罹患髋部骨折 1 年,死亡风险约为 30%,[85]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com[86]Fredman L, Hawkes WG, Black S, et al. Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. J Am Geriatr Soc. 2006 Jul;54(7):1074-81.http://www.ncbi.nlm.nih.gov/pubmed/16866678?tool=bestpractice.com 25%~75% 的社区居住成人可能不会恢复其骨折前的功能水平。[87]Thorngren KG. Fractures in the elderly. Acta Orthop Scand Suppl. 1995 Oct;266:208-10.http://www.ncbi.nlm.nih.gov/pubmed/8553854?tool=bestpractice.com[88]Thorngren KG. Fractures in older persons. Disabil Rehabil. 1994 Jul-Sep;16(3):119-26.http://www.ncbi.nlm.nih.gov/pubmed/7919395?tool=bestpractice.com[89]Borgquist L, Ceder L, Thorngren KG. Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand. 1990 Oct;61(5):404-10.http://www.ncbi.nlm.nih.gov/pubmed/2239162?tool=bestpractice.com[90]Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Am Geriatr Soc. 1992 Sep;40(9):861-6.http://www.ncbi.nlm.nih.gov/pubmed/1512379?tool=bestpractice.com 死亡预测因素包括显著共病、损伤前认知功能较低、术前 ECG 异常、年龄大于 85 岁及骨折前活动性下降。[91]Marottoli RA, Berkman LF, Leo-Summers L, et al. Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE (Established Populations for Epidemiologic Studies of the Elderly) cohort. Am J Public Health. 1994 Nov;84(11):1807-12.http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.11.1807http://www.ncbi.nlm.nih.gov/pubmed/7977922?tool=bestpractice.com[92]Smith T, Pelpola K, Ball M, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014 Jul;43(4):464-71.https://academic.oup.com/ageing/article/43/4/464/2812257/Pre-operative-indicators-for-mortality-followinghttp://www.ncbi.nlm.nih.gov/pubmed/24895018?tool=bestpractice.com
研究显示,48 小时以内进行手术是有益的。[41]Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046175http://www.ncbi.nlm.nih.gov/pubmed/23056256?tool=bestpractice.com 健康状况良好且与他人一起生活的,具有阳性影响的患者预后较好,会产生良好的治疗效果。[85]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com[89]Borgquist L, Ceder L, Thorngren KG. Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand. 1990 Oct;61(5):404-10.http://www.ncbi.nlm.nih.gov/pubmed/2239162?tool=bestpractice.com 年老和住院时间增加导致治疗效果更差,无法恢复到骨折前的功能状态。[85]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com 一些研究已对髋部骨折老年人患者在手术治疗后使用合成类固醇进行了评估;然而,类固醇在康复方面的功效依然具有不确定性。[93]Farooqi V, van den Berg ME, Cameron ID, et al. Anabolic steroids for rehabilitation after hip fracture in older people. Cochrane Database Syst Rev. 2014 Oct 6;(10):CD008887.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008887.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25284341?tool=bestpractice.com 住院时咨询老年病学专家可能有助于降低入院期间谵妄发病率,但是出院后是否继续有效尚不清楚。[94]Siddiqi N, Harrison JK, Clegg A, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016 Mar 11;3:CD005563.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005563.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26967259?tool=bestpractice.com 有证据表明,针对高龄骨科患者展开医学合作可降低患者接受髋部骨折修复术后的死亡率。[76]Prestmo A, Hagen G, Sletvold O, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015 Apr 25;385(9978):1623-33.http://www.ncbi.nlm.nih.gov/pubmed/25662415?tool=bestpractice.com[95]Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014 Mar;28(3):e49-55.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909556/http://www.ncbi.nlm.nih.gov/pubmed/23912859?tool=bestpractice.com