合并慢性肝衰竭老年髋部骨折的救治与围术期管理

Treatment and perioperative management of hip fractures in elderly patients with chronic liver failure

[目的]探讨和总结合并慢性肝衰竭（chronic liver failure,CLF）老年髋部骨折的救治方法及围手术期管理经验。[方法]选取2008年1月~2013年12月于本科连续收治的12例合并慢性肝衰竭的老年髋部骨折患者,对其进行术前ASA评级、MELD评分、POSSUM评分及P-POSSUM评分并实施骨科损害控制技术,记录患者一般资料、肝硬化Child-Pugh分期、术前天数、手术方式、麻醉方法及术后并发症情况。[结果]所有患者均安全度过围手术期,住院期间无死亡病例,术后手术伤口均甲级愈合,相关并发症经过内科治疗均治愈。12例全部获得随访,平均随访21.3个月（3~47个月）,最后一次随访髋关节Harris评分平均83.2分（68~93）分,优良率77.8%。[结论]合并慢性肝衰竭的老年髋部骨折患者,经过术前积极风险评估并结合骨科损害控制技术,只要选择恰当的手术时机、手术方式以及麻醉方法,围术期间采取措施控制贫血、腹水及门脉高压及相关并发症,必要时术后辅助应用人工肝支持系统,其手术是安全有效的。

[Objective]To determine and summarize the experiences of treatment and perioperative management in elderly patients with chronic liver failure（CLF）. [ Method] From January 2008 to December 2013,12 consecutive elderly patients suf- feting from hip fractures and CLF were enrolled in this study. The ASA,MELD,POSSUM and P -POSSUM scores were evalua- ted and damage control techniques of orthopedics were carried out before the operation. Demographic variables, including gen- der ,age, Child- Pugh periodization, perioperative duration, operation and anesthesia methods, postoperative complications, were recorded respectively. [ Restult ] All cases safely pulled out the perioperative period, and no cases died during the hospitalization. The wounds healed at the first stage, and all related complications were cured by medical treatment. All patients were followed up for a mean period of 21.3 months （ range,3 to 47 months）. The average Harris hip score was 83.2 （ range,68 to 93 ）, and the excellent and good results rate was 77.8%. [ Conclusion]The orthopedic surgeries can be safely and effectively received on the elderly patients suffering from hip fractures with CLF as long as the operation opportunities, operation and anesthesia methods, and artificial liver support system for those at Child - Pugh C stage, are selected and conducted properly.