合并慢性肝衰竭老年髋部骨折的救治与围术期管理

发布时间：2018-06-19 04:15

本文选题：慢性肝衰竭 + 老年髋部骨折　；参考：《中国矫形外科杂志》2015年16期

【摘要】：[目的]探讨和总结合并慢性肝衰竭(chronic liver failure,CLF)老年髋部骨折的救治方法及围手术期管理经验。[方法]选取2008年1月~2013年12月于本科连续收治的12例合并慢性肝衰竭的老年髋部骨折患者,对其进行术前ASA评级、MELD评分、POSSUM评分及P-POSSUM评分并实施骨科损害控制技术,记录患者一般资料、肝硬化Child-Pugh分期、术前天数、手术方式、麻醉方法及术后并发症情况。[结果]所有患者均安全度过围手术期,住院期间无死亡病例,术后手术伤口均甲级愈合,相关并发症经过内科治疗均治愈。12例全部获得随访,平均随访21.3个月(3~47个月),最后一次随访髋关节Harris评分平均83.2分(68~93)分,优良率77.8%。[结论]合并慢性肝衰竭的老年髋部骨折患者,经过术前积极风险评估并结合骨科损害控制技术,只要选择恰当的手术时机、手术方式以及麻醉方法,围术期间采取措施控制贫血、腹水及门脉高压及相关并发症,必要时术后辅助应用人工肝支持系统,其手术是安全有效的。
[Abstract]:[objective] to explore and summarize the treatment methods and perioperative management experience of hip fracture in elderly patients with chronic liver failure. [methods] from January 2008 to December 2013, 12 cases of senile hip fracture patients with chronic liver failure were selected. ASA rating meld score and P-POSSUM score and orthopaedic damage control technique were performed. The general data, Child-Pugh stage, preoperative days, operative methods, anesthetic methods and postoperative complications were recorded. [results] all the patients survived the perioperative period safely, there were no cases of death in hospital, all the wounds healed in grade A after operation, and all the 12 cases of related complications were cured by internal medical treatment, all of them were followed up. The average follow-up was 21.3 months from 3 to 47 months, and the average Harris score of hip joint at the last follow-up was 83.2 points (6893). The excellent and good rate was 77.8%. [conclusion] in elderly patients with chronic liver failure, after positive risk assessment before operation and combined with orthopedic damage control technique, we should choose the right operation time, operation method and anaesthesia method. Perioperative measures were taken to control anemia, ascites and portal hypertension and related complications, and to apply artificial liver support system after operation if necessary, the operation was safe and effective.
【作者单位】：第三军医大学大坪医院野战外科研究所骨科;
【分类号】：R687.3;R575.3

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