围手术期多学科协作早期手术治疗 在老年股骨转子间骨折中的应用

Application of perioperative multidisciplinary collaborative early surgery for femoral intertrochanteric fracture in the elderly

目的观察并评价围手术期多学科协作并早期手术在老年患者股骨转子间骨折的临床疗效。方法选取2019年6月至2022年3月江西省中西医结合医院收治的60例老年股骨转子间骨折患者为研究对象,采用随机数字表法将其分为A组和B组,每组各30例。A组患者采用由骨科医生主导在围手术期采取多学科协作行非早期股骨近端髓内钉(PFNA)手术治疗,手术时机为入院后大于3 d(>3 d)。B组患者采用由骨科医生主导在围手术期采取多学科协作行早期PFNA内固定手术治疗,手术时机为入院后3 d以内手术(≤3 d)。比较两组围手术期手术失血总容量、术中操作所需时间、患者遭受疼痛(VAS≥4分)时间、住院天数、骨折临床愈合所需时间,术后3个月髋关节功能Harris评分、术后并发症发生率。结果B组患者围手术期患者遭受疼痛时间、住院天数指标均短于A组,差异有统计学意义(P<0.05)。两组的围手术期手术失血总容量、术中操作时间、骨折临床愈合所需时间、髋关节功能Harris评分、术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论围手术期多学科协作早期手术治疗老年股骨转子间骨折患者,患者遭受疼痛时间、住院天数均较短,符合快速康复的理念,是一种有效的治疗方式。

Objective To observe the effect of clinical application of perioperative multidisciplinary collaborative early surgery for femoral intertrochanteric fracture in the elderly.Methods A total of 60 elderly patients with femoral intertrochanteric fracture in Jiangxi Province Hospital of Integrated Chinese and Western Medicine from June 2019 to March 2022 were selected as research objects.They were divided into group A and group B by the random number table method,with 30 cases in each group.The patients in group A were treated by multidisciplinary cooperation during perioperative period,and the operation time was more than 3 days after admission(>3 days).The patients in group B were treated with early proximal femoral nail antirotation(PFNA)internal fixation surgery led by orthopedic surgeons during perioperative period,and the operation time was less than 3 days after admission(≤3 days).The total blood loss volume during perioperative period,the time required for intraoperative operation,the time of patients suffering from pain,the days in the hospital,the time required for clinical healing of fractures,Harris score of hip joint function and the incidence of postoperative complications were compared between the two groups.Results The duration of perioperative pain and the hospital stay in group B were lower than those in group A,the differences were statistically significant(P<0.05).There were no significant difference in the total blood loss,the operation time during operation,the clinical healing time of fracture,the Harris score of hip joint function and the total incidence rate postoperative complications between the two groups(P>0.05).Conclusion Perioperative multidisciplinary collaboration in early operation for elderly patients with femoral intertrochanteric fracture is an effective treatment method,which is in line with the concept of rapid recovery.