Clinical Investigation And Risk Factors Of Fracture For Hemiplegia Patients Due To Cerebrovascular Diseases

Objective:The purpose of this study is to investigate clinical characteristics of cerebrovascular patients combined with hemiplegia and fracture in our country, and to know the risk factors which contribute to fracture, which may provide a basis for the development of targeted interventions to reduce the incidence of fractures for the cerebrovascular patients combine with hemiplegia, improve these patients’ quality of life, reducing the burden of their families and our society.Methods:We use Xuhui District Central Hospital CMIS case management system to collect cerebrovascular patients combined with hemiplegia and fracture reside in our rehabilitation department from January2009to December2012, excluding patients who have fracture before cerebrovascular disease or have dysfunction before cerebrovascular disease.65patients meet the above requirements, and we collected the patients’ clinical data of fracture (the time of fracture after hemiplegia, the place and cause of fracture, and fracture site), general state of health (age, sex, type of cerebrovascular, hemiplegia duration, complications, etc.), and hemiplegia states (hemiplegic, hemiplegic limb function, muscle tension, sitting orthostatic balance, walking ability, verbal cognitive impairment, and ankle varus). The retrospectively analysis was used to analyze these clinical data. We randomly selected66patients who were also have hemiplegia due to cerebrovascular diseases but don’t have fracture as a control group. The single-factor control analysis (chi-square test) was used to compare gender, age, the hemiplegia parts, hemiplegia type, comorbidities, limbs function between the two groups. P less than0.05was considered have statistical significance. We use hemiplegia patients with or without fracture as the dependent variable, significant factors (P less than0.05) analyzed before as independent variables, to stepwise undertake multivariate logistic regression analysis. Results:1. From January2009to December2012, the total number of hospitalizations for cerebrovascular disease in my hospital is4253cases, a total of65patients combined with hemiplegia and fractures. The incidence is1.53%. These65patients totally have80times of fracture.9patients have2times, and3patients have3times. All limb fractures are located in the hemiplegic side. Fracture site was mostly located in lower limb, with a rate of57.5%, followed by rib and vertebral fractures, with a rate of28.75%.The direct cause of fracture was fall down, the proportion was63.75%., the remaining mild external force and no obvious incentive to only contribute to18.75%.52patients have a fracture took place at home accounting for80%. Cerebrovascular patients with duration of4-12months have the highest incidence of fractures, accounting for35.38%, followed by cerebrovascular patients with duration greater than1year, accounting for33.85%.2. Compared with66cases of non-fracture patients, senior citizens, women with osteoporosis, paralysis of longer duration, ankle varus and hemiplegia lower limb Brounnstrom grading, standing balance may be a risk factor of fracture for patients with hemiplegia. There is no significant difference between the two group on hemiplegia site, high blood pressure, diabetes, heart disease, hyperlipidemia, Parkinson’s, mental disorders, upper limb and hand of Brounnstrom grading, sitting balance, the walk balance, with or without cognitive impairment, and speech disorder.3. Use hemiplegia patients with or without fracture as the dependent variable, meaningful factors (P less than0.05) analyzed before as independent variables, multivariate logistic stepwise regression analysis was peformed. The analysis revealed that the patient’s sex, age, hemiplegic lower extremity Brounnsrom rating, the ankle of the affected limb varus fractures, are an independent risk factor for fracture patients with hemiplegia due to cerebrovascular disease.Conclusions:1. Fractures of patients with hemiplegia mainly occurs in the hemiplegic side, including hemiplegic side femur, ribs, brachial, radial and vertebral which are also osteoporotic fractures predilection sites. Cerebrovascular patients at the stage of convalescence or sequelae are more susceptible to fracture. 2. advanced age, women, Brounnstrom grade of lower hemiplegia, and ankle varus are an independent risk factor of fracture for hemiplegia patients due to cerebrovascular diseases.