大腿骨近位部骨折高齢者の周術期における歩行再獲得に影響を及ぼす要因

Factors Associated with the Recovery of Walking Ability during the Perioperative Period in Older Adults with Proximal Femoral Fractures

抄録

　研究目的は，大腿骨近位部骨折（PFF）高齢者の周術期における歩行再獲得に影響を及ぼす要因について明らかにすることである．対象者は整形外科病棟4施設に入院した周術期にあるPFF高齢者45人とした．方法は，対象者の概要，入院経過，認知機能，生活機能，栄養状態のデータを診療録等や観察・聴取・測定により収集した．退院時の歩行状態で歩行再獲得群，訓練時歩行群，歩行不能群の3つに群別し，ほかの変数との関連の分析後，重回帰分析を行った．結果，歩行再獲得の影響要因として，NMスケール得点と術式（人工骨頭挿入術）（どちらもβ＝.403，p＜.001），エネルギー摂取量（β＝.382，p＝.001），入院時Alb値（β＝.268，p＝.010）が挙げられた（調整済み決定係数R²＝.580）．すなわち，周術期にあるPFF高齢者では，人工骨頭挿入術を受けた者で，認知症の重症度が軽度であるほど，さらに栄養状態はエネルギー摂取量が高く，入院時Alb値が高い者ほど，歩行を再獲得できていたことが示された．

　This study aimed to clarify factors that are associated with the recovery of walking ability during the perioperative period in older adults with proximal femoral fractures (PFF).

　Forty-five older adults with PFF were recruited from four orthopedic wards during the perioperative period. Data on characteristics of subjects, hospitalization, cognitive functions, life functions and nutritional status were collected using hospital records, observations, interviews with participants, and measurements. At the time of discharge, participants were classified into three categories (walking ability recovered, walking only during training, and non-walking). Multiple regression analysis was used to identify important factors.

　The result showed that the Nishimura Mental State Scale score and type of surgery (bipolar hip arthroplasty) (β=.403, p＜.001, respectively), energy intake (β=.382, p=.001), and albumin level at admission (β=.268, p=.010) were associated with recovery of walking ability (adjusted coefficient of determination R² =.580).

　These findings suggest that older adults with PFF with less severe dementia, higher energy intake, higher albumin level at admission, and those after bipolar hip arthroplasty were able to recover their ability to walk during the perioperative period.