臺灣博碩士論文加值系統

中文摘要
由於國人壽命逐漸延長，而老年人口數目與比例亦逐年增加。除去一些慢性病的威脅外，事故傷害是老年人死亡的另一個重要的原因，老年人在事故傷害中，發生骨折的機率很高，而文獻指出骨折發生的情況又有城鄉差異。故本研究擬就台北市與花蓮縣，兩個城鄉差距大的地方，探討老人骨折的情形。研究資料取自健保資料庫，其目的在瞭解自健保開辦之後，台北市與花蓮縣自1996年1月至1997年10月間65歲以上因骨折住院的老年人之骨折外因、骨折部位、骨折類型、住院天數及住院後狀況；並比較之。研究重要結果如下:
1.台北市與花蓮縣老年骨折住院病患，有外因者所佔的比例不同，分別為41.7%及76%，且兩地主要外因也不同，台北市患者因跌倒墜落而骨折者較花蓮縣患者多；而花蓮縣患者因機動車交通事故而骨折者較台北市患者多。
2.台北市與花蓮縣老年骨折住院病患骨折部位雖均以為股骨頸骨折為多。但台北市股骨頸骨折患者比例較花蓮縣為多；而花蓮縣有顱骨骨折者之比例較台北市為多。
3.台北市與花蓮縣老年骨折住院患者骨折類型大多為單一骨折。而在不及8%的複合部位骨折者中以男性、年紀較輕者及機動車交通事故者居多。
4.台北市與花蓮縣老年骨折住院病患其住院後死亡者皆在2%以下。影響台北市患者死亡的危險因子為:男性、年紀較長者、顱骨骨折患者、股骨頸骨折患者及複合部位等；而影響花蓮縣患者死亡的危險因子卻不明顯。
關鍵詞: 老年人、骨折、住院

Abstract
The proportion of elderly people in our population is increasing. In addition to the threat of the chronic disease, injury is another major cause of death for elderly people. Elderly people are at high risk of fracture during the occurrence of injuries. Research article indicated that there are differences between the urban and the rural areas on the incidence of fracture. Since Taipei City and Hualien County are good representatives of urban and rural areas in Taiwan, the study was designed to compare between Taipei and Hualien on fracture locations, fracture types, length of stay and mortality among hospitalized fracture patients at age 65 or above. Data come from National Health Insurance Data base, covering 22 months from January 1996, to October 1997. The main findings are-
1. The percentages of fractures with external causes among were 47.1 in Taipei and 76 in Hualien. Among all external causes, the percentage of falls was higher in Taipei, whereas the percentage of motor vehicle accidents was higher in Hualien.
2. Hip fractures were the most frequently seen cases both in Taipei and Hualien. However, among all kinds of fractures the percentage of hip fractures was higher in Taipei, whereas the percentage of skull fracture was higher in Hualien.
3. Less than 8% of elderly fractures were compound fractures in both areas. Patients with compound fracture were mostly male, younger and injured by motor vehicle accidents.
4. Both in Taipei and Hualien mortality cases were counted for less than 2% among elderly fracture inpatients. Factors related to mortality of fracture inpatients identified from Taipei data were male, older age, skull fracture, hip fracture and compound fractures. There was no significant risk factor of fracture death identified from Hualien data.
Keywords: elderly people、fracture、hospitalization

