老年髋部骨折快速手术的研究进展  

Research progress of rapid surgery for hip fracture in elderly patients

作　　者：韩超[1] 李晓丹[2] 孙翔[1] 韩哲 刘佳男 何伟伟 董强 HAN Chao;LI Xiaodan;SUN Xiang;HAN Zhe;LIU Jianan;HE Weiwei;DONG Qiang(Department of Hip Traumatology,DivisionⅡ,Tianjin Hospital,Tianjin University(Tianjin Hospital),Tianjin,300211,P.R.China;Department of Anesthesiology,Tianjin First Center Hospital,Tianjin,300192,P.R.China)

机构地区：[1]天津大学天津医院(天津市天津医院)创伤髋关节二科,天津300211 [2]天津市第一中心医院麻醉科,天津300192

出　　处：《中国修复重建外科杂志》2023年第12期1556-1561,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：天津市自然科学基金多元投入基金面上项目(21JCYBJC01840)。

摘　　要：目的对老年髋部骨折快速手术研究进展进行综述。方法广泛回顾国内外相关研究及专家共识、指南,从人口老龄化特点、快速手术收益、延迟手术弊端以及专家共识、指南建议等方面进行总结,以期为临床实践提供参考。结果髋部骨折是老年人群常见骨折类型,由于老年患者体质普遍较差且往往存在多种基础疾病,如保守治疗可能出现坠积性肺炎、褥疮、下肢深静脉血栓形成等多种并发症,致残率、死亡率均较高,因此首选手术治疗。目前相关研究及国内外专家共识、指南大多支持快速手术,即入院后立即开始术前检查、明确并积极纠正服用抗凝药物、严重心血管疾病、严重贫血等导致手术延迟的不利因素后,尽可能在入院后48 h内完成手术。快速手术不仅能显著降低患者死亡率,还能减少住院时间、降低患者围术期认知功能障碍发生率,有利于住院期间患者疼痛缓解和术后功能恢复,改善患者预后。结论老年髋部骨折患者入院后在积极纠正不利因素前提下宜尽早手术,以避免延迟手术带来的诸多问题。全面评估和准备、制定个体化手术方案以及组建多学科医疗团队等措施能够降低老年髋部骨折的手术风险,提高治疗结果。Objective To review the research progress of rapid surgery for hip fracture in elderly patients.Methods The published studies,expert consensus,and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population,the benefits of rapid surgery,the disadvantages of delayed surgery,and the recommendations of current guidelines,so as to further guide clinical practice.Results Hip fracture is a common fracture type in the elderly population.As elderly patients generally have poor physique and often have a variety of underlying diseases,such as hypostatic pneumonia,bedsore,lower limb vein thrombosis,and other complications in conservative treatment,its disability rate and mortality are high,so surgical treatment is the first choice.At present,most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery,that is,preoperative examination should be started immediately after admission,and adverse factors such as taking anticoagulant drugs,serious cardiovascular diseases,and severe anemia should be clearly and actively corrected,and surgery should be completed within 48 hours after admission as far as possible.Rapid surgery can not only significantly reduce the mortality of patients,but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment,which is conducive to the recovery of patients with pain during hospitalization and postoperative function,and improve the prognosis of patients.Conclusion In order to avoid many problems caused by delayed surgery,the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors.Comprehensive evaluation and preparation,the development of an individualized surgical plan,and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.

关 键 词：髋部骨折 老年患者 手术时机 影响因素 

分 类 号：R687.3[医药卫生—骨科学]