Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Health economics for intra-capsular hip fractures undertaking fixation

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide.The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.AIM To determine the most beneficial method of fixation for patients with intracapsular hip fractures.METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods.Patient notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after surgery.RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period.There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture configuration.There was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation methods.Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25.There were 9(19%)and 4(11%)patients respectively,who required re-operation.There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring re-operation.This was predicted by initial fracture displacement and patient age.Arthroplasty may need to be carefully considered for health economics and patient benefit.

Manual reduction with traditional small splints for distal radius fracture in older patients

Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(P<0.05).The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment(P<0.05).The time of fracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.

A Review of Hip Fracture Mortality—Why and How Does Such a Large Proportion of These Elderly Patients Die?

As the number of aged patients presenting with hip fractures continues to rise [1], the substantial mortality associated with this pathology must continue to be an area of scrutiny and improvement. While some dismiss the high mortality as an inevitable consequence of the comorbidities inherent in the original injury and the patient population, data suggest that at 2 years post-hip fracture, survivors’ risks have regressed significantly and in fact, return to the same mortality risk as the non-fracture population [2]. This indicates that the risk of death is largely created specifically by the hip fracture and its treatment per se rather than the comorbidities of the hip fracture population, and offers scope for the potential reduction of these causes of death if we can identify and manage them appropriately. At a time when the incidence of hip fracture worldwide is on a steady rise, this review considers why and how these older patients die, and whether our developing guidelines and continuing research is adequately addressing these causes of death.

Clinical analysis of nosocomial infection in 180 elderly patients with hip fractures

Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck

Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?

BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.

Evaluation of joint awareness after acetabular fracture:Validation of the Forgotten Joint Score according to the COSMIN checklist protocol

BACKGROUND A fracture of the acetabulum is an uncommon,but serious injury.Established outcome tools do not reflect the patient’s perspective after fracture of the hip joint.Originally designed for post-arthroplasty patients,the Forgotten Joint Score(FJS)is a patient-reported outcome measurement(PROM)tool evaluating the diseasespecific health-related quality of life(HR-QoL).AIM To validate the FJS in patients after acetabular fracture.METHODS In a prospective mono-centric cohort study,we evaluated 100 patients at mean 5.2±3.6 years after a fracture of the acetabulum.The validation study followed the complete COSMIN checklist protocol.For calculation of convergent validity,we used the Tegner-Activity Scale,the Western Ontario and McMaster Universities Osteoarthritis Index,the EuroQol-5D,and a subjective rating of change as an anchor variable.RESULTS We confirmed good internal consistency with a Cronbach‘s alpha of 0.95.With an intraclass correlation coefficient of 0.99(95%CI:0.97,0.99),test-retest reliability of the FJS was excellent.Correlation coefficients between the questionnaires were moderate to high ranging from|0.56|to|0.83|(absolute value).No relevant floor or ceiling effects occurred.Standard error of measurement was 3.2 and smallest detectable change(SDC)was 8.8.Thus,changes greater than 8.8 points between two assessments denote a real change in FJS.CONCLUSION The FJS is a valid and reliable tool for evaluation of patient-reported outcome in posttraumatic condition after acetabular fracture.The SDC indicating a real clinical improvement was 8.8 points in the FJS.We could confirm responsiveness of the FJS and found no relevant floor-or ceiling effects.

The effects of a patient-centred rehabilitation model of care targeting older adults with cognitive impairment on healthcare practitioners

Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adults with a CI may negatively influence the attitudes and job satisfaction of healthcare practitioners working with this population. The current study is a part of a larger intervention study allowing patients with CI following a hip fracture access to rehabilitation care and implementing a patient-centred model to facilitate caring for this new population. This new model required a substantial change in the skillset and knowledge of healthcare practitioners. The focus of this study was to explore the impact on the healthcare practitioners of adopting this new model for providing care to older adults with a CI following a hip fracture. The attitudes, dementia knowledge, job satisfaction, and work stress of healthcare practitioners were the focus of evaluation. Key study findings showed that stress due to relationships with coworkers, workloads and scheduling, and the physical design and conditions at work were moderated post-intervention. Staff responses also improved for job satisfaction, biomedical knowledge of dementia, and degree of hopefulness about dementia. Although we cannot state conclusively that the our model was solely responsible for all the staff improvements observed post-intervention, our findings provide further support to the argument that patients with CI should be allowed access to rehabilitation care. Rehabilitation units need to provide education that utilizes a person-centred approach accepting of patients with CI, and focuses on areas that can bolster staff’s positive, dementia-sensitive attitudes. Ultimately, the aim is to create a culture that provides the highest standard of care for all patients, reduces work-related stress, increases job satisfaction, and leads to the highest quality of life for patients during and after rehabilitation.

