台灣老年髖骨骨折病患特色分析以及術後住院期間復健治療之使用狀況

The Characteristics of Elderly Hip Fracture Patients and Rehabilitation Utilization after Hip Fracture Surgery during Admission in Taiwan

徐子雯(Tzu-Wen Hsu) ； 林彣芷(Wen-Chih Lin) ； 何宗翰(Chung-Han Ho) ； 何啟傑(Ci-Jie Ho) ； 蕭珮琦(Pei-Chi Hsiao) ； 董莉貞(Li-Chen Tung) ； 周偉倪(Willy Chou)

《台灣復健醫學雜誌》 42卷1期 (2014/03) Pp. 63-68

https://doi.org/10.6315/2014.42(1)07

摘要

研究目的：髖骨骨折是老人跌倒後常見的臨床醫療問題。骨折術後的併發症會與病人的共病症多寡有關，又併發症的發生也會增加病人日後再入院的機率上升。本篇研究的目的，是希望分析台灣地區老年髖骨骨折病患的特色以及在接受術後住院期間復健的使用率情形，並討論此族群病人的共病狀況，希望能提供臨床醫師為此族群病患安排復健或其他治療時可做為參考依據。研究方法：收集於2000年到2009年台灣健保資料庫，針對65歲以上發生髖骨骨折病友接受手術的病患共146405位，其中48146位在術後於住院期間接受復健治療介入，並定義其為復健介入組，對照組則為術後無復健治療介入（n = 98259），分析這兩組間的年齡、性別、骨折型態、手術方式以及疾病共病情形。結果：在65歲以上發生髖骨骨折的老人中，性別以女性為多（61.6%），年齡又以75到85歲患者最多，骨折形式則以轉子間骨折（intertrochanteric fracture type）最多（50.23%），但以股骨頸骨折病患族群在術後接受住院期間復健組的比例較對照組高（51.99% vs. 49.12%，p ＜ 0.0001）。術式部分則是大部分以內固定手術（internal fixation）為主（n = 89487），佔61.12%，然接受關節置換術（arthroplasty）患者會有較高比率在術後接受住院期間復健治療介入（43.72% vs. 38.13%，p ＜ 0.0001）。兩組間的察爾森共病指數（Charlson comorbidity index）平均值無顯著差異（1.22 ± 2.02 vs. 1.22 ± 2.07, p = 0.9859）。糖尿病，腦血管疾病以及慢性肺部疾病是較常見的共病疾病種類，其中又以併有糖尿病、鬱血性心衰竭、腦血管疾病、以及偏癱或截癱（hemiplegia or paraplegia）患者有較高比率在術後接受住院期間復健，反而慢性肺部疾病、周邊血管疾病以及失智症患者在術後接受住院期間復健的比率較低。結論：藉由本篇針對台灣地區65歲以上老年髖骨骨折病患特色分析，可了解75歲到85歲女性為多數。糖尿病，腦血管疾病以及慢性肺部疾病是較常見的共病疾病種類。會在術後接受住院期間復健多為接受關節置換術術式的患者、併有糖尿病、鬱血性心衰竭、腦血管疾病以及偏癱或截癱的患者。藉由此篇資料，可讓我們了解台灣地區老年髖骨骨折病人之特色以及那些族群會在術後有較高的住院期間復健使用率，提供臨床醫師為此族群病人安排復健治療之參考。

關鍵字

髖骨骨折 ； 老年病人 ； 術後復健

並列摘要

Purpose: Among elderly patients, hip fracture is a common clinical problem after falling. Associated complications after hip fracture surgery increase the risk of readmission. The purpose of this article is to analyze the characteristics of elderly hip fracture patients in Taiwan and rehabilitation utilization after hip surgery during admission. We also investigated the comorbidity of hip fracture. We hope to provide information to the clinician for further medical decision making. Materials and Methods: We analyzed patients older than 65 years who received hip fracture surgery from 2000 to 2009 (n = 146405) from the Taiwan’s National Health Insurance Research Database (NHIRD). We defined patients undergoing post-operative rehabilitation during admission as the intervention group (n = 48146) and those who did not receive interventions as the control group (n = 98259). We compared age, gender, fracture type, operation type and comorbidities between the groups. Results: In our study, most hip fracture patients older than 65 years were women (61.6%) and intertrochanteric fractures were the most common type (50.23%). The number of patients with femoral neck fracture in the intervention group is more than that in the control group (51.99% vs. 49.12%, p ＜ 0.0001). In addition, internal fixation surgery (n = 89487) was the main type of surgery (61.12%); post-operative rehabilitation rate during admission was higher among the patients with arthroplasty compared to the control group (43.72% vs. 38.13%, p＜0.0001). The intervention and control groups exhibited no difference in mean Charlson comorbidity index (CCI) (1.22 ± 2.02 vs. 1.22 ± 2.07, p = .9859). Diabetes mellitus, cerebrovascular disease and chronic pulmonary disease were the most common comorbidities. Among the intervention group, the patients who had diabetes mellitus, congestive heart failure, cerebrovascular disease, and hemiplegia or paraplegia were likely to undergo rehabilitation after hip fracture during admission. Patients with chronic pulmonary disease, peripheral vascular disease and dementia were less likely to receive post-operative rehabilitation during admission. Conclusion: Among elderly patients with hip fracture, most of them were females or aged 75 to 85 years. The most common comorbidities were diabetes mellitus, cerebrovascular disease, and chronic pulmonary disease. Patients with arthroplasty, diabetes mellitus, congestive heart failure, cerebrovascular disease, and hemiplegia or paraplegia were likely to undergo rehabilitation after hip fracture during admission. This study therefore can provide information in medical decision making to clinicians for understanding the characteristics of elderly hip fracture patients and utilization of postoperative rehabilitation services during admission in Taiwan.

並列關鍵字

hip fracture ； elderly patients ； post-operative rehabilitation