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90岁以上髋部骨折患者不同手术时机的术后疗效分析

, PP. 158-163

Keywords: 岁以上,髋部骨折,手术时机,损害控制

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Abstract:

目的研究90岁以上髋部骨折患者不同手术时机对术后疗效的影响。方法对2002年1月至2014年2月在我院骨科中心接受手术治疗的75例90岁以上髋部骨折患者进行回顾性研究。其中男性21例,女性54例,年龄90~99(92.35±2.60)岁。股骨颈骨折34例,股骨转子间骨折41例。将患者分为早期手术组(入院后48h内手术,n=27)、延迟手术组(入院后48~72h手术,n=18)、晚期手术组(入院后72h以后手术,n=30)。入院后对患者进行全面评估后,身体条件好者早期手术治疗;身体条件差、基础疾病严重者适当延迟手术,给予损害控制。搜集并分析患者相关临床指标,包括术前评估情况、基础疾病、手术相关指标等,比较术后住院期间并发症情况、不同时期死亡率、生存曲线的异同。结果早期、延迟和晚期手术组原发病数量分别为(3.04±1.91)、(4.06±1.59)、(4.13±1.61)种,晚期手术组多于早期手术组(P=0.019);心源性基础疾病分别为6、4、15例,晚期手术组高于早期手术组和延迟手术组(P=0.044);伤前生活能力评分(activitiesofdailyliving,ADL)分别为(68.89±8.70)、(67.50±8.95)、(62.83±7.73)分,晚期手术组明显低于早期手术组(P=0.008)。晚期手术组住院时间多于早期手术组和延迟手术组(P<0.05)。3组患者性别,年龄,ASA分级,骨折类型,麻醉方式,手术方式等一般情况以及术后住院期间并发症发生率,术后第1、3、6个月死亡率,生存曲线相比,差异无统计学意义(P>0.05)。结论对基础疾病严重、身体条件差的90岁以上髋部骨折患者适当推迟手术同时全面评估其风险、纠正机体紊乱是安全、有效的,其术后生存状况可达到与身体条件较好的早期手术患者等同的水平。

References

[1]  中华人民共和国国家统计局. 2010年第六次全国人口普查主要数据公报(第1号)[EB/OL]. (2011-4-28) http: //www. stats. gov. cn/tjsj/tjgb/rkpcgb/qgrkpcgb/201104/t20110428_30327. html. [2]Uzoigwe C E, Burnand H G, Cheesman C L, et al. Early and ultra-early surgery in hip fracture patients improves survival[J]. Injury, 2013, 44(6): 726-729. [3]Librero J, Peiro S, Leutscher E, et al. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System[J]. BMC Health Serv Res, 2012, 12: 15. [4]Adie S, Harris I A, Thorn L, et al. Non-emergency management of hip fractures in older patients[J]. J Orthop Surg (Hong Kong), 2009, 17(3): 301-304. [5]Xia W B, He S L, Xu L, et al. Rapidly increasing rates of hip fracture in Beijing, China[J]. J Bone Miner Res, 2012, 27(1): 125-129. [6]Khan S K, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients[J]. Injury, 2009, 40(7): 692-697. [7]Matharu G S, Porter K M. Timing of surgery for hip fractures[J]. Injury, 2011, 42(2): 223-224. [8]Lefaivre K A, Macadam S A, Davidson D J, et al. Length of stay, mortality, morbidity and delay to surgery in hip fractures[J]. J Bone Joint Surg Br, 2009, 91(7): 922-927. [9]Pioli G, Lauretani F, Davoli M L, et al. Older people with hip fracture and IADL disability require earlier surgery[J]. J Gerontol A Biol Sci Med Sci, 2012, 67(11): 1272-1277. [10]Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression[J]. Can J Anaesth, 2008, 55(3): 146-154. [11]王晓伟, 孙天胜, 刘树清, 等. 老年髋部骨折手术时机选择与术后疗效分析[J]. 中华骨科杂志, 2010, 30(12): 1171-1174. [12]Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients[J]. PLoS One, 2012, 7(10): e46175. [13]Peleg K, Rozenfeld M, Radomislensky I, et al. Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients[J]. Injury, 2014, 45(7): 1085-1090. [14]Leung F, Lau T W, Kwan K, et al. Does timing of surgery matter in fragility hip fractures?[J]. Osteoporos Int, 2010, 21(Suppl 4): S529-S534. [15]Yonezawa T, Yamazaki K, Atsumi T, et al. Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients[J]. J Orthop Sci, 2009, 14(5): 566-573. [16]Kondo A, Zierler B K, Hagino H. The timing of hip fracture surgery and mortality within 1 year: a comparison between the United States and Japan[J]. Orthop Nurs, 2011, 30(1): 54-61. [17]Scottish Intercollegiate Guidelines Network. Management of hip fracture in older people: A national clinical guideline. SIGN guidelines no. 111[EB/OL]. (2009-6) http: //www. sign. ac. uk/pdf/sign111. pdf. [18]Holt G, Smith R, Duncan K, et al. Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit[J]. J Bone Joint Surg Br, 2008, 90(10): 1357-1363. [19]Holt G, Smith R, Duncan K, et al. Does delay to theatre for medical reasons affect the peri-operative mortality in patients with a fracture of the hip?[J]. J Bone Joint Surg Br, 2010, 92(6): 835-841.

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