术前内科合并症对高龄股骨转子间骨折术后疗效的影响  

Influence of preoperative systemic complications on the clinical outcome of intertrochanteric fracture in elderly patients

作　　者：黄鑫[1] 王晓宁[1] 刘婷茹[1] 吴克俭[1] 洪磊[1] 朱颖波[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中华创伤骨科杂志》2013年第2期113-117,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨术前内科合并症对股骨近端防旋髓内钉（PFNA）内固定治疗高龄股骨转子问骨折疗效的影响。方法回顾性分析2008年1月至2011年6月采用PFNA治疗且获得随访的185例高龄股骨转子问骨折患者资料，根据术前是否合并内科合并症分为两组：术前合并内科合并症组148例，男69例，女79例；平均年龄为（82．6±7．5）岁；骨折改良Evans分型：I型40例，Ⅱ型52例，Ⅲ型39例，Ⅳ型17例。术前无内科合并症组37例，男14例，女23例；平均年龄为（81．1±6．8）岁；骨折改良Evans分型：I型8例，Ⅱ型15例，Ⅲ型10例，Ⅳ型4例。比较两组患者的围手术期失血量、末次随访时患髋功能及围手术期并发症发生情况。结果185例患者术后获平均12个月（6～18个月）随访。术前合并内科合并症组患者围手术期总失血量[（1125．4±107．1）mL】显著多于术前无内科合并症组[（937．7±75．5）mL]。末次随访时根据髋关节Harris评分标准评定患髋功能：术前合并内科合并症组优62例，良49例，可32例，差5例，优良率为75．0％；术前无内科合并症组优23例，良11例，可3例，优良率为91．9％。术前合并内科合并症组患者围手术期并发症发生率为19．6％（29／148），显著高于术前无内科合并症组[5．4％（2／37）】，以上项目两组间比较差异均有统计学意义（P〈0．05）。结论术前内科合并症是影响PFNA内固定治疗高龄股骨转子问骨折患者疗效的重要因素。Objective To investigate the influence of preoperative systemic complications on the clinical outcome of intertroehanteric fracture treated with proximal femoral nail antirotafion （PFNA） in elderly patients. Methods A retrospective analysis was performed of 185 elderly patients with intertrochanteric fracture who had been treated in our institute fi＇om January 2008 to June 2011. They were divided into 2 groups according to presence or absence of preoperative systemic complications. In the complication group, there were 148 patients, 69 males and 79 females, with an average age of 82.6 -＋ 7.5; there were 40 cases of type I, 52 cases of type ]I, 39 cases of type HI and 17 cases of type 1V by the modified Evans classifi- cation. In the complication-free group, there were 37 patients, 14 males and 23 females, with an average age of 81. 1 -＋ 6. 8 years; there were 8 cases of type I, 15 eases of type ~, 10 cases of type ]]I and 4 cases of type 1V by the modified Evans classification. The perioperative blood loss and the hip function by Harris scoring and complications at the last follow-up were compared between the 2 groups. Results The pe- rioperative blood loss in the complication group （1125.4 ＋ 107. 1 mL） was significantly higher than in the complication-free group （937.7 ＋ 75.5 mL） （ P 〈 0.05）. By Harris scoring, the hip function was evaluated as excellent in 62 cases, good in 49 cases, fair in 32 cases and poor in 5 cases in the complication group while the hip function was evaluated as excellent in 23 cases, good in 11 cases and fair in 3 cases in the compli- cation-free group. The good to excellent rate in the former（75.0% ） was significantly lower than that （91.9%） in the latter （ P 〈 0. 05） . The rate of postoperative complication was 19.6% （29/148） in the complication group, significantly higher than that [5.4% （2/37） ] in the complication-free group （ P 〈 0. 05）. Con- clusion Preoperative systemic complications are important factors affecting the clini

关 键 词：髋骨折 骨折固定术 内 骨钉 治疗结果 内科合并症 

分 类 号：R687.3[医药卫生—骨科学]