多学科综合治疗对老年髋部骨折预后的影响

摘要

目的 本文旨在探究多学科综合治疗(multidisciplinary team,MDT)模式对老年髋部骨折手术预后的影响.方法 将40例>65岁髋部骨折病人分为照组(n=18)和MDT组(n=22).对照组术后采用传统治疗模式,MDT组术后采用MDT模式,分别在手术当天(D0)、术后第1天(D1)、第3天(D3)以及第7天(D7)早晨采用简易智能精神状态评价量表(mini mental state examination,MMSE)评估各组病人术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率,并测定病人血浆中C反应蛋白(C-reactive protein,CRP)浓度.同时采用自拟量表对所有病人治疗前、后肢体功能恢复情况进行评估,比较2组治疗效果及治疗后肢体功能差异.结果MDT组病人MMSE评分在术后第1天和第3天均显著高于对照组(P<0.05),而手术当天和术后第7天2组病人的MMSE评分差异无统计学意义(P>0.05).MDT组病人术后第1天、第3天的POCD发生率以及POCD总发生率均显著低于对照组(P<0.05),同时MDT组病人术后第1天、第3天的CRP浓度与对照组相比显著降低(P<0.05);MDT组治疗后骨折愈合时间、下床活动时间、疼痛缓解时间、住院时间较对照组缩短(P<0.01),MDT组治疗后疼痛评分、活动度、稳定性及行走功能评分均高于对照组(P<0.05).结论 MDT可以明显提高老年髋部骨折治疗效果,改善老年髋部骨折的预后.%Objective To investigate the effect of multidisciplinary team ( MDT) on prognosis in elderly patients with hip fracture. Methods Forty elderly patients with hip fracture were randomly divided into MDT group ( n= 22 ) and control group ( n= 18 ) . Patients in control group received cnventional therapy, and patients in MDT group were treated with MDT. Mini mental state examination (MMSE) was evaluated at the operative day, 1 d (D1), 3 d (D3) and 7 d (D7) after operation, respectively. The incidence rate of postoperative cognitive dysfunction ( POCD ) was calculated. Meanwhile, blood samples were obtained for the determination of C-reactive protein ( CRP ) . Self-made questionnaire was used to evaluate the recovery of limb function in two groups before and after treatment. The treating effects and the limb function of the two groups were compared. Results Compared to control group, MDT group had higher MMSE scores on D1 and D3 (P<0. 05). The incidence rate of POCD of MDT group was significant lower than that of control group ( P<0. 05) , and the plasma level of CRP was significantly decreased in MDT group after operation (P<0. 05). The fracture healing time, ambulation time, pain relief time, hospitalization time in MDT group were shorter than those in control group ( P<0. 01) . The scores of pain, activity, stability and walking function of MDT group were higher than those of control group ( P<0. 05 ) . Conclusions MDT treatment in elderly patients with hip fracture can improve the therapeutic effect, and improve the prognosis of hip fracture.