老年髋部骨折患者围术期死亡风险评估  

Perioperative mortality risk assessment of elderly patients with hip fracture

作　　者：万永鲜[1] 徐丽丽[2] 卓乃强[1] 葛建华[1] 叶俊武[1] 阳运康[1] 张忠杰[1] 鲁晓波[1] 

机构地区：[1]泸州医学院附属医院骨与关节外科,646000 [2]泸州医学院附属医院康复医学科,646000

出　　处：《中华创伤杂志》2016年第3期213-217,共5页Chinese Journal of Trauma

基　　金：基金项目：四川省科技厅项目（2014SZ0235）

摘　　要：目的探讨老年髋部骨折患者围术期死亡风险。方法回顾性分析2012年1月-2014年1月收治的60岁以上老年髋部骨折患者177例，其中男79例，女98例；年龄61-90岁，平均72．2岁。骨折类型：转子问骨折109例，股骨颈骨折68例。合并2种以上内科疾病60例，合并1种内科疾病97例，20例无其他合并症。行闭合或微创有限切开复位内固定手术107例，切开复位内固定手术48例，全髋关节置换术17例，半髋置换术5例。观察比较围术期死亡患者与年龄、术前合并症、麻醉及手术方式、手术时间等因素的相关性。结果手术患者中围术期共死亡7例，其中死亡患者中年龄〉80岁6例，61-80岁1例；术前合并症≥2种的患者6例，〈2种合并症的患者1例；采用非微创手术方式围术期死亡率7．14％，微创手术方式死亡率1．87％。手术时间〉120min围术期死亡率为33．33％，手术时问≤120min围术期死亡率为3．45％。上述各组间比较差异均有统计学意义（P〈0．05），围术期死亡率与麻醉方式之间的比较差异无统计学意义（P〉0．05）。结论老年髋部骨折患者年龄〉80岁，合并2种以上尤其是合并有肺部疾病的患者围术期死亡风险较高，手术方式及手术时间长短与死亡风险存在相关性，其中采用非微创手术方式、手术时间〉120rain的患者围术期死亡风险较高。Objective To investigate the perioperative mortality risks of elderly patients with hip fracture. Methods A retrospective review was made on 177 elder patients with hip fracture hospitalized from January 2012 to January 2014. There were 79 males and 98 females, aged from 61 to 92 years （ mean, 72.2 years）. Intertrochanteric or femoral neck fracture was noted in 109 patients and 68 patients respectively. Sixty patients were complicated with two or more medical conditions, 97 were complicated with one medical condition, and 20 had no other complications. In all, 177 patients were treated surgically, including closed or minimally invasive limited open reduction and internal fixation （ n = 107 ） , open reduction and internal fixation （n =48）, total hip replacement （n = 17） and half hip replacement （n = 5 ）. Correlations of perioperative death with age, fracture type, anesthesia, operation mode and preoperative complications were determined. Results Seven patients died within perioperative period. Six deaths aged more than 80. Six deaths were complicated with 2 medical conditions and over. Mortality rate was 7.14% among the conventionally operated patients and 1.87% among the patients operated in a minimally invasive way. Perioperative mortality was 33.33% among the patients operated for 〉 120 min and 3.45%among the patients operated for ~〈 120 rain. Conclusions A higher mortality occun＇ed in the patients aged 〉 80 years and with more than two medical conditions, especially pulmonary disease. Perioperative mortality relates to operative ways and operative time, and seems to have a strong relationship with mini- mally invasive operation and operation time 〉 120 rain.

关 键 词：髋骨折 手术中并发症 老年人 

分 类 号：R687.3[医药卫生—骨科学]