围手术期内科并存病对高龄股骨转子间骨折术后疗效的影响  

Influence of preoperative complications on the clinical outcome of elderly intertrochanteric fractures patients

作　　者：黄鑫[1] 苏柯[1] 王晓宁[1] 朱颖波[1] 王金昌[1] 吴克俭[1] 刘亭茹[1] Huang xin;Su Ke;Wang Xiaoning;Zhu Yingbo;Wang Jinchang;Wu Kejian;Liu tingru(Orthopaedic Institute, the First Affiliate of General Hospital of PLA, Beijing 100048, China)

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中华老年骨科与康复电子杂志》2017年第1期11-16,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：基金项目:首都临床特色应用研究与成果推广(Z151100004015012)

摘　　要：目的探讨围手术期内科并存病对股骨近端防旋髓内钉(PFNA)内固定治疗高龄股骨转子间骨折患者疗效的影响。方法回顾性分析2012年1月至2015年1月解放军总医院第一附属医院采用PFNA治疗的185例高龄股骨转子间骨折患者资料,根据围手术期是否有内科并存病分为有内科并存病组与无内科并存病组。随访并比较两组患者的围手术期失血量、疼痛、意识障碍、术后疗效及并发症发生情况。结果 185例患者获得满意随访,随访时间10~46月,平均28±5月。有内科并存病组的围手术期总失血量(1 125±107)ml,显著高于无内科并存病组(938±76)ml,差异有统计学意义(t=18.436,P<0.05)。有内科并存病组Harris髋关节评分为(74.2±2.9)分,优良率为75.0%;无内科并存病组为(85.6±2.3)分,优良率为91.9%,差异有统计学意义(U=3.124,P<0.05)。有内科并存病组术后并发症发生率为19.6%(29/148),显著高于无内科并存病组5.4%(2/37,x^2=4.580,P<0.05)。有内科并存病组术后Glasgow评分[(9.2±2.5)分]低于无内科并存病组[(11.3±3.4)分;t=18.635,P<0.05]。两组术后VAS评分比较,差异无统计学意义。结论内科并存病是影响PFNA内固定治疗高龄股骨转子间骨折患者疗效的重要因素。Objective To investigate the possible affect of preoperative complications on PFNA fixation efficacy in elderly patients with intertrochanteric fractures. Methods A retrospective analysis was performed in The First Affiliate of General Hospital of PLA from January 2010 to January 2015, including 185 elderly intertrochanteric fractures. Patients were divided into complication group and non-complication group according to the existence of complications. The blood loss, pain, conscious disturbance, postoperative efficacy and incidence of complications were recorded and comparion were done between two groups.Results All patients were well followed up for 10-46 months with an average of 28±5 months. After PFNA treatment, The perioperative blood loss was 938±76 ml in non-complication group, which was significant lower than the complication group (1,125±107 ml), difference was statistically significant (t=18.436, P<0.05). The Harris Hip score in the non- complication group was 74.2±2.9 points (36- 92), excellent rate was 91.9%,comparing to 85.6±2.3 points (48-93) and 75.0% excellent rate in the complication group, difference was statistically significant (U=3.124, P<0.05). In addition, 29/148 patients (19.6% ) in complication group gained postoperative complications, which was significantly higher than that of non- complication group (2/37,5.4% ), difference was statistically significant (c2=4.580, P<0.05). The postoperative Glasgow scale of complication group[(9.2 ± 2.5)scores]was significantly higher than the non- complication group[(11.3 ± 3.4) scores] (t=18.635, P<0.05). The postoperative VAS score in complication group has no significant difference with the non- complication group. Conclusion The preoperative complications can greatly affect the efficacy of PFNA fixation in the treatment of intertrochanteric fractures in elderly.

关 键 词：并存病 骨折固定术 内 髋骨折 骨钉 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]