老年患者髋部骨折治疗方法的选择与预后探讨

Analysis of Prognosis of Hip Fracture in Gerontal Patients after Operative Treatment and Non - operative Treatment

目的分析比较老年患者,尤其脑血管病后遗症不全瘫患者的股骨近端骨折手术与非手术治疗方法的预后.方法回顾分析1994年1月～2002年9月获得随访的髋部骨折住院患者310例,年龄60～91岁,伤前有脑血管病后遗症不全瘫者49例,其中222例接受手术治疗,88例非手术治疗.对照分析手术治疗与非手术治疗患者功能恢复、并发症的发生及死亡等情况.结果老年髋部骨折手术治疗组并发症及死亡率均低于非手术组(P值均＜0.01),即使合并脑血管病后遗症,其术后死亡率及并发症发生率亦明显低于非手术组.结论除非患者生命垂危,老年髋部骨折均应手术治疗,尤其对并存较严重疾病者手术治疗有积极意义.

Objective To evaluate and compare the prognosis of hip fracture in gerontal patients after operative treatment and non - operative treatment, especially those with previous hemiplegia due to cerebrovascular accident. Methods A total of 310 gerontal patients with hip fracture admitted to the general hospital of Beijng Mining Group were included in this retrospective study. Among these 49 were affected by neurologic impairment caused by cerebrolvascular accident with hemiplegia. Of all the patients, 222 were treated by operation and 88 by non - operation, they were followed - up 9 months to 3 years. The functional recovery, incidence of complications and mortality were compared and analysed. Results A statistically significant higher incidence of complications and mortality was recorded in conservatively treated patients than in operative treated patients (P<0.01), even if in patients with previous hemiplegia, the incidence of complications and mortality was also significant higher in conservatively treated patients than in operative treated patients (P<0.01). Conclusion To gerontal patients suffered from hip fracture, operation should be chosen unless the patient is at crisis. Especially, operation seems more valuable to those who have previous hemiplegia.