Objective: To observe the clinical application of multidisciplinary team (MDT) treatment in the management of geriatric hip fractures and evaluate its effectiveness.
Methods: The clinical data of 76 elderly patients with hip fracture managed by MDT approach between August 2016 and February 2018 (MDT group) were retrospectively analyzed and compared with 102 patients managed by traditional orthopedics approach between January 2014 and December 2015 (conventional group). There was no significant difference in gender, age, fracture type, surgical procedure, and other general data between the two groups ( P>0.05). However, the number of comorbidities in the MDT group was significantly higher than that in the conventional group ( t=6.295, P=0.000), and the proportion of the number of comorbidities between the two groups was also significantly different ( χ 2=28.442, P=0.000). The consultation rate and transfer rate, time to surgery, rate of surgery within 2 or 3 days, operation time, postoperative hospitalization stay, length of hospitalization stay, hospitalization expense, rate of loss to follow-up, and mortality during hospitalization, 30-day mortality, 90-day mortality, and 1-year mortality after operation were compared between the two groups.
Results: The rates of total consultations of the conventional group and the MDT group were 56.86% (58/102) and 56.58% (43/76), respectively, and the rates of total transferred patients were 15.69% (16/102) and 15.79% (12/76), respectively, with no significant differences ( P>0.05). Among them, the proportion of patients who transferred into intensive care unit (ICU) in conventional group was significantly higher than that in MDT group and the rates of patients who received geriatric consultation or transferred into geriatric department in MDT group were both significantly higher than those in conventional group ( P<0.05). There was no significant difference in rates of other department consultation or transfer between the two groups ( P>0.05). The time to surgery, operation time, postoperative hospitalization stay, and length of hospitalization stay in MDT group were significantly less than those in conventional group, but the proportion of patients who received surgery within 3 days in MDT group was significantly higher than that in conventional group ( P<0.05). There was no significant difference in the proportion of patients who received surgery within 2 days ( χ 2=2.027, P=0.155). The hospitalization expenses of total patients, femoral neck fracture, and intertrochanteric fracture subgroups in MDT group were all significantly higher than those in conventional group ( P<0.05). However, there was no significant difference in hospitalization expense of subtrochanteric fracture subgroup between the two groups ( Z=-1.715, P=0.086). The rate of loss to follow-up in conventional group and MDT group was 6.86% (7/102) and 3.95% (3/76), respectively, with no significant difference ( χ 2=0.698, P=0.403). The mortalities at hospitalization, 1 month, 3 months, and 1 year after operation in conventional group were 0, 1.05% (1/95), 3.16% (3/95), and 7.37% (7/95), respectively, and in MDT group were 0, 0, 2.74% (2/73), 6.85% (5/73), respectively, showing no significant differences in mortalities between the two groups ( P>0.05).
Conclusion: MDT model in the management of geriatric hip fractures has been shown to reduce time to surgery, postoperative hospitalization stay, length of hospitalization stay, operation time, and the proportion of patients who received ICU consultation or transferred into ICU. Furthermore, MDT can improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.
目的: 观察多学科协作诊疗（multidisciplinary team，MDT）在老年髋部骨折治疗中应用的临床疗效。.
方法: 回顾分析 2016 年 8 月—2018 年 2 月采用 MDT 模式管理的 76 例老年髋部骨折患者临床资料（MDT 组），并与 2014 年 1 月—2015 年 12 月采用骨科传统模式管理的 102 例患者资料（传统组）进行比较。两组患者性别、年龄及年龄构成、骨折类型以及手术方式等一般资料比较差异无统计学意义（ P>0.05）；但 MDT 组患者合并症数目显著高于传统组（ t=6.295， P=0.000），且两组不同合并症数目的比例比较差异亦有统计学意义（ χ 2=28.442， P=0.000）。比较两组患者会诊率与转科率、术前等待时间、2 d 和 3 d 内手术率、手术时间、术后住院时间、总住院时间、住院费用、失访率及住院期间、术后 1 个月、3 个月、1 年死亡率。.
结果: 传统组和 MDT 组患者围术期接受的总会诊率分别为 56.86%（58/102）和 56.58%（43/76），总转科率分别为 15.69%（16/102）和 15.79%（12/76），差异均无统计学意义（ P>0.05）。其中传统组重症医学科（intensive care unit，ICU）转科率显著高于 MDT 组，MDT 组老年科会诊率和转科率显著高于传统组，差异均有统计学意义（ P<0.05）；两组其他科室会诊率和转科率比较差异无统计学意义（ P>0.05）。MDT 组术前等待时间、手术时间、术后住院时间及总住院时间均显著短于传统组，3 d 内手术率显著高于传统组，差异均有统计学意义（ P<0.05）；两组 2 d 内手术率比较差异无统计学意义（ χ 2=2.027， P=0.155）。MDT 组总住院费用、股骨颈骨折及转子间骨折住院费用均显著高于传统组，差异有统计学意义（ P<0.05），两组转子下骨折住院费用比较差异无统计学意义（ Z=−1.715， P=0.086）。传统组和 MDT 组失访率分别为 6.86%（7/102）和 3.95%（3/76），差异无统计学意义（ χ 2=0.698， P=0.403）。传统组患者住院期间、术后 1 个月、3 个月及 1 年死亡率分别为 0、1.05%（1/95）、3.16%（3/95）、7.37%（7/95），MDT 组分别为 0、0、2.74%（2/73）、6.85%（5/73），两组各时间点死亡率比较差异均无统计学意义（ P>0.05）。.
结论: 在老年髋部骨折治疗管理中实施 MDT 模式缩短了患者术前等待时间、手术时间、术后住院时间、总住院时间，降低了 ICU 转科率和会诊率，提高了接收病情复杂患者手术的能力，更合理地利用了医疗资源。.
Keywords: Multidisciplinary team; clinical application; geriatric hip fracture.