老年髋部骨折48小时内手术的疗效分析  

Curative effect of surgery within 48 hours after hip fracture in elderly patients

作　　者：李涧[1] 常留辉 顾颀 刘功稳 高焱[1] 谢宗刚[1] 徐炜[1] 周海斌[1] 董启榕[1] 徐又佳[1] Li Jian;Chang Liuhui;Gu Qi;Liu Gongwen;Gao Yan;Xie Zonggang;Xu Wei;Zhou Haibin;Dong Qirong;Xu Youjia(Department of Orthopaedics,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Anesthesiology, the Second Affiliated Hospital of Soochow University, Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院骨科,215004 [2]苏州大学附属第二医院麻醉ICU,215004

出　　处：《中华骨科杂志》2019年第17期1037-1043,共7页Chinese Journal of Orthopaedics

基　　金：苏州市科技发展项目(SYS201621);苏州大学附属第二医院优势学科群项目(XKQ2015001).

摘　　要：目的比较老年髋部骨折患者入院后48 h内手术与超过48 h手术的疗效。方法前瞻性分析2017年5月至2018年4月,手术治疗47例75岁以上髋部骨折患者,根据手术时间分组为48 h内手术组(48 h内组)和超过48 h手术组(超48 h组)。其中48 h内组患者22例,男5例,女17例;年龄76~97岁,平均(83.6±5.0)岁;股骨颈骨折10例(全髋置换3例、半髋置换7例),股骨转子间骨折12例(股骨近端髓内钉固定)。超48 h组患者25例,男7例,女18例;年龄76~98岁,平均(83.8±5.8)岁;股骨颈骨折10例(全髋置换2例、半髋置换8例),股骨转子间骨折15例(股骨近端髓内钉固定)。比较两组患者的住院时间、除内植物外的住院费用、术后1个月内的并发症、术后1个月及3个月时的髋关节Harris评分、术后3个月及末次随访时的死亡率等。结果两组患者均获得随访,随访时间12~24个月,平均17.7个月。48 h内组的住院时间[(7.9±3.0) d]、除内植物外住院费用[(16 627.5±6 428.8)元]、术后早期并发症发生率(59.1%)、术后1个月Harris评分[(80.9±8.6)分]均明显优于超48 h组[分别为(12.3±4.1) d、(23 799.0±9 785.3)元、88.0%、(71.1±9.2)分)]。术后3个月时Harris评分两组无明显差异[48 h内组为(83.9±7.3)分,超48 h组为(82.3±8.9)分;t=0.668,P=0.507]。术后3个月,48 h内组患者无一例死亡,超48 h组2例患者发生2例;末次随访时,48 h内组新增1例死亡病例。结论老年髋部骨折患者入院后48 h内手术获益显著。Objective To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients. Methods From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed. Results Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group;t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-h

关 键 词：老年人 髓 骨折 

分 类 号：R687.3[医药卫生—骨科学]