目錄 頁次
第一章、 緒論
第一節 研究背景及重要性…………………………………….1
第二節 研究動機及目的……………………………………….3
第二章、 文獻探討
第一節 什麼是骨折…………………………………………….4
第二節 老年人發生骨折的人口學特性……………………….8
第三節 老年人發生骨折的相關因素及預後………………….12
第三章、 研究方法與步驟
第一節 名詞界定……………………………………………….18
第二節 探討問題、研究架構與假設………………………….21
第三節 研究步驟……………………………………………….24
第四節 資料之統計與分析…………………………………….26
第四章、 研究結果
第一節 台北市與花蓮縣老年骨折住院病患之概況…………..28
第二節 分別敘述台北市與花蓮縣老年骨折住院病患之
原因與類別……………………………………………..31
第三節 分別敘述台北市與花蓮縣老年骨折住院病患
其住院情況……………………………………………..39
第四節 影響台北市與花蓮縣老年骨折住院病患死亡之因素..45
第五章、 討論
第一節 台北市與花蓮縣老年骨折住院病患之差異…………..46
第二節 資料查核問題…………………………………………..54
第三節 研究限制………………………………………………..56
第六章、 結論與建議
第一節 結論……………………………………………………..57
第二節 建議……………………………………………………..60
第七章、 參考文獻……………………………………………………62
表目錄
表一：台北市與花蓮縣老年骨折住院病患且主要診斷為骨折者在各 變項之比較……………………………………………………69
表二：台北市與花蓮縣老年骨折住院病患且主要診斷為顱骨骨折者 其外因別之比較………………………………………………71
表三：台北市與花蓮縣老年骨折住院病患且主要診斷為肱骨骨折者其外因別之比較…………………………………………….…71
表四：台北市與花蓮縣老年骨折住院病患且主要診斷為橈骨及尺骨骨折者其外因別之比較………………………………………71
表五：台北市與花蓮縣老年骨折住院病患且主要診斷為股骨頸骨折者其外因別之比較……………………………………………72
表六：台北市與花蓮縣老年骨折住院病患且主要診斷為骨折之機動車交通事故者骨折部位之比較………………………………..73
表七：台北市與花蓮縣老年骨折住院病患且主要診斷為骨折之墜落者骨折部位之比較……………………………………………73
表八：台北市老年骨折住院病患且主要診斷為骨折者其外因別與其他變項之比較…………………………………………………74
表九：花蓮縣老年骨折住院病患且主要診斷為骨折者其外因別與其他變項之比較…………………………………………………75
表十：台北市老年骨折住院病患且主要診斷為骨折者其外因別與其他變項之比較………………………………………………….76
表十一：花蓮縣老年骨折住院病患且主要診斷為骨折者其外因別與其他變項之比較………………………………………………..77
表十二：台北市老年骨折住院病患且主要診斷為骨折者其骨折部位 與其他變項之比較…………………………………………..78
表十三：台北市老年骨折住院病患且主要診斷為骨折者其骨折部位 與其他變項之比較…………………………………………..79
表十四：花蓮縣老年骨折住院病患且主要診斷為骨折者其骨折部位與其他變項之比較…………………………………………..80
表十五：花蓮縣老年骨折住院病患且主要診斷為骨折者其骨折部位與其他變項之比較…………………………………………..81
表十六：台北市老年骨折住院病患且主要診斷為骨折者其骨折類型與其他變項之比較…………………………………………82
表十七：花蓮縣老年骨折住院病患且主要診斷為骨折者其骨折類型與其他變項之比較………………………………………….83
表十八：台北市老年骨折住院病患且主要診斷為骨折者其住院天數與其他變項之比較………………………………………….84
表十九：花蓮縣老年骨折住院病患且主要診斷為骨折者其住院天數與其他變項之比較………………………………………….85
表二十：台北市老年骨折住院病患且主要診斷為骨折者其住院後狀況與其他變項之比較……………………………………….86
表二十一：花蓮縣老年骨折住院病患且主要診斷為骨折者其住院後狀況與其他變項之比較…………………………………88
表二十二：台北市老年骨折住院病患且主要診斷為骨折者其住院後死亡之危險因子………………………………………….90
表二十三：花蓮縣老年骨折住院病患且主要診斷為骨折者其住院後死亡之危險因子…………………………………………….91
表二十四：老年骨折住院病患且主要診斷為骨折者其住院後死亡之危險因子…………………………………………………….92
附 錄
附錄一：國內外文獻之彙集…………………………………………..93
附錄二：國際疾病傷害及死因分類標準之骨折分類……………….100
附錄三：全民健康保險住院醫療費用清單………………………….109
附錄四：住院費用清單填表說明……………………………………..110

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