损害控制技术在高龄股骨转子间骨折治疗中的应用  

Application of damage control technique in treatment of intertrochanteric fracture in the elderly

作　　者：王蒙[1] 周雪峰[1] 白克文[1] 鲍磊[1] 彭军[1] 马晓明[1] 周家宁[1] 伍佳剑 

机构地区：[1]解放军第三0六医院骨科,北京100101

出　　处：《中华创伤杂志》2014年第12期1196-1200,共5页Chinese Journal of Trauma

摘　　要：目的 探讨应用损害控制技术治疗高龄股骨转子间骨折的临床疗效.方法 选择2008年12月-2013年12月应用损害控制治疗的166例高龄股骨转子间骨折患者,其中男68例,女98例;年龄（85.23±3.19）岁.AO分型：A1型18例,A2型89例,A3型59例.围术期实施损害控制治疗,运用改良生理学与手术严重度评分系统（physiological and operative severity scorefor the enumeration of mortality and morbidity,POSSUM）预测并发症率,用朴茨茅斯改良的POSSUM（Portsmouth modified POSSUM,P-POSSUM）预测病死率,观察预测效价及患者术后预后情况.结果 入院时POSSUM评分＜20分的并发症低风险患者61例,实施损害控制治疗;POSSUM评分评分≥20分的并发症高风险患者105例,完成生理学控制后行损害控制性手术治疗.损害控制前预测并发症发生率为（48.6±6.8）％,病死率为（10.1±1.9）％;损害控制后并发症发生率为（35.6±4.5）％,病死率为（4.6±1.4）％;实际并发症发生率为37.4％,病死率为1.8％,与损害控制前比较,差异均有统计学意义（P均＜0.05）.结论 对高龄股骨转子间骨折患者实施损害控制措施,能够规避手术风险,降低术后并发症率及病死率.Objective To evaluate the clinical efficacy of damage control measures in treatment of femoral intertrochanteric fracture among the elderly.Methods A total of 166 patients with intertrochanteric fracture treated with damage control measures from December 2008 to December 2013 were included in the retrospective study.There were 68 men and 98 women at age of （85.23 ±3.19） years.Fracture classification using the AO system was type A1 in 18 cases,type A2 in 89 cases and type A3 in 59 cases.Mortality and incidences of postoperative complications were predicted respectively by the physiological and operative severity score for the enumeration of mortality and morbidity （POSSUM） and Portsmouth modified POSSUM （P-POSSUM）.The validity of damage control measures was evaluated by comparing the predicted risks and observed outcomes.Results On admission,there were 61 patients with low risk of complications （POSSUM 〈 20 points） treated with damage control surgery but 105 patients with high risk of complication （POSSUM ≥20 points） treated with physiological control following damage control surgery.Predicted incidences of complications and mortality were （48.6 ± 6.8） % and （10.1 ±1.9） % respectively prior to damage control,but they were （35.6 ± 4.5） % and （4.6 ± 1.4） % after damage control.Observed incidences of complications and mortality were 37.4% and 1.8% respectively,with significant differences in comparison with those before damage control （all P 〈 0.05）.Conclusion For the elderly patients with intertrochanteric fracture,damage control measures can avoid surgical risks and reduce the incidences of postoperative complications and death.

关 键 词：股骨骨折 高龄 损害控制骨科 

分 类 号：R687.3[医药卫生—骨科学]