快速康复外科理念在老年髋部手术中的应用

Application of Fast-track Surgery in Elderly Hip Surgery

目的探讨老年髋部骨折手术引入快速康复外科（fast-track surgery，FTS）理念的效果。方法2011年4月～2013年4月手术治疗86例老年髋部骨折患者，年龄63～94岁，行人工股骨头置换术17例，全髋关节置换术26例，髓内固定（PFN）12例，髓外固定（DHS）31例。围手术期应用FTS护理模式。结果本组手术时间35～123min，出血量110—359ml。所有患者术后顺利康复，平均住院时间12（8—26）d。术后16例（18．6％）出现并发症。随访77例，平均时间9（3—18）个月。骨折愈合时间平均为6（4—10）个月。术后基本恢复正常，可从事轻体力劳动者5例，生活能够自理者56例，因其他合并症需要护理者14例，因内科疾病死亡2例。结论FTS理念应用于老年髋部骨折手术的围术期护理，可使患者康复显著加快，明显提高患者的生活质量，值得在多学科中推广应用。

Objective To discuss the effect of fast-track surgery （FIS） in elderly hip fracture surgery. Methods A total of 86 hip fracture cases, aged from 63 to 94 years, admitted from April 2011 to April 2013 were retrospectively analyzed, including 17 of artificial femoral head replacement, 26 of total hip replacement, 12 of intramedullary fixation （PFN） and 31 of pulp external fixation （DHS）. Nursing models of FTS was ap- plied during peroperative period. Results The average operation time was 35 to 123 minutes, and the blood loss was 110 to 359 ml. All cases were recovered and the hospitals stay was 8 to 26 days. 16 cases were found postoperative complications. 77 cases were followed up for 3 to 18 months （averagely 9）. The fracture was healing during 4 to 10 months follow-up after the operation. 5 cases were achieved normal to light manual labor, 56 were self-supporting, 14 remained nursing care and 2 died of medical disease. Conclusion The applica- tion of vrs can speed up the function recovery and improve the quality of life for aged cases with hip fracture during the peroperative period, and is worthy of popularization.