手术时机对老年髋部骨折患者临床疗效及预后的影响  

Impact of Surgery Time on the Clinical Efficacy and Prognosis of Elderly Patients with Hip Fractures

作　　者：崔露萍 皮燕燕 CUI Luping;PI Yan-yan(Department of Orthopedics,Dongfeng General Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]湖北医药学院附属国药东风总医院骨科,湖北十堰442000

出　　处：《湖北医药学院学报》2024年第6期650-653,661,共5页Journal of Hubei University of Medicine

基　　金：湖北省科技厅面上项目(20172110)。

摘　　要：目的:探讨手术时机对老年髋部骨折患者术后临床疗效及预后的影响。方法:回顾性分析2022年1月至2023年12月我院收治的188例老年髋部骨折行手术治疗患者的临床资料。根据手术时机分为早期手术组86例(入院至手术时间≤48 h)和延期手术组102例(入院至手术时间>48 h),比较2组患者入院时、术前、术毕时凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、纤维蛋白原降解产物水平(FDP)、D-二聚体(D-D)水平)]及术后下肢深静脉血栓形成(DVT)发生率、手术时间、围术期输血率、术中出血量、术后转ICU率、术后并发症发生率、住院时间。结果:两组患者骨折类型、麻醉方式、手术方式、手术时间、术前凝血功能指标差异无统计学意义(P>0.05);早期手术组围术期输血率、术中出血量、术后DVT发生率、凝血功能指标、压力性损伤发生率明显低于延期手术组,住院时间明显短于延期手术组(P<0.05);两组术后切口感染率、泌尿系统感染率、心肌梗死发生率、转ICU率差异无统计学意义(P>0.05)。结论:早期手术患者的血流动力学稳定性较高,术后下肢DVT发生率低,安全性高,值得临床推广。Objective To explore the influence of surgery time on the clinical efficacy and prognosis of elderly patients with hip fractures.Methods A retrospective analysis was conducted on the clinical data of 188 elderly patients with hip fractures who underwent surgical treatment in the Sinopharm Dongfeng General Hospital,Hubei University of Medicine from January 2022 to December 2023.According to the surgery time,patients were divided into an early surgery group of 86 cases(ad⁃mission to surgery time≤48 h)and a delayed surgery group of 102 cases(admission to surgery time>48 h).Coagulation function indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),fibrinogen degradation product(FDP),D-dimer(D-D)]upon admission and before and after treatment,as well as lower extremity deep vein thrombosis(DVT)after surgery,surgery time,perioperative blood transfusion,intraoperative bleeding volume,postoperative ICU transfer,postoperative complications,and hospitalization time were compared between the two groups.Results There was no significant difference in fracture type,anesthesia method,surgical method,surgery time,and preop⁃erative coagulation functions between the two groups of patients(P>0.05).The perioperative blood transfusion,intraopera⁃tive bleeding volume,postoperative DVT,coagulation functions,and pressure injury in the early surgery group were lower than those in the delayed surgery group,and the hospitalization time was shorter than that in the delayed surgery group(P<0.05).No difference was found in postoperative incision infection,urinary system infection,myocardial infarction,and ICU transfer(P>0.05).Conclusion Patients undergoing early surgery have high hemodynamic stability and low postopera⁃tive DVT in lower limbs,with high safety,which is worthy of clinical promotion.

关 键 词：手术时机 老年髋部骨折 凝血功能 下肢深静脉血栓 

分 类 号：R687.3[医药卫生—骨科学]