老年髋部骨折手术风险评估系统研究进展

Current research in surgical risk assessments for elderly patients with hip fracture

老年髋部骨折患者多首选手术治疗,但此类患者常合并一种或多种基础疾病,手术风险大为增加,如何有效评估老年髋部骨折的手术风险,对于提高手术安全性、保证手术效果具有重要意义。目前用以预测骨科患者手术风险的通用评分系统多达数十种,但老年髋部骨折有其特殊性,不能完全照搬通用的评分系统。该文在介绍外科及骨科常用手术风险评分系统的基础上,重点综述用于死亡率和并发症率计算的生理学和手术严重程度评分(POSSUM)、Portsmouth改良POSSUM(P-POSSUM)、改良骨科POSSUM、生理功能与手术应激评估(EPASS)等评分系统在老年髋部骨折手术风险评估中的应用。

For most of elderly patients with hip fracture,surgery is the treatment of choice.But the-patients are always accompanied with one or more basic diseases,which could greatly increase the surgical risks.So it is crucial to find an operative risk evaluation criterion for improving the surgical safety and ensuring the therapeutic effects.Currently,there are dozens of general scoring systems to predict the surgical risks for orthopaedic patients,but they could not be suitable to evaluate elderly patients with hip fracture completely due to the particularity of those patients.Based on the introduction of surgical risk assessments frequently used in surgery and orthopaedics fields,the application of scoring systems for evaluating surgical risks for elderly patients with hip fracture were reviewed in this paper,including physiological and operative severity score for enumeration of mortality and morbidity（POSSUM）,Portsmouth modified POSSUM,modified orthopaedic POSSUM,estimation of physiologic ability and surgical stress（E-PASS）,etc.