老年股骨转子间骨折手术治疗的风险与防范

Risk in Treatment of Intertrochanteric Fracture in Elderly Patients and Its Precaution

目的探讨老年患者股骨转子间骨折手术治疗的风险与防范对策。方法对老年股骨转子间骨折的38例患者进行治疗分析,其中男22例,女16例。年龄70～82岁,平均76岁。骨折按Evans分型:Ⅰ型5例,Ⅱ型17例,Ⅲ型12例,Ⅳ型4例。38例中有28例合并有内科疾病,其中高血压冠心病18例,慢性支气管炎肺气肿13例,糖尿病10例,胃肠疾病4例,老年神经精神疾病3例,并存2种及以上内科疾病的患者12例。结果38例患者经围手术期准备后均顺利进行手术,住院8～23d,平均14d,术后并发肺部感染4例,脑梗塞1例,下肢深静脉栓塞2例,心功能衰竭1例,其中有2种以上并发症者3例,并发症发生率为21%,随访时间为1～5年,平均2.1年,优良率84.2%。结论多数转子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,而是注重缩短手术和麻醉时间,减少出血,尽可能减少麻醉对患者的干扰。

Objective To discuss the risk in the treatment of intertrochanteric fracture in elderly patients and the precaution measures. Method The treatment of 38 patients with intertroehanteric fracture treated from Au- gust 2003 to January 2009 was analyzed. There were 22 males and 16 females aged from 70 to 82 years （ aver- agely 76 years）. According to Evans classification system for intertrochanteric fracture, 5 cases were type I, 17 were type ]I, 12 were type Ill, 4 were typelV. Twenty eight patients had suffered from cardiovascular dis- ease, respiratory disease, endocrine-metabolic disease, digestive disease and nervous system disease before the operation, and 12 eases were found to have two or more diseases. Results The interval between the ad- mission and the operation ranged from 8 to 23 days （ averagely 14 days）. Nine cases of complication occurred after the operation, including 4 pulmonary infections, 1 case of cerebral infarction, 2 cases of deep venous thrombosis in lower extremity an complications. The rate of comp d lic 1 case of heart failure. Three patients were found to have two or more of ations was 21%. The patients were followed up for 1 to 5 years （ averagely 2. 1 years）, the Conclusion The or more diseases, excellent elderly the risk and good rate was patients often suffer is not only from the 84.2%. from one operation but also from these medical conditions. By the good pr the operation should be performed as early as possible. eparat The ion before operation to control the complications, time of operation and anesthesia should be short- ened and bleeding should be reduced instead of paying much attention to anatomic reduction to minimize the interfere to patients by the operation and anesthesia