Optimized clinical practice for superaged patients with hip fracture:significance of damage control and enhanced recovery program

With the advent of global aging,the incidence,mortality,and medical costs of hip fracture among aged patients are increasing annually.The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day.However,unfortunately,no specific recommendations regarding the procedures for the treatment of hip fracture are available.Meanwhile,the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice.These factors make the therapeutic approach for aged patients,especially among superaged patients with hip fracture,extremely challenging.This study focuses on superaged patients(>80 years as defined by the World Health Organization)with hip fracture and includes their preoperative pathological condition;therapeutic decision-making in terms of the benefit and risk ratio,damage control theory,and enhanced recovery after surgery were also investigated.These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently.The study presents some new ideas and approaches currently recognized in the field,such as preoperative assessment,surgical planning,safety consideration,complication intervention,and enhanced recovery implementation,and further presents some clear interpretations regarding misunderstandings in clinical practice.Finally,optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined.

高龄髋部骨折病人开展3H护理干预后Barthel指数、Harris评分、心理状态的评估

目的:探讨医治高龄髋部骨折病人介入3H护理干预后患者Barthel指数、Harris评分、心理状态结果变化。方法:基于回顾分析,抽取研究对象为2019年6月-2020年3月骨科治疗的80例老年髋部骨折患者临床资料并统计。借助非盲法将患者平均分为2组,每组各40例。对照组为接受常规骨折护理患者,而观察组为接受3H护理理念的患者。观察2组并发症发生率、日常生活活动能力以及髋关节功能、护理前后心理状态、生活质量、护理满意度、遵医行为以及自护能力。结果:将2组于护理前做心理状况比较,差异无统计学意义,P>0.05。而护理后,观察组心理状况比对照组更佳,且并发症发生率低,差异有统计学意义,P<0.05;观察组反馈的Barthel、Harris评分等均优于对照组,2组比较有统计学意义,P<0.05。结论:面对高龄髋部骨折病人融入3H护理工作能保证骨关节恢复良好,维护患者的良好心态,促进其生活质量提升,临床推行价值可观。

老年不稳定型股骨粗隆间骨折应用双动头置换和Intertan内固定治疗的优劣差异

目的探讨老年不稳定型股骨粗隆间骨折应用双动头置换和Intertan内固定治疗的临床疗效差异。方法选取2010年3月~2014年6月我院收入治疗的老年不稳定型股骨粗隆间骨折患者60例,根据其选择的治疗方式分为置换组和内固定组,置换组30例患者采用双动头置换治疗,内固定组30例患者采用Intertan内固定治疗,比较两组患者在手术时间、住院时间、围术期输血量等手术相关数据差异、完全负重时间,术后1、3、12个月髋关节功能评分（Harris评分）及两组患者术后1年的并发症发生率、死亡率。结果两组患者在手术时间等手术相关数据上均无统计学意义（P〉0.05）;置换组患者完全负重时间为（4.2±1.3）周,术后1个月Harris评分为（73.9±3.6）分,术后3个月Harris评分（82.6±4.3）分均较内固定组患者（9.8±2.5）周的完全负重时间、（53.1±3.7）分的术后1个月Harris评分及（78.8±4.1）分的术后3个月Harris评分具有统计学意义（P〈0.05）;且置换组患者术后随访情况差异无统计学意义（P〉0.05）。结论双动头置换术与Intertan内固定术治疗老年不稳定型股骨粗隆间骨折均具有不错的临床疗效,但双动头置换术更利于患者的早期负重及髋关节功能恢复,利于患者的及早康复。

