術後床邊物理治療對脆弱性髖部再骨折的影響

The Impact of Post-Surgery Bedside Physical Therapy on Hip Refracture Following Fragility Femoral Fracture

降低高齡脆弱性髖部骨折病人的再骨折率，是重要議題。臺大醫浣物理治療中心（Physical Therapy Center, PTC）成立於2008年。在PTC成立之前，除了有明顯運動功能障礙，骨折病人在手術後，並未例行進行術後床邊物理治療（hip fracture without routine bed side physical therapy, HFnoPT）, PTC成立後開始推動例行術後床邊物理治療（hip fracture with routine bed side physical therapy, HFPT）。本研究採用病歷回溯的方式，追蹤2003年到2006年、與2009年到2012年期間，在臺大醫院因為首次發生脆弱性髖部骨折而接受手術的病例，分析這兩種照護模式對病人術後5年內發生髖部再骨折的影響。HFnoPT組計有1779名個案，其中有48名個案在5年追蹤期間，發生第2次脆弱性髖部骨折並再度接受手術，再骨折率為2.7%；手術後半年內、1年內與1年後再骨折的個案數分別為：19例、7例與22例。HFPT維計有1778名病例，其中有55名病例發生髖部再骨折，再骨折率為3.1%；再骨折發生在首次骨折手術後半年內、1年內與1年後的個案數分別為：9例、15例與31例。以卡方檢定分析手術後3個時段再骨折個案數，發現HFnoPT組在手術半年間發生再骨折個案比HFPT組多，且達統計意義（=0.023）。本研究顯示脆弱性髖部骨折術後接受術後床邊物理治療，有效降低手術後半年發生髖部再骨折事件，可支持髖部骨折手術後病房床邊物理治療介入的重要性。

Reducing refracture among elderly patients with fragility hip fractures is a critical issue. The Physical Therapy Center (PTC) at National Taiwan University Hospital was established in 2008. Prior to its establishment, postoperative bedside physical therapy was not routinely administered to hip fracture patients (HFnoPT), except in cases of significant motor function impairment. Following the inception of PTC, postoperative bedside physical therapy became routine practice (HFPT). This study employed a retrospective chart review to track fragility hip fracture cases at National Taiwan University Hospital from 2003 to 2006 and from 2009 to 2012. This study aimed to analyze the impact of these two care models on the incidence of fragility hip re-fracture within 5 years postsurgery in patients with fragility hip fractures. The HFnoPT group included 1,779 cases, of which 48 experienced hip surgery due to fragility refractures within the five-year follow-up period, resulting in a refracture rate of 2.7%. Among these refracture events, 19 cases occurred within 6 months, 7 within the first year, and 22 after 1 year. The HFPT group comprised 1,778 cases, with 55 patients experiencing hip refractures, yielding a refracture rate of 3.1%. Cases of refracture occurred as follows: 9 within 6 months, 15 within the first year, and 31 after 1 year. A chi-square test analyzing refracture incidences across the three postoperative intervals revealed a significantly higher hip refracture occurrence in the HFnoPT group within the first 6 months compared to the HFPT group (p=0.023). This study revealed that postoperative bedside physical therapy significantly reduces the incidence of hip refractures within the first 6 months post-surgery for patients with fragility hip fractures. This study showed evidence to reinforce the importance of the post-operation bed side physical therapy for patient with fragility hip fractures.