骨折聯合照護服務在髖部骨折病人成功經驗：有效的減少死亡率

The Success of Fracture Liaison Service in Hip Fracture: Effective in Reducing Mortality

林松彥(Sung-Yen Lin) ； 楊榮森(Rong-Sen Yang) ； 林高田(Gau-Tyan Lin) ； 何承融(Cheng-Jung Ho) ； 呂衍謀(Yen-Mou Lu) ； 黃炫迪(Hsuan-Ti Huang) ； 方姿蓉(Tzu-Jung Fang) ； 徐逸芬(Yi-Fen Hsu) ； 陳晏緹(Yan-Ti Chen) ； 陳崇桓(Chung-Hwan Chen)

《台灣醫學》 22卷2期 (2018/03) Pp. 168-173

https://doi.org/10.6320/FJM.201803_22(2).0008

摘要

随著人口愈來愈老化，骨質疏鬆症也已成為全球第二大流行病。台灣的髖部骨折世界第九，甚至高居亞洲最高。骨折發生頻率最高的是脊椎、腕部和髖部。過去的研究，髖部骨折住院死亡率高達9.5%，一年死亡率曾經被報導高達36%。髖部骨折後再骨折風險增加，約有50%患者會經歷二次骨折。聘用專案協調員，將骨科團隊、骨質疏鬆症和跌倒醫療服務作業、患者的第一線醫師聯繫起來，也就是「骨折聯合照護服務」(fracture liaison service，FLS)。可被用於閉合全球眾多醫療保健體系在繼發性骨折預防醫療照護上的缺口。高雄醫學大學附設醫院的骨折聯合照護服務(FLS)，由骨科部，內科部老年醫學科的專家，與個管師配合，從病房進行髖部骨折病人骨折聯合照護服務(FLS)的相關評估與治療。在高雄醫學大學附設醫院追蹤的136個髖部骨折的病人中，一年的死亡率為2.9%。在高雄市立大同醫院（委託高醫經營）追蹤的76個髖部骨折的病人中，一年的死亡率為2.6%，整體而言，骨折聯合照護服務(FLS)實施之後，一年的死亡率為2.8%。要減少髖部骨折病人的死亡率，最重要還是治療共病。住院期間將共病控制好，出院後，可以利用各管師追蹤病人骨質疏鬆治療時，也要關心病人共病的狀況，督促病人治療並控制其共病是主要的成功因素。

關鍵字

共病 ； 骨折聯合照護服務 ； 髖部骨折 ； 死亡率 ； 骨質疏鬆症

並列摘要

With the aging of population, osteoporosis becomes the 2^(nd) prevalent disease in the world. The incidence of hip fracture in Taiwan is highest in Asia and 9^(th) in the world. Osteoporotic fractures usually occur in spine, wrist and hip. Previous studies revealed high mortality rate during hospitalization in hip fracture as high as 9.5% and 36% one year mortality. The risk of re-fracture increases after the first hip fracture and about half of the patients with hip fracture will have re-fracture in the hip. Fracture Liaison Services, commonly known as FLS, are coordinator-based, secondary fracture prevention services implemented by health care systems for the treatment of osteoporotic patients. The FLS is designed to close the care gap for fracture patients, 80% of whom are currently never offered screening and/or treatment for osteoporosis. The FLS in Kaohsiung Medical University Hospital is run by coordinator and the specialists from Orthopedic department and Geriatric department. We screened all patients with hip fracture admitted in Orthopedic department for FLS. In 136 patients in Kaohsiung Medical University Hospital, the one year mortality rate is 2.9%. In 76 patients in Kaohsiung Municipal Ta-Tung Hospital, the one year mortality rate is 2.6%. Overall, one year mortality is 2.8% after FLS. The most important part to reduce mortality is to treat co-morbidities. Controlling co-morbidities during hospitalization and urging patients to receive treatment of co-morbidities in addition to their treatment of osteoporosis contacted by coordinator is the key to reduce mortality.

並列關鍵字

co-morbidity ； Fracture Liaison Services (FLS) ； hip fracture ； mortality ； osteoporosis

參考文獻

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