老年髋部骨折合并终末期肾病的手术疗效分析

Surgery outcomes of elderly hip fracture associated with end-stage renal disease

目的了解终末期肾病 (end stage renal disease,ESRD) 在髋部骨折患者中的发病率,研究 ESRD 对髋部骨折患者预后的影响。方法 2012 年 1 月至 2016 年 12 月我院共收治 60 岁以上、行手术治疗的髋部骨折患者 1004 例,其中合并 ESRD 患者 41 例 (4.1%),其中男 22 例,女 19 例,年龄 60~87 岁,平均(77.39±7.04) 岁,股骨转子间骨折 25 例,股骨颈骨折 16 例,分析 ESRD 对老年髋部骨折预后的影响。结果合并 ESRD 老年髋部骨折患者术后 30 天、1 年病死率分别为 19.5% (8 / 41)、43.9% (18 / 41),19 例 (46.3%) 患者发生 27 项并发症,人均并发症为 (0.683±0.820) 项,平均住院时间 (15.53±14.51) 天,8 例 (19.5%) 术后需再手术,其中 6 例为股骨颈骨折未愈合,1 例股骨粗隆间骨折内固定失效,1 例因假体周围骨折行钢板固定,术后 1 年 ADL 评分平均为 (55.00±7.23) 分,存活患者中 4 例卧床,17 例需辅助装置行走,2 例可完全独立行走。结论髋部骨折合并 ESRD 患者发病率较高,此类患者预后较差,住院时间长,再手术率高,术后1 年病死率高,功能恢复差。

Objective To investigate the impact of end-stage renal disease on the prognosis of hip fracture.Methods From January 2012 to December 2016,1004 hip fracture patients over 60 years old who underwent surgical treatment were admitted to our hospital.End-stage renal disease (ESRD) was observed in 41 patients (4.1%),including 22 males and 19 females with an average age of (77.39±7.04) years (range:60-87 years).There were 25 intertrochanteric fractures and 16 femoral neck fractures.Results The mortality of hip fracture patients with ESRD at 30 days and 1 year was 19.5% (8 / 41),43.9% (18 / 41),respectively.There were 27 complications in 19 patients with ESRD (46.3%).The average complication was (0.683±0.820),while hospital stay (15.53±14.51) days.Eight patients (19.5%) underwent reoperation,including 6 non-healing femoral neck fractures,1 failed fixation of intertrochanteric fracture,and 1 plate fixation after femoral periprosthetic fracture.The average ADL score of patients with ESRD was (55.00±7.23).Among 4 survivors with end-stage renal disease,4 were bedridden,17 could walk with auxiliary device and 2 could walk independently.Conclusions High incidence,poor prognosis and functional recovery,longer hospital stay,higher reoperation rate and mortality rate 1 year after operation are emphasized in the treatment of hip fracture with ESRD.