Mortalidade e Agravamento de Capacidade de Marcha em Doentes com Fraturas de Fragilidade da Extremidade Proximal do Fémur

Rui Prado Costa, Helena Tavares, Sara Ganhão, Francisca Aguiar

Resumo


Introdução: As fraturas de fragilidade da extremidade proximal do fémur (FFEPF) associam-se a significativa mortalidade e perda de autonomia. O objetivo deste trabalho consistiu na determinação dos fatores associados ao agravamento da capacidade de marcha seis meses pósfratura e a mortalidade no primeiro ano em doentes com FFEPF.

Métodos: Estudo retrospetivo de doentes admitidos num centro hospitalar terciário por FFEPF. Foram colhidos os dados a partir dos registos clínicos. Foi realizada análise comparativa de vários fatores relativamente ao agravamento da capacidade de marcha seis meses pós-fratura e a mortalidade no primeiro ano.

Resultados: Quinhentos vinte e dois doentes foram admitidos por FFEPF. Cerca de 49% dos doentes tiveram agravamento da marcha a seis meses relativamente ao estado pré-fratura. Pela análise do subgrupo de doentes que tiveram intervenção através da Rede Nacional de Cuidados Continuados (RNCCI), apenas 11% recuperaram o nível prévio de capacidade de marcha durante o internamento de Ortotraumatologia e 28% tiveram recuperação adicional na RNCCI. Das diferentes variáveis analisadas, não se encontrou associação significativa com o agravamento de marcha a seis meses. Dos doentes, 18% faleceram no primeiro ano pós-fratura. A ausência de marcha pré-fratura (p=0,094), a ausência de marcha pósfratura a seis meses (p=0,024), a fratura do colo do fémur (p=0,006) e cirurgia com artroplastia total e hemiartroplastia (p=0,047 e p=0,033 respetivamente) apresentaram curvas de sobrevivência significativamente inferiores. O modelo de regressão logística determinou que o género masculino (OR 2,95; p=0,033) e a ausência de capacidade de marcha a seis meses (OR 7,43; p=0,024) após a fratura foram preditores de mortalidade no primeiro ano.

Conclusão: A mortalidade no primeiro ano e o agravamento da capacidade de marcha, são consideráveis nos doentes com FFPEF. A gestão desses doentes deve priorizar a reabilitação integral, em fase precoce dado o seu possível impacto ao nível do prognóstico vital e funcional.


Palavras-chave


Idoso; Fratura de Anca/mortalidade; Fratura da Anca/reabilitação

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DOI: http://dx.doi.org/10.25759/spmfr.325

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Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação