本文關鍵詞： 髖部骨折 綠色通道 相關因素 功能恢復　出處：《河北醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:研究影響老年髖部骨折患者術后功能恢復的相關因素,為臨床工作中治療老年髖部骨折提高其術后功能恢復提供相關資料,同時為提高其遠期生存質量、生存率提供相關意見。方法:回顧性分析2005年3月至2015年1月之間在我院住院治療的435例老年髖部骨折術后患者臨床資料,其中305例隨訪成功并納入研究,對老年髖部骨折患者術后功能恢復的相關因素進行分析,其中涵蓋年齡、性別、傷前基礎病、骨折類型、手術的時機、術后并發(fā)癥等因素。采用SPSS16.0軟件數(shù)據(jù),分別采用?2檢驗或校正的?2檢驗、秩和檢驗的統(tǒng)計學分析,以P0.05為差異有顯著性,先進行單因素分析,剔除無統(tǒng)計學意義的變量,再對結果中存在統(tǒng)計學意義的變量再次進行多因素logistic回歸分析,判斷該因素是否為影響老年髖部骨折術后功能恢復的獨立因素。結果:采用統(tǒng)計學分析,患者的年齡、性別、骨折類型對于老年髖部骨折患者術后功能恢復非危險因素,而傷前基礎病、手術時機、術后并發(fā)癥三種因素對于老年髖部骨折患者術后功能恢復有較明顯影響(P0.05),其術后功能恢復相對越差。經(jīng)過多因素二分類Logistic回歸分析則發(fā)現(xiàn)患者的傷前基礎病是老年髖部骨折患者術后功能恢復的獨立因素,老年髖部骨折患者傷前基礎病種類越多,嚴重性越大的患者,術后功能恢復相對越差。結論:1臨床工作當中要高度重視對于傷前基礎病的治療及評估,經(jīng)討論發(fā)現(xiàn)傷前基礎病中心腦血管疾病又做為其首要影響因素直接影響其術后功能恢復程度。2年齡并不是決定髖部骨折術后功能恢復的最主要因素,不應因單純的高齡來遷延或放棄手術治療。3老年髖部骨折患者進行手術的時機選擇上應因人而異。4骨折的嚴重程度在一定程度上影響了術后功能恢復,臨床工作當中應重視骨折分型詳細評估骨質質量來指導手術方案及內固定材料的選擇。5骨折復位良好與否在髖部骨折治療過程中有至關重要的作用,因而術中應盡量解剖復位。6術后護理及康復鍛煉也應予以充分的重視,密切關注圍手術期并發(fā)癥和手術相關并發(fā)癥,一旦出現(xiàn),應當及時處理。7隨著我國人口老齡化進程的不斷加快,建議遠期在基層醫(yī)院能夠普及建立“老年髖部骨折綠色通道模式治療病房”,為降低術后病死率及提高術后功能恢復程度提供積極意義。
[Abstract]:Objective: to study the related factors affecting the postoperative functional recovery of elderly hip fracture patients, and to provide relevant data for the treatment of elderly hip fractures and improve their long-term quality of life. Methods: the clinical data of 435 elderly patients with hip fracture who were hospitalized in our hospital between March 2005 and January 2015 were analyzed retrospectively. 305 of them were followed up successfully and included in the study. The related factors of postoperative functional recovery in elderly patients with hip fracture were analyzed, including age, sex, pretraumatic basic disease, fracture type, timing of operation, postoperative complications and so on. (2) checked or corrected? 2 the statistical analysis of test, rank sum test, taking P0.05 as the significant difference, first carries on the single factor analysis, removes the variable which has no statistical significance, then carries on the multivariate logistic regression analysis again to the variable which has the statistical significance in the result. Results: using statistical analysis, age, sex and type of fracture were used as non-risk factors for functional recovery in elderly patients with hip fracture. And the basic diseases before injury, the timing of surgery, Three factors of postoperative complications have significant influence on postoperative functional recovery in elderly patients with hip fracture, and the worse the postoperative functional recovery is, the worse the postoperative functional recovery is. After multivariate two-classification Logistic regression analysis, it is found that the patients with pretraumatic basic diseases are old. Independent factors of postoperative functional recovery in hip fracture patients, In elderly patients with hip fracture, the more kinds of basic diseases before injury and the greater the severity, the worse the functional recovery after operation. Conclusion in the clinical work of 1 / 1, we should attach great importance to the treatment and evaluation of pretraumatic basic diseases. After discussion, it was found that cardio-cerebrovascular disease in pretraumatic basic diseases was not the most important factor to determine the functional recovery after hip fracture, as the primary influencing factor, the degree of functional recovery was not directly affected by the age of .2 years. The timing of operation for elderly hip fracture patients should not be delayed or abandoned because of simple old age. The severity of the fracture of .4 should be different from person to person, and the recovery of postoperative function should be affected to a certain extent. In clinical work, attention should be paid to the detailed evaluation of bone quality by fracture classification to guide the selection of surgical schemes and internal fixation materials. The reduction of 5 fractures is of vital importance in the treatment of hip fractures. Therefore, we should pay more attention to the nursing care and rehabilitation exercise after anatomic reduction as much as possible, pay close attention to the perioperative complications and operative related complications, once they appear, As the ageing process of our population continues to accelerate, it should be addressed in a timely manner, It is suggested that the establishment of "Green Channel treatment Ward for Old Hip fracture" can be popularized in grass-roots hospitals in the long term, which provides a positive significance for reducing the postoperative mortality and improving the degree of postoperative functional recovery.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R687.3

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