80岁以上髋部骨质疏松性骨折的治疗选择

Treatment options of hip osteoporotic fractures in patients over 80 years old

目的探讨80岁以上髋部骨质疏松性骨折患者的治疗选择。方法回顾97例80岁以上髋部骨折患者采取手术、非手术治疗的结果。结果 64例患者实施了手术治疗,术后3 w内死亡10例,死亡原因:心功能衰竭3例,切口感染最终导致败血症、多系统器官功能衰竭2例,高血压病致颅内出血1例,呼吸衰竭1例,肝功能衰竭1例,多脏器功能衰竭1例,进食时误吸致呼吸心跳骤停死亡1例。其余54例手术的患者均顺利出院,随访1年,9例在1年内因各种原因死亡。45例患者髋关节功能根据Harris评分标准,优1例,良7例,中15例,差22例。非手术组共33例,随访1年,其中12例在伤后3月内、9例在伤后1年内死亡。有9例粗隆间骨折患者经卧床后骨折畸形愈合,3例股骨颈骨折患者,骨折没有愈合。髋关节功能根据Harris评分标准,中2例,差10例。结论 80岁以上高龄髋部骨质疏松性骨折患者病情复杂,合并症多,处理困难,手术可以降低死亡率,是治疗的首选。

Objective To investigate the treatment options of hip osteoporotic fractures in patients over 80 years old. Methods The results of operation or non-operation in 97 patients who were over 80 years old with hip osteoporotic fractures, were reviewed. Results Sixty-four patients underwent operations and 10 patients died in the first 3 weeks after the operation. Three of them died of heart failure, 2 of them died of septicemia and multiple systemic organ failure induced by incision infection, 1 of them died of intracranial hemorrhage induced by hypertension, 1 of them died of respiratory failure, 1 of them died of liver failure, 1 of them died of multiple organ failure, and 1 of them died of cardiorespiratory arrest due to aspiration during eating. The left 54 patients who received operations were discharged. They were followed up for 1 year, and 9 of them died of various reasons. Hip function of the living 45 patients was evaluated by Hip Joint Harris Score. One case was excellent, 7 cases were good, 15 cases were moderate, and 22 cases were bad. Thirty- three patients in non-operation group were followed up for 1 year. Twelve of them died in 3 months after injury and 9 of them died in 1 year after injury. Nine patients with intertrochanteric fractures treated by lying up in bed healed in malunion. Three patients with femoral neck fractures without operation did not heal. According to Hip Joint Harris Score, 2 cases were moderate and 10 cases were bad. Conclusion The conditions of patients over 80 years old with hip osteoporotic fractures are complex. Complications are various and managements are difficult. Surgery can reduce mortality and should be considered as primary choice of the treatment.