社區腦中風患者跌倒特徵與髖骨骨折相關性之研究

The Correlation of Fall Characteristics and Hip Fracture in Community-dwelling Stroke Patients

魏大森(Ta-Sen Wei) ； 劉鵬達(Peng-Ta Liu) ； 丁瑜瑄(Chen-Chen Liu) ； 劉真真(Yu-Shiuan Ding)

《台灣老年醫學暨老年學雜誌》 3卷2期 (2008/05) Pp. 130-140

https://doi.org/10.29461/TGG.200805.0006

摘要

目的：探討社區腦中風患者跌倒時特徵與髖骨骨折之相關性，以做爲日後預防策略之參考。
方法：某醫學中心住院之腦中風患者，出院後追蹤一年，定期調查有否發生跌倒與骨折，期間跌倒併髖骨骨折者界定爲「骨折」組，並配對有跌倒但無骨折者爲「無骨折」組。跌倒特徵的紀錄包括跌倒次數、發生地點、當時活動、自覺跌倒原因、跌倒時姿勢與方向、撞擊部位、有無扶持物與行走能力等。
結果：研究期間共收集99位腦中風患者發生跌倒，其中33位合併髖骨骨折。室內爲跌倒之好發生地點，走動時較易造成跌倒，「無力」是發生跌倒的主因，骨折多數發生於偏癱側(79%)。「骨折」組與「無骨折」組在跌倒時有顯著差異的特徵，是：「步行能力」（吃力或需助行器vs.獨立行走）、「跌倒時姿勢」（站姿轉位vs.坐姿轉位）、「最先接觸地面部位」（髖臀部vs.其它部位）、「髖部是否直接撞擊」，及「附近有否扶持物」，其危險比分別爲5.8，5.0，11.1，7.9與6.5。多變項迴歸分析發現三個影響跌倒合併髖骨骨折的危險因子，是「髖或臀直接受到撞擊」（校正後危險比[adjusted odds ratio, aOR]，10.6；95%信賴區間[confidence interval, CI]，2.8-39.9），「站姿轉位」(aOR, 10.7; 95% CI, 1.6-69.9)，及「附近無扶持物」(aOR, 7.3; 95% CI, 1.6-32.3)。
結論：腦中風患者肢體無力是發生跌倒的主要原因，髖臀部受到撞擊」、「站姿轉位」與「無扶持物」則是患者發生髖骨骨折之獨立危險因子。故對腦中風患者髖骨骨折之預防，給與一般居家安全教育與消除環境危險因素外，增加肌力強度與反射性保護之訓練也是重要目標。

關鍵字

腦中風 ； 意外跌倒 ； 髖骨骨折

並列摘要

Objectives: This study aimed to investigate the incidence of falls and hip fractures and their characteristics among community-dwelling elderly with stroke.
Methods: Patients admitted for stroke at a medical center were followed up after-discharge. During one year follow-up, patients who had falls and combined with hip fractures were grouped as ”fracture-group”. And those who had falls but no fracture were referred as ”no-fracture group”. The characteristics of falls were recorded, including frequency, location, posture, activity, ability of ambulation, any support, direction of falls, concussion of which body parts or direct impact.
Results: Ninety-nine patients with stroke were included in this study, and 33 had falls combined with hip fractures. Indoor (place), walking (activity) and weakness (self-precept reason) were most frequently reported by patients, and 79% of hip fractures were at their hemiparetic side. There were significant differences between the two groups as follows: functional ambulation (difficult or with assistive device vs. independently walk); pose (transfer during standing vs. during sitting); and site of contact (hip vs. other parts); the risk ratios were 5.8, 5.0, 11.1, 7.9 and 6.5, respectively. Multiple logistic regression analysis revealed three independent risk factors of hip fracture were hip suffered direct impact (adjusted odds ratio [aOR], 10.6; 95% confidence interval [CI], 2.8-39.9), transfer during standing (aOR, 10.7; 95%CI, 1.6-69.9), and no support (aOR, 7.3; 95%CI, 1.6-32.3).
Conclusion: Muscle weakness was the main reason for falls in stroke patients. Direct impact on hip, transferring upon standing, and falling without support were independent risk factors for hip fracture of falls. In addition to education of home safety and elimination of environmental hazards, strengthening and protective reflex training are crucial to prevent hip fracture in patients with stroke.

並列關鍵字

stroke ； falls ； hip fracture