2063.2016.03.006]
　Chen Xuguang,Zhang Tianyan,Shan Xin,et al.Effect of depressive disorder on tissue factor expression of monocytes and platelet function in elderly patients undergoing orthopaedic surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):155.[doi:10.3877//cma.j.issn2096-2063.2016.03.006]

备注/Memo

备注/Memo:
基金项目：北京市医院管理中心“青苗”计划（QML20190402）；北京积水潭医院“学科骨干”培养计划（XKGG201808）
更新日期/Last Update: 2022-10-31