高龄股骨粗隆间骨折的围手术期处理

Management of elderly patients with femoral intertrochanteric fracture in perioperative period

目的探讨Gamma 3型髓内钉内固定治疗高龄股骨粗隆间骨折的疗效及围手术期治疗策略。方法对62例高龄(>80岁)股骨粗隆间骨折采用有效的围手术期综合处理和牵引复位Gamma 3型髓内钉内固定治疗。4例无明确合并症,合并症较多的为2型糖尿病、原发性高血压病、冠状动脉粥样硬化性心脏病、慢性阻塞性肺病和脑梗死后遗症。结果62例均安全度过围手术期,术后早期并发症9例,术后无切口感染、术后下肢深静脉血栓形成。结论严格有效的围手术期处理是高龄股骨粗隆间骨折手术的安全保障,充分评估和有预见性的早期处置是治疗有效的前提。

Objective To discuss the therapeutic effects of the treatment of femoral intertrochanteric fracture in elderly patients by Gamma 3 intramedullary nail and the management method in perioperative period. Methods A total of 62 cases of femoral intertrochanteric fracture （all were older than 80 years old） were treated with Gamma 3 intramedullary nail and the effective preparation was performed before operation. Fifty-eight patients suffered from medical illness of cardiovascular, respiratory, diabetes, chronic obstructive pulmonary disease, cerebral infarction sequala. Results All patients underwent the operation safely. Nine were suffered from early postoperative complicationns. No complications such as incisions infection, deep vein thrombusis occurred. Conclusion Effective preparation and management in perioperative period is very important to success of operation in the aged patients with intertrochanteric fracture. The full evaluation and previsional treatment are the prerequisite for femoral intertrochanteric fractures in the elderly.