老年髋部骨折围术期防急性骨丢失康复和护理△

Rehabilitation and nursing care for prevention of acute bone loss in perioperative period of hip fracture in elderly /

摘要:

[目的]探讨老年髋部骨折患者围术期预防急性骨丢失的临床护理效果。[方法]将 2022 年 7 月— 2023 年 6 月髋部骨折行髋关节置换的 95 例患者纳入本研究，采用随机数字表法分为防丢失组 47 例，常规组 48 例， 给予相应处理，比较两组临床及检验结果。[结果]两组患者均顺利手术。防丢失组首次下床时间 [(41.6±5.6) h vs (54.5±8.7) d, P＜0.001]、术后 3 d 最远行走距离 [(88.6±9.5) m vs (67.8±8.9) m, P＜0.001] 显著优于常规组。随时间推移，两组 VAS 评分、Harris 评分显著改善（P＜0.05），防丢失组术后 24 h VAS 评分 [(2.3±1.0) vs (3.0±1.2), P=0.004]、出院时 [(1.1±0.8) vs (2.4±1.1), P＜0.001] 显著优于常规组；防丢失组 Harris 评分出院时 [(60.4±6.8) vs (54.5±9.4), P＜0.001]、术后 4 周 [(76.6±4.7) vs (74.2±6.0), P 0.029]、术后 12 周 [(86.4±6.4) vs (81.8±5.8), P 0.001] 显著优于常规组。检验方面，与术前相比，两组患者术后 4、12 周骨钙素（bone gzlutamyl protein, BGP）、总 I 型胶原氨基端延长肽 （N-terminal propeptide of type I collagen, PINP） 和 I 型胶原羧基端肽 β 特殊序列 （Beta c-terminal cross-linked telopep- tides of type I collagen, β-CTX）的含量均显著增加（P＜0.05），术前两组上述检验指标的差异均无统计学意义（P＞0.05），术后 4、 12 周防丢失组 BGP、PINP 显著高于常规组（P＜0.05），而 β-CTX 显著低于常规组（P＜0.05）。[结论]预防急性骨丢失护理可降低老年髋部骨折患者围术期急性骨丢失的发生，减轻术后疼痛，促进患者康复。

Abstract:

[Objective] To investigate the clinical outcome of rehabilitation and nursing care for prevention of acute bone loss in periop- erative period of hip fracture in the elderly. [Methods] A total of 95 patients who were undergoing hip arthroplasty (HA) for hip fracture from July 2022 to June 2023 were included in this study, and were divided into anti-loss group (47 cases) and routine group (48 cases) by random number table method. The corresponding rehabilitation and nursing care were given, and the clinical and blood test results of the two groups were compared. [Results] All patients in both groups had HA performed smoothly. The anti-loss group proved significantly superior to the routine group in terms of first time of getting out of bed [(41.6±5.6) h vs (54.5±8.7) h, P 0.001] and the maximum postoperative walking distance [(88.6±9.5) m vs (67.8±8.9) m, P 0.001]. The VAS and Harris scores of the two groups were significantly improved over time (P＜0.05). The anti-loss group was also significantly better than the routine group regarding to VAS score [(2.3±1.0) vs (3.0±1.2), P 0.004] 24 hours postoperatively, and [(1.1±0.8) vs (2.4±1.1), P＜0.001] at discharge, as well as Harris score [(60.4±6.8) vs (54.5±9.4), P＜0.001] at discharge, [(76.6±4.7) vs (74.2±6.0), P 0.029] 4 weeks after operation and [(86.4±6.4) vs (81.8±5.8), P 0.001] 12 weeks postoperatively. As for lab test, the bone gzlutamyl protein (BGP), N-terminal propeptide of type I collagen (PINP) and beta c-terminal cross-linked telopeptides of typeⅠ collagen (β-CTX) were significantly increased 4 and 12 weeks after operation compared with those preoperatively (P＜0.05). Although there were no significant differences in the above lab test items between the two groups before surgery (P＞0.05), the anti-loss group had significantly higher BGP and PINP, while significantly lower β-CTX than the routine group 4 and 12 weeks after surgery (P＜0.05). [Conclusion] The rehabilitation and nursing care for prevention of acute bone loss do reduce occurrence of perioperative acute bone loss, relieve postoperative pain and promote functional recovery in perioperative period of HA for hip fracture in elderly