老年股骨转子间骨折患者的围手术期风险评估与控制

Perioperative Risk Assessment and Control in Elderly Patients with Intertrochanteric Fractures

目的对老年股骨转子间骨折患者在围手术期的风险情况进行评估,并对风险情况进行有效的控制。方法该院在2014年1月—2016年6月期间,一共收治了50例老年股骨转子间骨折患者,通过对以上50例患者的临床症状进行回顾性研究,对所有患者的骨析分型以及手术方法、患者的并发症的发生情况、术前的评估情况以及准备情况进行分析。结果I型患者共有7例,其中6例患者通过髋动力螺钉方法进行固定,1例患者通过单臂外固定支架进行固定,II型患者共有16例,其中14例患者通过髋动力螺钉方法进行固定,2例患者通过单臂外固定支架进行固定,III型患者共有15例,其中6例患者通过髋动力螺钉方法进行固定,9例患者通过PFNA钉进行固定,IV型患者共有6例,所有患者通过PFNA钉进行固定,V型患者共有6例,所有患者通过PEN钉进行固定;50例患者中有21例患者出现并发症情况,其中发生肺部感染的患者共有7例,发生深静脉血栓的患者共有6例,发生髋内翻的患者共有6例,发生死亡的患者共有2例;50例患者,2例患者因为在手术过程中突发脑出血死亡,余下的48例患者均顺利完成手术,手术之后,对患者进行长达4年的随访工作,随访结果为:患者的骨折情况康复患者有27例(54.0%),骨折情况恢复情况比较良好的患者有14例(28.0%),骨折情况恢复较差患者有7例(14.0%),死亡患者有2例(4.0%)。结论老年股骨转子间骨折患者的治疗是十分复杂的,患者的具体情况与手术效果密切相关,所以,术前需要对患者的具体情况进行了解,在进行治疗,可以有效避免并发症,甚至死亡。

Objective To evaluate the risk of perioperative period in elderly patients with intertrochanteric fractures and to effectively control the risk.Methods From January 2014 to June 2016,a total of 50 elderly patients with intertrochanteric fractures of the femur were treated.The authors conducted a retrospective study of the clinical symptoms of the above 50 patients.The analysis of the osteotomy and the surgical method,the occurrence of the patient's complications,the preoperative evaluation and the preparation were analyzed.Results There were 7 patients with type I,6 of whom were fixed by the hip-powered screw method,1 patient was fixed by a single-arm external fixation stent,and 16 patients were type II,14 of whom were treated with the hip-powered screw method for fixation,2 patients were fixed by one-arm external fixation.There were 15 patients with type III,of which 6 were fixed by hip dynamic screw method,9 were fixed by PFNA nail,and 6 were type IV.The patients were fixed by PFNA nails.There were 6 patients with V-type.All patients were fixed by PEN nails.21 of 50 patients had complications.Among them,7 patients had pulmonary vein infection and deep vein thrombosis occurred.There were 6 patients,6 patients with hip varus,and 2 patients with death;50 patients,2 patients died of sudden cerebral hemorrhage during surgery,and the remaining 48 patients were successfully completed.After surgery and surgery,the patient was followed up for 4 years.The follow-up results were as follows:27 patients(54.0%)recovered from the fracture of the patient,and the fracture was restored.There were 14 patients(28.0%)with good recovery,7 patients(14.0%)with poor recovery,and 2 patients(4.0%)with death.Conclusion The treatment of patients with intertrochanteric fractures in the elderly is very complicated.The specific conditions of the patients are closely related to the surgical results.Therefore,it is necessary to understand the specific conditions of the patients before surgery,and to prevent complications and even death.