老年股骨颈骨折合并尿毒症患者行人工股骨头置换术的治疗体会  

Treatment of femoral head replacement in elderly patients with femoral neck fracture complicated with uremia

作　　者：郑国卿[1] 徐文停[1] 倪诚[1] 王宇轩 裴文江 ZHENG Guo-qing;XU Wen-ting;NI Cheng;WANG Yu-xuan;PEI Wen-jiang(Shanghai Jiangong Hospital,Shanghai 200083,China)

机构地区：[1]上海建工医院,上海200083

出　　处：《中国骨伤》2022年第7期634-637,共4页China Journal of Orthopaedics and Traumatology

基　　金：上海市虹口区卫健委医学科研课题(编号:1901-06)。

摘　　要：目的:探讨老年股骨颈骨折合并尿毒症患者行人工股骨头置换术的治疗方法及疗效。方法:2016年1月至2020年12月收治21例老年股骨颈骨折合并尿毒症患者行人工股骨头置换手术治疗,男3例,女18例;年龄65~83(77.2±1.9)岁。所有骨折患者合并尿毒症且需长期维持血液透析;患者透析龄2~11(6.3±1.6)年,血透次数2~3次/周。患者受伤至入院手术时间3~7(4.0±2.1) d。术前积极纠正患者的贫血及低蛋白血症,通过血液透析调整患者的血钾及血肌酐指标。结果:所有患者切口Ⅰ期愈合,无伤口感染、假体松动、脱位及深静脉血栓并发症发生。所有患者术后及时恢复日常血液透析维持血肌酐及血钾水平稳定。21例患者术后随访5~23(16.8±2.6)个月。Harris评分由术前(24.8±2.5)分转为术后(87.2±3.1)分。结论:老年股骨颈骨折合并尿毒症患者行人工股骨头置换手术,只要围手术期处理得当,配合术后积极康复治疗,可以获得很好的临床疗效。Objective:To investigate the treatment method and effect of artificial femoral head replacement for elderly patients with femoral neck fracture complicated with uremia.Methods:From January 2016 to December 2020,21 elderly patients with femoral neck fracture complicated with uremia were treated with artificial femoral head replacement.There were 3 males and 18 females,aged 65 to 83 years old with an average of(77.2±1.9) years.All patients were complicated with uremia and required long-term maintenance of hemodialysis.The age of dialysis was 2 to 11 years with an average of(6.3±1.6) years,2 to3 times per week.The time from injury to admission to operation was 3 to 7 days with an average of(4.0±2.1) days.The anemia and hypoproteinemia of the patients were corrected preoperatively,and the serum potassium and creatinine indexes of the patients were adjusted by hemodialysis.Results:All the incisions were healed in the first stage,and there were no complications of wound infection,prosthesis loosening,dislocation and deep vein thrombosis.All patients resumed routine hemodialysis in time to maintain the stability of serum creatinine and potassium levels.All 21 patients were followed up for 5 to 23 months with an average of(16.8±2.6) months.Harris scores changed from(24.8±2.5) scores preoperatively to(87.2±3.1) scores postoperatively.Conclusion:Elderly patients with femoral neck fracture combined with uremia underwent artificial femoral head replacement surgery,as long as the perioperative treatment is appropriate,with active postoperative rehabilitation treatment,can obtain a good clinical effect.

关 键 词：老年人 股骨颈骨折 尿毒症 血液透析 

分 类 号：R687.42[医药卫生—骨科学]