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| 80岁以上髋部骨折患者手术治疗策略选择:附915例报告 |
| 曹烈虎1,2,陈晓1,2,翁蔚宗1,2,崔进1,2,汪琳1,2,张军1,2,周启荣1,2,王尧1,2,苏佳灿1,2* |
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(1. 第二军医大学长海医院创伤骨科, 上海 200433;
2. 中韩生物医学工程中心, 上海 201802
*通信作者) |
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| 摘要: |
| 目的 回顾性分析我院创伤骨科10年间手术治疗的915例80岁以上髋部骨折患者临床资料，总结高龄髋部骨折的手术治疗策略。方法 2007年6月-2016年6月我院创伤骨科手术治疗的80岁以上高龄髋部骨折患者915例，根据术前患者的个体情况进行围手术期全身情况及基础疾病的调整，选择合适的麻醉方式和手术方案，尽早手术治疗。术后进行积极的早期功能锻炼、专科护理和科普宣教。回顾分析患者手术等待时间、手术时间、住院时间、出血量、术后全身和局部并发症及1年内死亡率。结果 915例患者手术时间50~120 min，平均（69.5±34.2）min；手术出血量150~440 mL，平均（278.3±56.8）mL；住院时间5~31 d，平均（5.6±3.2）d。发生全身和局部并发症210例，其中全身和局部并发症分别为117例和93例。14例（1.5%）患者死亡。根据手术等待时间分为<2 d组、2~7 d组和>7 d组，3组患者的死亡率和并发症发生率差异有统计学意义（P<0.05），等待时间越长，死亡率和并发症发生率越高。结论 高龄髋部骨折通过积极的术前准备和评估，在围手术期充分调整全身情况及基础疾病用药，选择合适的麻醉方式，根据骨折部位、类型选择合理的内固定方式，尽早实行髋部骨折手术，并积极开展专科护理和术前宣教，实现髋部骨折的个体化诊疗，可获得满意疗效。 |
| 关键词: 80岁以上老年人 髋骨折 并发症 内固定术 围手术期医护 |
| DOI：10.16781/j.0258-879x.2017.04.0409 |
| 投稿时间：2016-12-20修订日期：2017-03-28 |
| 基金项目:国家自然科学基金国际合作项目（8141101156），上海市自然科学基金（15ZR1412500），上海市科委生物医药专项（15411950600）. |
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| Surgical treatment options for hip fractures in elderly patients aged 80 years old and over: a report of 915 cases |
| CAO Lie-hu1,2,CHEN Xiao1,2,WENG Wei-zong1,2,CUI Jin1,2,WANG Lin1,2,ZHANG Jun1,2,ZHOU Qi-rong1,2,WANG Yao1,2,SU Jia-can1,2* |
(1. Department of Orthopaedic Trauma, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. China-South Korea Biomedical Engineering Center, Shanghai 201802, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the clinical data of 915 elderly patients with hip fractures (≥80 years old) receiving surgical treatment in our department over the past 10 years, so as to summarize the surgical strategies of hip fractures in elderly patients. Methods We included 915 patients with hip fractures aged 80 years and over from Jun. 2007 to Jun. 2016. Based on preoperative preparation and evaluation, the general condition and underlying diseases of patients were adjusted individually during the perioperation, and then the suitable anesthesia methods and reasonable internal fixation were selected and the surgery was performed as soon as possible. Active early functional exercise, specialist nursing and health education were conducted after surgery. The waiting time for operation, operation time, hospital stays, bleeding volume, postoperative systemic and local complications and 1-year mortality were analyzed. Results The mean operation time of the 915 patients was (69.5±34.2) min (range 50-120 min), the mean bleeding volume was (278.3±56.8) mL (range 150-440 mL), and the mean hospital stay was (5.6±3.2) d (range 5-31 d). There were 210 cases having systemic and local complications, with 117 cases of systemic complications and 93 cases of local complications. Fourteen patients died, accounting for 1.5% (14/915) of the total. The patients were divided into <2 d group, 2-7 d group and >7 d group according to the waiting time for operation. Our results showed that the waiting time for operation was longer, the mortalities and incidences of complications of patients were higher, with a significant difference found between the 3 groups (P<0.05). Conclusion Active preoperative preparation and evaluation, right anesthesia methods, reasonable internal fixation according to the fracture site and type, adjusting general condition and underlying disease drug during the perioperation, early surgery, active specialist nursing, preoperative health education and individualized diagnosis can all contribute to the treatment of elderly patients with hip fractures, improving the clinical efficacy and reduce the complications effectively. |
| Key words: aged over 80 years hip fractures complications internal fixation perioperative care |
