髋部骨质疏松性骨折48小时手术的临床意义  

The clinical significance of osteoporotic hip fracture surgery within 48 hours

作　　者：刘功稳 高焱[1] 徐又佳[1] Liu Gongwen;Gao Yan;Xu Youjia(Osteoprosis Institute of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院骨科,苏州大学骨质疏松诊疗技术研究所,215004

出　　处：《中华骨科杂志》2019年第17期1096-1100,共5页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81572179);国家自然基金预研基金(SDFEGJ1601);苏州市民生科技项目(SS201814);苏州大学附属第二医院优势学科群项目(XKQ2015001).

摘　　要：髋部骨质疏松性骨折多发生在老年人群,随着社会老龄化,这类骨折发生率越来越高。对于髋部骨质疏松性骨折,如采用非手术治疗,则死亡率较高,因此目前大多数采用手术治疗。那么,骨折后究竟多长时间手术为佳?有学者认为这类骨折患者多有各类基础疾病且机体生理储备功能明显降低,应术前充分纠正全身情况后再实施手术;但是也有学者认为这类骨折后2~3 d基础疾病还未加重,应充分利用这段“窗口期”实施手术,帮助患者术后尽早站立,这样既有利于基础疾病控制,又可防止骨折后卧床导致的肺炎、褥疮、肌萎缩等并发症的发生。为此,各国相关“指南”、“共识”中关于骨折后手术时间有不同观点,包括36 h、48 h、120 h、尽早实施手术等不同描述。在这些时间节点中,“骨折后48 h内手术”观点已被以色列卫生部纳入国家医保支付条件、已被美国骨科医师协会列入指南,同时相关的临床研究报道最多。针对髋部骨质疏松性骨折后不同手术时间的研究观点进行文献梳理,特别是对“骨折后48 h内手术”观点提出的缘由、临床优点、管理特点等临床意义进行分析,为髋部骨质疏松性骨折临床治疗和医院管理提供参考、启发。Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non-surgical treatment. In the choice of time interval about "fracture-operation", several studies found that elderly with osteoporotic hip fracture had various co-morbidities and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. However, others believed that the co-morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co-morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. Therefore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, including 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after fracture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide reference and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.

关 键 词：髋部骨质疏松性骨折 非手术治疗 临床意义 疾病控制 骨折患者 手术时间 医院管理 骨折后 

分 类 号：R687.3[医药卫生—骨科学]