人工半髋置换治疗高龄股骨颈骨折的相关研究

发布时间：2018-03-24 00:24

  本文选题：股骨颈骨折　切入点：非骨水泥型人工双极头置换术　出处：《上海交通大学》2015年博士论文

【摘要】：目的:随着老龄化的进展,股骨颈骨折的发病率也正呈逐年增高。应用人工关节置换治疗高龄股骨颈骨折患者已经得到了越来越多的肯定。目前,应用非骨水泥型人工双极股骨头置换术治疗老年患者已经成为临床医生们的常规选择之一。然而高龄患者往往由于身体机能退化等诸多因素,合并较多内外科基础疾病,身体耐受性较差。疾病带来的创伤常常需要较长时间才能恢复,故而手术的效果也往往不甚理想。在本项研究中,我们回顾了行非骨水泥型人工双极头置换的高龄股骨颈骨折患者的临床资料,包括患者术前的一般情况,合并的基础疾病,以及手术相关情况,回顾术后的疗效随访,以此评估手术效果;按术前基础疾病将患者分组,讨论不同的基础疾病共同存在时对于患者预后的影响。方法:研究中,我们回顾了2006年1月至2012年12月期间于上海交通大学附属第九人民医院行非骨水泥型人工双极股骨头置换术治疗股骨颈骨折的80岁以上高龄患者258例。回顾了包括:年龄、BMI、ASA麻醉评分、麻醉方式、术前等待时间、手术时间、术中出血;术后并发症,包括:人工关脱位、假体周围骨折、假体松动、二次手术、深静脉血栓、术后感染、伤口愈合不良、术后三十天及一年死亡率。术后及随访期间关节功能Harris评分。研究中我们根据患者实际术后Harris评分将患者分为优秀组,良好组和尚可组。同时回顾了患者术前既往的基础疾病,按所患疾病数量将患者分组,同时将患者术前各参数纳入研究,进行有序Logistic回归分析,探讨患者的一般情况与基础疾病对于患者术后关节功能的影响。结果:患者的平均年龄为85.140±4.37,其中男性患者71例(27.5%),女性患者187例(72.5%)。按Garden分型分类患者,Ⅰ型6例(2.3%),Ⅱ型8例(3.1%),Ⅲ型84例(32.6%),Ⅳ型160例(62.0%)。最常见的术前合并症依次为:高血压98例(40.0%),糖尿病85例(32.9%),COPD39例(15.1%),冠心病36例(14.0%)。其中,无基础疾病的患者为68人(26.4%),患有一种疾病的有95人(36.8%),患2种54人(20.9%),患3种及以上者为41人(15.6%)。ASA评分中Ⅰ级47例(18.2%),Ⅱ级145例(56.2%),Ⅲ级59例(22.9%),Ⅳ级7例(2.7%)。大部分病人(239,92.6%)在全麻下做了手术,另一小部分(19,7.4%)则在椎管内麻醉下完成手术。患者术前平均等待时间为50.678±7.215小时,平均手术时间(从切开至缝合完毕)为48.236±12.448分钟,术中平均出血为105.937±37.219毫升。术后脱位3例,3例的患者发生假体周围骨折。仅有1例出现症状性DVT。术后一年死亡率为24人。关节功能评分平均为88.71±8.62分。患者年龄、BMI、ASA评分、麻醉方式、基础疾病数量等参数中,术前等待时间、手术时间、术中出血和麻醉方式的选择与术后关节功能的优良并无直接关系。年龄越大,术后Harris评分越低(P=0.007,OR=1.12)。BMI越大,术后Harris评分越低(P=0.005,OR=1.22)。ASA评分经分析后,高分组的预后比低分组差(P=0.001,OR=3.23)。基础疾病对于术后关节功能的影响较大,只患1种疾病的患者组,相比无合并症的患者组并无显著差异(P=0.3090.05),而患2种疾病组和至少3种疾病组中,根据OR(3.76,8.81)可知,随着患者术前基础疾病数量的增多,术后关节功能评分下降,且影响程度逐渐增高。在高血压、冠心病、COPD和糖尿病中,只有糖尿病患者对结果有影响(P0.001,OR=1.19)。在死亡原因中,心血管原因和呼吸系统原因是致死的主要因素。结论:(1)本研究中随访期间患者无感染患者,脱位率为1.16%,1.16%的患者发生假体周围骨折。仅有1例出现症状性DVT。术后一年死亡率为9.3%。关节功能评分平均为89分。患者术后康复良好,生活质量较高。对于一般情况较复杂的老年患者,本结果基本令人满意。(2)在影响预后的各项因素中,患者年龄越大、BMI越高、ASA评分越高、合并的基础疾病越多则术后关节功能越差。而在高血压、糖尿病、COPD和冠心病四种常见基础疾病中,糖尿病是影响患者预后的主要负面因素。所以,在面对高龄、偏胖和患有糖尿病的患者时,在术后康复中需要更加关注。为了提高生存率,需要提高心脑血管的监护和预防肺部感染。
[Abstract]:Objective: with the progress of the aging of the femoral neck fracture incidence is increased year by year. The application of artificial joint replacement in the treatment of elderly patients with femoral neck fracture has been more and more sure. At present, the application of cementless bipolar artificial femoral head replacement in the treatment of elderly patients has become one of the routine selection of clinicians. However, elderly patients often because of many factors such as physical degradation, with more surgical disease, the body tolerance is poor. Diseases caused by trauma often takes a long time to recover, so the operation effect is often not ideal. In this study, we reviewed the clinical data of patients with femoral neck for non cementless bipolar head replacement fractures, including the general situation of the patients with underlying diseases, combined, and related to the operation, the curative effect of postoperative follow-up review, In order to evaluate the effect of surgery; patients were grouped according to the preoperative underlying diseases, discuss the influence for the prognosis of patients with various basic diseases exist together. Methods: in this study, we reviewed during the period from January 2006 to December 2012 in the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University for 258 elderly patients over the age of 80 cemented bipolar hemiarthroplasty. Femoral neck fracture were reviewed. Including: age, BMI, ASA score of anesthesia, anesthesia, waiting time, operative time, intraoperative hemorrhage; postoperative complications included: artificial hip, dislocation, periprosthetic fracture, prosthesis loosening, two surgery, deep vein thrombosis, postoperative infection, wound healing bad, after thirty days and one year mortality. Postoperative Harris score in our study. According to the actual patient postoperative Harris scores were divided into excellent group, good group of monks 鍙�缁�.鍚屾椂鍥為【浜嗘偅鑰呮湳鍓嶆棦寰，

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