兒童繪畫發展與臨床應用

Child Drawing Development and Clinical Practice

髖部骨折不僅造成病人活動受限、日常生活獨立性減低、喪失信心，甚至導致失能及死亡，而腦中風病人容易發生髖部骨折。本研究目的在探討不同腦中風類型(缺血性腦中風、非缺血性腦中風)病人發生髖部骨折的相關風險，採病例對照性研究，樣本來自2007年國家衛生研究院發行的全民健康保險研究資料庫，選擇第一次發生髖部骨折的住院病人877位為病例組，控制年齡、性別與影響骨質疏鬆的藥物(抗心律不整和毛地黃、雙磷酸鹽、利尿劑、荷爾蒙、β-阻斷劑、鈣通道阻斷劑、硝酸鹽、抗糖尿病藥物、類固醇)。依病例組性別及年齡層別1比5頻率匹配，選擇4,385位病人為對照組，研究對象總共5,262人。採SAS9.1統計套裝軟體，以次數、百分比、平均值及標準差呈現資料，邏輯式迴歸進行資料分析。結果顯示腦中風病人發生髖部骨折的勝算比為1.35；缺血性腦中風者更高。女性腦中風病人發生髖部骨折的風險高，71-80歲腦中風病人發生髖部骨折的風險高於18-70歲腦中風病人。本研究證實腦中風病人發生髖部骨折的風險高於沒有腦中風病人；建議腦中風病人需預防發生髖部骨折，定期監測骨質密度，加強預防跌倒及病理性骨質疏鬆的護理指導，更要鼓勵女性及年長腦中風病人適當曬太陽、步行及鈣質攝取。

Hip fractures after stroke are frequent; our goal was to estimate the risk of hip fractures after stroke. We used a case control study and analyzed 2007 data from the Taiwan National Health Insurance Research Database. Cases of hip fractures were identified according to the International Classification of Diseases, Ninth Edition, Clinical Modification. A total of 877 hip fractures and 4,385 nonhip fractures after stroke existed in the sampled data. Variables including gender, age, medications (i.e., thiazide diuretics, beta-blockers, calcium channel blockers, nitrates, antidiabetics, antiarrhythmics, bisphosphonates, hormones, and corticosteroids) were controlled for. Data were analyzed using descriptive statistics and logistic regression. The results indicated an increased risk of a hip fracture in patients who experienced a stroke at any time before the index date. Fracture risk was highest among patients who had experienced an ischemic stroke, female patients, and patients aged 71-80 years. This study determined that stroke is associated with a 1.35-fold increase in the risk of a hip fracture. Bone mineral density measurements, fall prevention programs, sunlight exposure, poststroke walking, and increased calcium intake may be necessary to reduce the occurrence of a hip fractures during and after stroke.