评价新型冠状病毒肺炎疫情前后多学科协作模式治疗老年髋部骨折的效果，探索常态化疫情防控形势下进一步完善临床诊疗路径的突破点。

回顾性收集自2019年1月至2020年12月间北京积水潭医院老年创伤骨科以多学科协作模式治疗的老年髋部骨折患者的相关信息进行分析比较，包括年龄、性别、骨折类型、美国麻醉医师协会（ASA）评分、手术治疗率、受伤至急诊时间、急诊至入院时间、入院至手术时间、入院48 h内手术率、住院时间、围手术期并发症发生率及院内死亡率等。

本研究共纳入老年髋部骨折患者2 275例，平均年龄79.7岁（65~105岁）；男性663例（29.1%），女性1 612例（70.9%）；股骨颈骨折1 219例（53.6%），股骨粗隆间骨折1 016例（44.7%），股骨粗隆下骨折40例（1.8%）；ASA评分高分级占比49.6%；手术治疗率为97.7%；院内死亡率为0.2%（4例）。相较于2019年，2020年所收治患者受伤至急诊平均时间明显延长（1.7 d VS. 3.4 d，P=0.000），急诊至入院平均时间无明显变化（23.4 h VS. 24.0 h，P=0.109），入院至手术平均时间略有增长（30.7 h VS. 38.3 h，P=0.000），入院48 h内手术率有所下降（82.1% VS. 72.4%，P=0.000），平均住院时间略有延长（4.1 d VS. 4.3 d，P=0.005）；围手术期并发症发生率明显增加（16.9% VS. 22.5%，P=0.001），主要体现在压疮、肺部感染及泌尿系感染的发生率明显上升。

基于多学科协作的老年髋部骨折"绿色通道"诊疗模式院内死亡率极低；有效地缩短术前等待时间，可能降低围手术期并发症发生率。

This research aims to evaluate the efficacy of multidisciplinary care model in the management of geriatric hip fractures before and after COVID-19 pandemic and explore the breakthrough of the clinical pathway optimization in the situation of routine epidemic prevention and control.

The elderly patients with hip fracture treated with a multidisciplinary approach in the Department of Geriatric Orthopaedics and Traumatology of Beijing Jishuitan Hospital from January 2019 to December 2020 were included. The clinical data including age, gender, fracture type, ASA score, surgical treatment rate, time from injury to emergency, time from emergency to admission, time from admission to operation, operation rate within 48 hours of admission, length of stay, incidence of perioperative complications and in-hospital mortality were collected retrospectively and analyzed.

A total of 2275 elderly patients with hip fracture were enrolled, in which 663 males (29.1%) and 1612 females (70.9%). The average age was 79.7 y (65-105 y). There were 1219 cases of femoral neck fracture (53.6%), 1016 cases of trochanteric fracture (44.7%), and 40 cases of subtrochanteric fracture (1.8%). High ASA score accounted for 49.6%. The surgical treatment rate was 97.7%. The in-hospital mortality rate was 0.2% (4 cases). Compared with 2019, in 2020, the average time from injury to emergency was significantly longer (1.7 d VS. 3.4 d, P=0.000); the average time from emergency to admission was unchanged (23.4 h VS. 24.0 h, P=0.109); the average time from admission to operation increased slightly (30.7 h VS. 38.3 h, P=0.000); the operation rate within 48 hours of admission decreased (82.1% VS. 72.4%, P=0.000); the average length of stay was slightly longer (4.1 d VS. 4.3 d, P=0.005); the incidence of perioperative complications increased significantly (16.9% VS. 22.5%, P=0.001), mainly reflected in the increased incidence of bedsore, pneumonia and urinary tract infection.

"Green Pathway" with a multidisciplinary approach is efficient in the management of geriatric hip fractures with an extremely low in-hospital mortality. Effective shortening the waiting time before operation might reduce the incidence of perioperative complications.