高龄患者髋部骨折围术期损害控制与加速康复

Damage control surgery and enhanced recovery of elderly patient undergoing hip fracture

随着全球老龄化社会的来临,高龄患者髋部骨折的发生率、病死率、治疗成本逐年攀升,而顺应循证医学原则实施的临床对照研究和卫生经济学分析也与日俱增,但对其治疗模式的探讨仍无确定性结论,传统治疗模式和新兴治疗理念的并存使得大部分临床医生在工作过程中常常面临困难的选择。本文将高龄患者定义为WHO界定的老年(> 75岁)以上的患者,纳入依据在于该人群髋部骨折的治疗集中体现了当前的学术争鸣。文章针对这部分患者人群的术前病理状态、基于获益/风险比的治疗选择、基于损害控制的外科技术、围术期加速康复等环节,从笔者所在学科的治疗现状出发,结合国内外近期发表的若干专家共识和荟萃分析进行阐述,解读了目前领域内一些新观点、新认识,也提出了对当前临床实践中存在的误区的理解,为高龄髋部骨折患者围术期损害控制与加速康复提供参考意见。该意见根据循证医学可信度划分为Ⅴ级。

The morbidity,mortality,and economic burden of hip fracture in elderly patients grow sharply with the advancement of the global aging society. While the controlled clinical trial based on evidence-based medicine increases correspondingly,as well as health economic statistical analysis,one dilemma we are facing is that the therapeutic mode is still inconclusive. This makes majority of the doctors confront great challenge when treating elderly patients undergoing hip fracture. This comprehensive article focuses on the key topics on comorbidity,the therapeutic decision-making based on benefit-risk ratio,damage-controlled surgery,and peri-operative enhanced rehabilitation in a specific elderly population with their age greater than 75 years according to the newest WHO classification. The authors presented their viewpoints by combining their own clinical practice and expert consensus,published guideline and meta-analysis. Some lately introduced theories,controversies and misunderstanding were also involved in the discussion,so as to offer the readers credible advices regarding the implement of damage control surgery and enhanced recovery on elderly patients with hip fracture. These advices were classified as type V in terms of the standard of evidence-based medicine.