老年股骨转子间骨折的手术时机对院内结果的影响  

Effect of surgical timing on in-patient outcomes in elderly patients with intertrochanteric fracture

作　　者：杨明辉[1] 孙旭[1] 韩巍[1] 李宇能[1] 周力[1] 王颢[1] 金梅[2] 孙可[2] 伊军[2] 袁亮婧[2] 胡焱[2] 张伟[2] 王庚[2] 迟春梅[1] 朱仕文[1] 王满宜[1] 吴新宝[1] 

机构地区：[1]北京积水潭医院(北京大学第四临床医学院)创伤骨科,100035 [2]北京积水潭医院(北京大学第四临床医学院)麻醉科,100035

出　　处：《中华创伤骨科杂志》2016年第6期461-464,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的研究老年股骨转子间骨折的手术时机对院内结果的影响。方法回顾性分析2014年1—12月收治的老年股骨转子间骨折患者资料，其中50例患者实施“绿色通道”（术前等待时间在72h内），优化治疗流程，缩短术前等待时间，设为研究组；从术前等待时间超过72h的患者中依据年龄、性别、住院距受伤时间、内科合并症与研究组进行1：1匹配，筛选患者纳入到对照组。两组患者术前临床基线比较差异均无统计学意义（P〉0．05），具有可比性。比较两组患者的术前等待时间、住院时间、住院费用和并发症方面的差别。结果研究组术前等待时间（42．4h）比对照组（162．9h）平均缩短5．0d，差异有统计学意义（P〈0．001）。研究组住院时间[（6．9±1．7）d]比对照组[（11．2±2．5）d]平均缩短4．3d，差异有统计学意义（P〈0．001）。研究组住院费用（49536．4元）较对照组（53882．6元）平均减少4346．2元，差异有统计意义（P=0．023）。术前深静脉血栓形成研究组有3例，对照组有6例。研究组住院过程中未发生褥疮、泌尿系感染或肺部感染，对照组发生1例褥疮、1例泌尿系感染。两组患者均无切口感染和院内死亡发生。结论通过优化流程缩短老年股骨转子间骨折患者术前等待时间，可以明显缩短患者住院时间及减少住院费用，且可能降低术前深静脉血栓形成和院内卧床相关并发症的发生率，同时不改变患者院内死亡率。Objective To investigate the potential benefits of early surgery for geriatric patients with intertrochanteric fracture. Methods Included in the observation group were 50 geriatric patients （ ≥65 years old） with intertrochanterie fracture who had been operated on within 72 hours after admission through the ＂green passage＂ from January through December 2014. The control group included the same number of geriatric patients with intertrochanterie fracture who had been operated on beyond 72 hours after admission but compatible in baseline clinical features like age, gender, time between injury and admission, eomorbidities （hypertension, diabetes and coronary heart disease）, with no statistically significant difference in demographics （ P 〉 0. 05）. The 2 groups were compared in terms of time between admission and operation, hospital stay, hospital expenditure and in-hospital complications. Results The average time between admission and operation for observation group [42. 4 h （1.8 d） ] was significantly shorter by 5.0 d than for control group [162. 9 h （6.8 d）] （ P 〈 0. 001）. The average hospital stay for observation group （6.9±1.7d） was significantly shorter by 4. 3 d than for control group （11.2 ± 2. 5 d） （ P 〈 0. 001 ） . The average hospital expenditure for observation group （￥49, 536.4） was significantly less by ￥4, 346. 2 than for control group （￥53, 882. 6） （ P = 0. 023） . Preoperative deep vein thrombosis occurred in 3 patients in observation group and in 6 patients in control group. One case of pressure sore and one case of urinary tract infection happened in control group during hospitalization, but there were no such complications in observation group. There was no wound infection or in-hospital death in both groups. Conclusions Compared to late surgery （〉 72 h）, early surgery （ 〈 72 h） for geriatric patients with intertrochanteric fracture can significantly shorten hospital stay, reduce hospital expenditure, and decrease the ris

关 键 词：老年人 股骨骨折 临床路径 

分 类 号：R687.3[医药卫生—骨科学]