80岁以上髋部骨折患者手术治疗策略选择:附915例报告

发布时间：2018-01-25 10:42

本文关键词： 岁以上老年人髋骨折并发症内固定术围手术期医护　出处：《第二军医大学学报》2017年04期 　论文类型：期刊论文

【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50~120min,平均(69.5±34.2)min;手术出血量150~440mL,平均(278.3±56.8)mL;住院时间5~31d,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2d组、2~7d组和7d组,3组患者的死亡率和并发症发生率差异有统计学意义(P0.05),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。
[Abstract]:Objective to analyze retrospectively the clinical data of 915 cases of hip fracture over 80 years old who were treated surgically in trauma orthopedic department in our hospital during the past 10 years. Methods from June 2007 to June 2016, 915 patients over 80 years old with hip fracture were treated by trauma orthopedic surgery in our hospital from June 2007 to June 2016. According to the individual condition of the patients before operation, the general condition and the basic diseases were adjusted during the perioperative period, the appropriate anesthetic method and operation plan were selected, the operation was done as early as possible, and the active early functional exercise was carried out after operation. Specialized nursing and popular science education. The waiting time, operation time, hospitalization time and bleeding volume of the patients were analyzed retrospectively. Results the operative time of 915 patients was 50 ~ 120 minutes, with an average of 69.5 卤34.2 minutes. The mean volume of blood loss during operation was 278.3 卤56.8mL, 150 ~ 440mL (mean, 278.3 卤56.8mL). The hospitalization time was 5 days, 31 days, with an average of 5.6 卤3.2 days. There were 210 cases of systemic and local complications. There were 117 cases of systemic and 93 cases of local complications. According to the waiting time of operation, they were divided into 2 days group and 7 day group and 7 day group respectively. The mortality and complication rate of the three groups were significantly different (P 0.05), the waiting time was longer. The higher the mortality and complication rate is, the higher the incidence of complications is. Conclusion through active preoperative preparation and evaluation, we can fully adjust the general situation and basic diseases during the perioperative period, and choose the appropriate anesthetic method. According to the position of fracture, the reasonable internal fixation method was selected, the operation of hip fracture was carried out as soon as possible, and the special nursing and preoperation education were carried out actively to realize the individualized diagnosis and treatment of hip fracture, and the curative effect was satisfied.
【作者单位】：第二军医大学长海医院创伤骨科;中韩生物医学工程中心;
【基金】：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)~~
【分类号】：R687.3
【正文快照】： [Acad J Sec Mil Med Univ,2017,38(4):409-414]随着我国进入老龄化以及骨质疏松患者的增加,髋部骨折也逐年增多[1-2]。手术是高龄髋部骨折患者的主要治疗方式,可以最大程度缓解疼痛,减少卧床并发症,实现自主功能锻炼,恢复自主功能。但高龄患者常合并多种内科疾病或潜在的多脏

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