老年股骨颈骨折患者的围手术期特点及手术处理

Perioperative characteristics of femoral neck fractures in the elderly patients and surgical treatment

目的分析75岁以上高龄股骨颈骨折患者的手术治疗过程,总结围手术其特点,对于今后高龄患者的治疗提供帮助。方法回顾性研究自2005年6月至2008年6月手术治疗的86例75岁以上的股骨颈骨折患者的治疗过程,男51例、女35例,平均年龄79.4岁。新鲜骨折79例,其中Garden I、II型稳定骨折9例,GardenⅢ、IV型移位骨折70例;陈旧骨折7例,均为Garden IV型。9例Garden I、II型骨折行空心钉内固定术;77例Garden Ⅲ、IV型骨折中,5例患者因髋臼有明显骨关节炎表现而行骨水泥行人工全髋置换术,其余72例均行人工股骨头置换术。结果空心钉内固定组平均手术时间51分钟,平均术中出血50ml;人工股骨头置换组平均手术时间81分钟,平均术中出血180ml;人工全髋置换组平均手术时间105分钟,平均术中出血350ml。空心内固定组、股骨头置换组和全髋置换组术后血红蛋白分别比术前平均下降12%,17%和18%,术后白蛋白分别比术前平均下降11%,18%和20%。结论 75岁以上的高龄股骨颈骨折患者常合并多种内科或神经科疾病,手术风险高,充分的术前准备、积极防治围手术期各种并发症是保证手术成功的重要因素。

Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 75 years by analyzing the surgical treatment procedures.Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2005 and June 2008,There were 51 males and 35 females,at average age of 79.4 years.Of all,there were 79 patients with fresh fractures including 9 with type Garden I orⅡfractures and 70 with type Garden Ⅲ or IV fractures,7 with old fractures（all type Garden IV）.9 patients with type Garden I or II fractures were treated with caunulated screw fixation（CSF）.Among 77 patients with type Garden Ⅲ or IV fractures including 70 fresh fractures and 7 old ones,72 patients were treated by hip hemiarthroplasty（HHA）,but the other 5 by cemented total hip arthroplasty（THA） because of preexisting hip osteoarthritis.Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group,81 minutes and 180 ml in HHA group,105 minutes and 350 ml in THA group.Postoperative hemoglobin was decreased by 12%,17%and 18% on average respectively in CSF group,HHA group and THA group,and postoperative albumin decreased by 11%,18%and 20% on average respectively in CSF group,HHA group and THA group.Conclusions The patients aged≥75 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurolosical diseases and have high risk in operation.Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.