80岁及以上患者股骨转子间骨折围术期并发症探讨  

Perioperative complications of intertrochanteric fractures in patients aged 80 years and over

作　　者：郑广超[1] 许海平[1] 刘慧松 董平[1] 刘振新[1] 叶小磊 

机构地区：[1]宁波大学医学院附属医院创伤骨科,315020 [2]宁波市医学科学研究所药物药理实验室,315020

出　　处：《中华老年医学杂志》2016年第5期530-532,共3页Chinese Journal of Geriatrics

基　　金：国家卫计委医药发展研究中心资助项目（W2015QJ041）

摘　　要：目的探讨80岁及以上股骨转子间骨折老年患者住院期间围术期并发症的预防和处理方法。方法回顾性分析2010年5月至2015年11月在我院行手术治疗的股骨转子间骨折高龄患者病例资料103例，男31例，女72例；年龄80～99岁，平均86．2岁。其中EvanⅠ型3例，Ⅱ型25例，Ⅲ型36例，Ⅳ型37例，V型2例。麻醉采用连续硬膜外麻醉82例，全麻21例；股骨近端髓内钉（PFN）固定101例，动力髋螺钉（DHS）固定2例。结果PFN平均手术时间30min，平均出血60ml；DHS平均手术时间60min，平均出血150ml。103例患者平均住院16．7d，术后住院期间死亡1例（0．9％）；术前出现卧床并发症10例（9．7％），其中中枢神经系统（3例）和呼吸系统（4例）最为高发；术后出现并发症38例（36．9％），其中中枢神经系统（13例）最为高发。入院至手术时间平均6d，其中6d以上的65例，出现术后并发症30例（46．2％）；6d以内者38例，出现术后并发症8例（21．1％）；两者差异有统计学意义（Х^2=6．49，P〈0．05）。结论高龄患者股骨颈骨折应尽早手术，建议采用连续硬膜外麻醉，熟练的手术技巧，较短的手术时间，术前、术后密切的病情观察及正确的及时处理是保证手术成功的关键。Objective To investigate the prevention and management of perioperative complications of intertroehanteric fractures in elderly in hospital patients（aged≥80 years）. Methods Clinical data of 103 intertrochanteric fracture patients（31 male and 72 female）undergoing surgical treatment at our hospital from May 2010 to Nov. 2015 were retrospectively analyzed. Their ages ranged from 80 to 99 years, with an average of 86.2 years. There were 3 Evan type I cases, 25 type Ⅱ cases, 36 type Ⅲ cases, 37 type Ⅳ cases and 2 type Ⅴ cases. Of these, 82 received epidural anesthesia and 21 had general anesthesia. Intertrochanteric fractures were treated with proximal femoral nail（PFN） internal fixation in i01 patients and dynamic hip screw（DHS）internal fixation in 2 patients. Results The average operation duration and blood loss were 30 rain and 60 ml in the PFN internal fixation group and 60 min and 150 ml in the DHS internal fixation group, respectively. The average hospitalization time was 16.7 days. One patient （0.9%）died after operation, 10 （9.7%）had preoperative complications of bed rest with 3 cases involving the central nervous system and 4 cases involving the respiratory system, and 38 cases （ 36. 9%） had postoperative complications with 13 involving the central nervous system. The average time from admission to operation was 6 days, with 65 cases above the average and 38 cases below the average, and there was a statistically significant difference in the incidence of postoperative complications between the two subgroups（30/65 or 46.2 for the former and 8/38 or 21.1% for the latter, Х^2=6.49, P〈 0.05）. Conclusions Elderly patients with intertrochanteric fractures should undergo surgery as soon as possible, preferably with epidural anesthesia. Proficiency in surgical kills, and postoperative conditions, and proper and success.

关 键 词：老年人 80以上 股骨颈骨折 围手术期医护 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]