大腿骨頚部骨折クリニカルパスの改訂

Revision of the Clinical Pathway for Treatment of Femoral Neck Fractures

　退院時の臨床アウトカム別に適応を決める大腿骨頚部骨折治療のクリニカルパスを作成した．クリニカルパスの構成は入院から手術後2日目までのユニットと，手術後3日目から退院までのユニットを組み合わせる方式とした．術後ユニットは，退院時のアウトカム別に作成した．適応基準には，受傷前の日常生活動作の評価方法であるBarthel Index（B. I.）を採用した．B. I. 85点以上は，入院期間の制約のない亜急性期病床で後療法を行い，自宅退院を目標とした．B. I. 85点未満は術後3週での転院を目標にした．

　A clinical pathway for the treatment of femoral neck fracture was developed for determining indications based on clinical outcomes at discharge. The clinical pathway consisted of a combination of two units：one was the unit from hospitalization to Day 2 after surgery, the other that from Day 3 after surgery to discharge. The postoperative unit was prepared based on outcomes at discharge. The Barthel Index (BI), a method for evaluating activities of daily living before patients had their fractures, was used as a criterion for determining indications. Those with a BI score of 85 points or higher were treated with rehabilitation intended for discharging them to their homes, with no restriction on the hospitalization period, while those with a BI score of less than 85 points received treatment intended for transferring them to other hospitals 3 weeks postoperatively.