ERAS理念下人工髋关节置换术治疗股骨颈骨折合并尿毒症患者围手术期风险因素分析及处理  

Analysis on the perioperative risk factors and their management in femoral neck fracture patients concomitant with uremia undergone artificial hip replacement under ERAS concept

作　　者：张银昌 陈平波 王超 熊寿良 李从明 杨昕 贺华正 王强 陶周善 王雷 ZHANG Yinchang;CHEN Pingbo;WANG Chao;XIONG Shouliang;LI Congming;YANG Xin;HE Huazheng;WANG Qiang;TAO Zhoushan;WANG Lei(Department of Joint Surgery,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院关节骨科,安徽芜湖241001

出　　处：《皖南医学院学报》2024年第2期138-141,共4页Journal of Wannan Medical College

基　　金：国家自然科学基金项目(82002322)。

摘　　要：目的:探讨加速康复(ERAS)理念下髋关节假体置换术在股骨颈骨折合并尿毒症患者中的疗效及安全性。方法:回顾分析2019年1月~2023年3月在弋矶山医院行人工髋关节置换术治疗股骨颈骨折合并尿毒症的18例患者,对患者进行围手术期的处理,记录围手术期并发症情况,出院后门诊随访拍摄髋关节正位片并记录患者的疼痛视觉模拟评分法(VAS)评分、髋关节Harris评分及并发症等情况;同时选取20例同期行髋关节假体置换术的股骨颈骨折不合并尿毒症的患者作为对照组。结果:所有患者术后中位随访时间为16.1(3~36)月。合并尿毒症组男性占比较高、平均年龄更小、术前血红蛋白更低、围手术期输血率更高、住院时间更长(P<0.05);两组患者Harris评分和VAS评分差异均无统计学意义(P>0.05)。合并尿毒症组2例术后发生上消化道出血,1例出院后15 d发生关节假体脱位再次入院;两组患者末次随访时均未发生关节感染、假体松动、脱位、假体周围骨折等并发症。结论:通过围手术期的积极有效处理,ERAS理念下人工髋关节假体置换术治疗股骨颈骨折合并尿毒症患者效果满意。Objective:To investigate the efficacy and safety of hip prosthesis replacement under the application of enhanced recovery after surgery(ERAS)in patients with femoral neck fracture and uremia.Methods:Retrospective analysis was performed in 18 patients of femoral neck fracture with concurrent uremia undergone hip arthroplasty in our hospital between January 2019 and March 2023.All patients received perioperative treatment,and were maintained regarding the incidences of perioperative complications and information after discharge,including the findings of anteroposterior radiograph of hip joint,VAS scores,Harris hip scores and complications during the follow-up on clinic visit basis.Besides,another 20 femoral neck fracture patients without uremia undergone hip prosthesis replacement in the same period were recruited as controls.Results:The median postoperative follow-up was 16.1 months(3 to 36 months)for all patients.Males were dominant,and the age was younger in patients with concurrent uremia.Additionally,lower hemoglobin level before surgery,higher perioperative transfusion rates and longer hospital stay were seen in such patients(all P<0.05).Upper gastrointestinal bleeding occurred in 2 patients,and one patient was re-admitted half a month after discharge because of prosthesis dislocation.There was no complication such as join infection,loosening and dislocation of the prosthesis as well as lower limb thrombosis and peri-prosthetic fractures between the two groups at the final follow-up.Conclusion:The efficacy can be satisfied in femoral neck fracture patients with uremia undergone hip prosthesis replacement under the concept of ERAS.,the hip prosthesis replacement is safe and feasible for the patients with femoral neck fracture and uremia,and provide patients with satisfactory results.

关 键 词：股骨颈骨折 尿毒症 髋关节置换术 围手术期 透析 并发症 

分 类 号：R683.42[医药卫生—骨科学] R692.5[医药卫生—外科学] R687.42[医药卫生—临床医学]