高龄髋部骨折患者围术期并存症和并发症的处理

Perioperative management of concomitant diseases and complications of hip fracture in patients aged 80 year and over

目的探讨80岁及以上高龄髋部骨折患者围术期并存症和并发症的临床处理策略及临床预后。方法回顾性分析我院95例年龄80岁以上髋部骨折且行手术治疗的患者，年龄80～96岁，其中股骨颈骨折42例，股骨粗隆间骨折53例，术前并存内科疾病71例（74．7％）。术中给予加压螺钉3例（3．2％）、人工半髋置换75例（78．9％）、全髋置换4例（4．2％）、防旋股骨近端髓内钉（PFNA）9例（9．5％）和重建钉4例（4．2％）。结果住院期间无死亡病例，术后并发贫血最常见为7例（74．7％），其次为低蛋白血症65例（68．4％），消化功能障碍29例（30．5％），电解质紊乱27例（28．4％）和精神症状15例（15．8％）。73例获得术后至少1年的随访，术后39例（53．4％）患者可独立活动，48例（65．8％）患者恢复到术前的活动水平。患者术前并存症（OR=0．23，P=0．011）、术前活动能力（OR=0．23，P=0．025）、国际麻醉学协会（ASA）分级（OR=0．19，P=0．025）是影响患者术后1年死亡率的相关因素。结论治疗老年髋部骨折的同时应注意并存疾病，做到术前、术中、术后积极预防可以减少或避免围术期致命性并发症的出现，术后可获得良好的功能恢复。

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis. Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years（80-90 years old） undergoing operation. There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture. 71 cases （74.7%） had preoperative concomitant medical diseases. Screw fixation was performed in 3 eases （3.2%）, hemiarthroplasty in 75 cases （78.9%）, total hip replacement in 4 eases （4.2%）, proximal femoral nail antirotation （PFNA） in 9 cases （9.5%） and reconstruction interlocking nail fixation in 4 cases （4.2%）. Results No mortality was found during hospitalization. Postoperative anemia was the most common （74.7%）, followed by hypoproteinemia （ 68.4%）, digestive disorders （ 30.5%）, electrolyte disturbance （28.4%） and psychiatric symptoms （15.8%）. At least one-year follow up was made in 73 cases. 39 cases （53.4%） acquired independent activities after surgery, 48 （65.8% ） patients recovered to the preoperative level of activity. The concomitant diseases before surgery （OR = 0.23, P = 0. 011 ）, preoperative ability of activity （OR=0. 23,P=0. 025）,the American Society of Anesthesiology （ASA） classification （OR= 0. 19,P= 0. 025） were the related factors influencing the one-year mortality. Conclusions The treatment of concomitant diseases should be emphasized in treating fracture. The active prevention during preoperative,intraoperative, postoperative period could reduce or avoid fatal complications and acquire good functions.