急诊手术治疗高龄患者股骨粗隆间骨折

Emergency operation for the treatment of intertrochanteric fractures in elderly patients

目的:评价急诊手术治疗高龄股骨粗隆间骨折的临床价值。方法:研究方法为回顾性分析。排除年龄小于70岁、陈旧性骨折、病理性骨折、多发创伤、入院时明显内科合并症患者。将2006年3月至2012年3月绵阳市中心医院收治的70岁以上高龄股骨粗隆间骨折患者127例(男38例,女89例)纳入研究。按是否采取急诊手术分为两组:急诊手术组56例,伤后24h内行手术治疗;非急诊手术组71例,入院24h后行手术治疗。回顾性调查内容:①住院期并发症,包括电解质紊乱、隐性失血、谵妄、深静脉血栓形成、上消化道出血、肺部感染、尿路感染、心脑血管意外、褥疮。②预后,包括住院期死亡例数、随访1年死亡例数、住院时间、骨折愈合时间及髋关节功能评分。结果:急诊手术组主要住院并发症依次为隐性失血、谵妄、肺部感染、电解质紊乱、尿路感染;非急诊手术组主要住院并发症依次为隐性失血、肺部感染、电解质紊乱、谵妄、褥疮。急诊手术组无住院期死亡病例,随访1年死亡1例;非急诊手术组住院期死亡4例,随访1年死亡7例。急诊手术组平均住院时间(9±3)d,低于非急诊手术组平均住院时间(17±8)d。骨折愈合时间平均为(12±2)周。电解质紊乱、谵妄、深静脉血栓形成、肺部感染、尿路感染、褥疮、住院期死亡人数、随访1年死亡人数、住院时间两组间差异均有统计学意义。隐性失血、上消化道出血、心脑血管意外、骨折愈合时间、髋关节功能方面两组间差异均无统计学意义。结论:高龄患者股骨粗隆间骨折伤后24h内的急诊手术可减少住院期间并发症,缩短住院时间,降低死亡风险。

Objective：To evaluate the emergency therapeutic effects of intertrochanteric fractures in elderly patients. Methods：A retrospective study was designed. From March 2006 to March 2012,254 patients with intertrochanteric fractures treated in Mianyang Central Hospital were reviewed. The patients with old fractures, pathological fractures, muhiple trauma and severe medical comorbidities of admission were excluded. So 127 patients with intertrochanteric fractures over 70 years old were included in the study,including 38 males and 89 females, and the patients were divided into 2 groups ：56 patients under- went emergency operation within 24 h after injury （emergency operation group）, 71 patients underwent an operation more than 24 h after injury （not emergency operation group）. The following data were collected retrospectively for all patients ： ①in-hospi- tal complications,including electrolyte disturbance,hidden blood loss,delirium, deep vein thrombosis,upper gastrointestinal hemorrhage, pulmonary infection, urinary tract infection, cardiovascular and cerebrovascular disease, bedsore. ②prognosis, in- cluding in-hospital mortality,mortality in the 1st year,length of hospital stay,fracture healing times,hip score. Comparisons between the two groups were made using SPSS13.0. The quantitative data and categorical data were analyzed by t test andx~ test,respectively. Results：The main medical complications in emergency operation group were hidden blood loss,delirium, pulmonary infection, electrolyte disturbances, urinary tract infections, and in not emergency operation group followed respec- tively by hidden blood loss ,lung infection ,electrolyte disturbances ,delirium, and pulmonary infection. In-hospital mortality was zero, and 1 in the 1st year in emergency operation group; while in not emergency operation group were 4 and 7 respective- ly. An average length of hospital stay with （9±3） d in emergency operation group was lower than （17±8） d in not emergency operation group. Fracture healing time was （12±2） weeks in both groups. The significant variables with P〈0.05 between the two groups were electrolyte disorders, delirium, deep venous thrombosis, pulmonary infection, urinary tract infection, bedsore, in-hospital mortality, mortality in the 1st year, and length of hospital stay. The differences of hidden blood loss, upper gastroin- testinal hemorrhage ,cardiovascular and cerebrovascular disease ,fracture healing times ,hip score between the two groups had no significant differences （P〉0.05）. Conclusion ：The emergency surgery （within 24 h after injury） reduces length of hospital stay, and may also reduce complications and mortality.