摘要
[目的]探讨高龄患者股骨粗隆间骨折手术治疗的风险与防范对策.[方法]对高龄股骨粗隆间骨折的病人42例进行治疗分析,其中男22例,女20例.年龄70～95岁,平均78岁.骨折按Evans分型:Ⅰ型7例,Ⅱ型19例,Ⅲ型12例,Ⅳ型4例.42例中有30例合并有内科疾病,占总病例数的71.4%.合并的内科疾病分别为:高血压冠心病22例(52.4%),老年性支气管炎肺气肿15例(35.7%),糖尿病12例(28.5%),胃肠疾病5例(11.9%),老年神经精神疾病5例(11.9%),并存2种及以上内科疾病的病人占15例(35.7%).[结果]42例病例经围手术期准备后均顺利进行手术,住院7～22 d,平均13 d,术后并发肺部感染5例,脑梗死1例,下肢深静脉栓塞5例,心功能衰竭1例,其中有2种及以上并发症者4例,总并发症发生率为21.4%,随访时间为6个月～3 a,平均12个月.[结论]多数粗隆间骨折的老年人同时患有1种或多种内科疾病,手术风险较大,主要风险不是手术本身,而是合并的内科疾病,但在充分做好术前准备控制内科并发症的情况下,尽可能的早期采取手术等积极措施是行之有效的方法.术中不追求解剖复位,而是注重缩短手术时间和麻醉时间,减少出血,尽可能减少麻醉和手术对病人的干扰.
[Objective]To discuss the risk and precaution of the treatment of intertrochanteric fracture in elderly patients. [ Method]The treatment of 42 patients with intertrochanteric fracture treated from Aug. 2001 to Dec. 2004 were analyzed. There were 22 males and 20 females aging from 70 to 95 years with an average of 78 years. According to Evans classification system for intertrochanteric fracture,7 cases were type Ⅰ, 19 cases type Ⅱ, 12 cases type Ⅲ, 4 cases type Ⅳ. Thirty patients suffered from medical illness of cardiovascular, respiratory, endocrine-metablolic, digestive, nervous preoperatively. Fifteen cases were found to have two kinds or more of diseases. [ Result] The interval between admission and operative treatment was from 7 to 22 days , with the average of 13 days. There were 9 complications after operation： pulmonary infection in 5 cases, hypoglycemia in 1 case, deep venous thrombosis in lower extremity in 5 cases, heart failure in 1 case; 4 patients were found to have two kinds or more of complications. The rate of complications was 21.4%. The patients were followed up from 6 months to 3 years, with the average of 12 months. [ Conclusion] The aged patients often suffer from one or more illness, the risk is not from operation but from the medical illness. After enough preparation of perioperative period before operation, the operation should be taken much more early. It doesnt need to pay attention to anatomic reduction, but to reducing the time of operation and anaesthesia, reducing bleeding, and reducing the interfere to patient by the operation and anaesthesia.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2005年第24期1848-1850,共3页
Orthopedic Journal of China
关键词
股骨粗隆间骨折
围手术期
老年
Intertrochanteric fracture
Perioperative period
Elderly
