摘要
目的探讨手术治疗高龄(≥80岁)髋部骨折患者住院期间并发症的预防和处理方法。方法回顾性分析1996年1月至2004年3月198例行手术治疗的高龄髋部骨折患者的病例资料,男55例,女143例;年龄80～98岁,平均85.2岁。股骨颈骨折93例,其中GardenⅠ型2例、Ⅱ型10例、Ⅲ型52例、Ⅳ型29例;股骨转子间骨折105例,其中EvanⅠ型3例、Ⅱ型37例、Ⅲ型39例、Ⅳ型26例。麻醉采用局麻加基础麻醉2例、全麻38例、连续硬膜外麻醉158例。股骨颈骨折的手术方法包括人工双极股骨头置换(骨水泥型)77例、全髋关节置换(混合型)13例、加压空心螺钉固定3例;股骨转子间骨折均采用闭合复位滑动式鹅头钉固定。结果人工股骨头置换平均手术时间53min,平均出血110ml;全髋关节置换平均手术时间94min,平均出血165ml;螺钉固定平均手术时间35min,平均出血30ml;滑动式鹅头钉固定平均手术时间40min,平均出血60ml。17例行关节置换者术中应用骨水泥时出现一过性血压下降。全部患者平均住院18.6d,住院期间死亡2例。术后36例(18.2%)出现并发症,其中中枢神经系统(13例)和心血管系统(13例)并发症最为高发。未出现与手术相关的并发症。入院至手术时间平均6d,其中7d以上者46例,术后出现并发症9例(19.6%);7d及以内者152例,出现并发症27例(17.8%),两者差异无统计学意义(%2=8.62,P>0.05)。结论高龄髋部骨折应尽量采用创伤小、快速的麻醉及手术方法,充分的术前准备和积极预防、正确处理并发症是保证手术成功的重要因素。
Objective To analyze the prevention and management of in-hospital complications to the surgical treatment of hip fractures in elder patients （≥80 years）. Methods An retrospective data of 198 hip fracture patients with surgical treatment between Jan. 1996 and Mar. 2004 was reviewed. Their age ranged from 80 to 98 years with an average of 85.2 years. 93 cases were femoral neck fracture （Garden type Ⅰ 2 cases, type Ⅱ 10 eases, type Ⅲ 52 cases and type Ⅳ 29 cases） while 105 were intertrochanteric fracture （ Evan type Ⅰ 3 cases, type Ⅱ 37 eases, type Ⅲ 39 cases and type Ⅳ 26 cases）. Local anaesthesia, general anaesthesia and epidural anaesthesia were used in 2. 38 and 158 eases respectively. Femoral neck fractures were treated with bipolar femoral head replacement in 77 patients, total hip replacement in 13 patients, and compressive eannulated scre fixation in 3 patients respectively. Intertroehanteric fractures were treated with close reduetion and dynamie hip screw （DHS） internal fixation. Results The average operation duration and bh）,d loss were 53 mill and 110 ml respectively in the bipolar femoral head replacement group, 94 rain and 165 ml in the total hip replacement group, 35 rain and 30 ml in the screw fixation group and 40 rain and 60 ml in the DHS group. 17 eases rmder cemented hip replacement suffered obviously transient arterial blood pressare drop. 36 eases （18.2%） had postoperative complications, among which the mental system and cireulation system were more irelined to be involved. The average in-hospital time was 18.6 days and 2 cases died in hospital. The average time from admission to operation （waiting time ） was 6 days. A mong 46 eases longer than 7 days. 9 eases （19.6%） had postoperative complications. Among 152 cases no longer than 7 days, 27 eases （17.8%） had postoperative complications. It showed no statistical significant difference between the two groups in complicatinn incidence. Conclusion To gain good results in elderly patients of hip fracture by operation, tess invasive and quick anaesthetic technique and operative procedures are encouraged. Meticulous preoperative preparation, active preventing and treating the intraoperative and postoperative complications should be emphasized on.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第10期591-594,共4页
Chinese Journal of Orthopaedics