老年髋部骨折术后1年病死率的危险因素分析及年龄矫正查尔森合并指数对其的预测价值

目的分析影响老年髋部骨折患者手术后1年病死率的危险因素及年龄矫正查尔森合并指数对其的预测价值。方法回顾性分析2018年1月至2022年11月在北京市顺义区医院创伤骨科行髋部骨折手术治疗的老年患者的病历资料,符合纳入标准共652例,收集年龄、性别、骨折侧别、骨折类型、美国麻醉医师协会(ASA)分级、住院天数、麻醉方式、术后白蛋白、术后白细胞、术后血红蛋白、年龄矫正查尔森合并指数(ACCI)和是否发生肺炎等信息,分析与患者1年病死率相关的危险因素。结果652例患者术后1年的病死率为21.5%(140/652)。单因素Cox回归分析显示年龄、住院时间、ACCI及术后是否发生肺炎与术后1年病死率有统计学意义。多因素Cox回归分析显示年龄(HR=1.087,95%CI:1.060~1.114,P=0),ACCI(HR=1.645,95%CI:1.548~1.747,P=0),术后发生肺炎(HR=2.353,95%CI:1.624~3.408,P=0)是老年髋部骨折患者1年内死亡的危险因素。ACCI预测老年髋部骨折患者术后1年病死率的AUC为0.912,最佳阈值为5.5时的特异度为0.834,敏感度为0.871。结论年龄、ACCI、术后发生肺炎时老年髋部骨折术后1年死亡的独立危险因素,ACCI对预测老年髋部骨折术后1年病死率有一定价值,可为临床病情评估提供方法。

骨科主导的多学科共管模式治疗老年股骨颈及股骨转子间骨折患者的效果分析

目的:探讨骨科主导的多学科共管模式在老年股骨颈及股骨转子间骨折患者治疗中的效果。方法:选取2019年3月-2023年3月内蒙古自治区包头市第四医院创伤运动医学科收治的220例老年股骨颈及股骨转子间骨折患者为研究对象,按照随机数字表法将患者分为对照组(n=120)与试验组(n=100)。对照组采用常规治疗,其中20例采用保守治疗,100例采用手术治疗,试验组采用多学科共管模式治疗。比较两组的治疗方法、治疗时间及治疗结果。结果:试验组术前等待时间、手术时间及住院时间均短于对照组,差异均有统计学意义(P<0.05)。试验组治愈率为85.00%,高于对照组的70.00%,褥疮发生率为5.00%,低于对照组的14.00%,差异均有统计学意义(P<0.05)。试验组病死率为3.00%,低于对照组的5.00%,但差异无统计学意义(P>0.05)。结论:老年股骨颈骨折及转子间骨折患者采用骨科主导的多学科共管模式,可对患者更快开展术前评估,减少患者术前等待及住院时间,降低不良反应发生率,整体效果更优。

渐进式平衡训练在老年髋部骨折术后康复中的应用

目的探讨渐进式平衡训练在老年髋部骨折术后康复中的应用效果。方法方便抽样法选取2022年1月-2023年12月在安徽中医药大学第二附属医院骨科收治的老年髋部骨折患者150例,按随机数字表法分为对照组(n=75)和观察组(n=75),对照组患者术后接受常规护理,观察组患者术后接受渐进式平衡训练。分别于术后1周、术后12周统计两组步长、步速、髋关节评分(Harris),分别于术后2周、4周、8周、12周统计两组Berg平衡量表(BBS)评分、Barthel评分。结果术后12周,观察组术后步长、步速、Harris评分均高于对照组(P<0.05);术后4周、8周、12周,观察组术后BBS和Barthel评分均高于对照组(P<0.05)。结论在老年髋部骨折术后康复中应用渐进式平衡训练是可行的和有效的,可促进老年髋部骨折术后患者康复。

痴呆对老年髋部骨折术后并发症的影响

背景:随着人口老龄化,合并痴呆的髋部骨折患者逐渐增加,给外科治疗带来挑战。目的:明确痴呆对老年髋部骨折患者术后并发症的影响。方法:分析2000-2019年在解放军总医院就诊的60岁以上首次髋部骨折患者,以入院时合并痴呆患者为研究对象,以年龄±5岁、性别、骨折类型为条件进行1∶10匹配非痴呆患者,比较两组术后并发症发生差异,包括肺炎、呼吸衰竭、胃肠道出血、泌尿系统感染、伤口感染、下肢深静脉血栓、肺栓塞、心绞痛、心律失常、心力衰竭、心肌梗死、脑卒中、死亡。采用多因素条件logistic回归评估痴呆对主要并发症的影响。结果与结论:纳入2887例患者,其中125例(4.3%)为痴呆患者,匹配1243例非痴呆患者。痴呆患者平均年龄为(80.6±7.4)岁,女性占64.8%,转子间骨折占53.6%,股骨颈骨折占46.4%。25例(20.0%)痴呆患者和123例(9.9%)非痴呆患者发生主要并发症(P<0.01)。痴呆患者髋部骨折术后主要并发症发生风险为200.0/1000(95%CI,139.3-278.6),非痴呆患者为99.0/1000(95%CI,83.6-116.9)。多因素条件logistic回归显示,痴呆患者髋部骨折术后主要并发症的发生风险是非痴呆患者的2倍(OR,2.11;95%CI,1.08-4.10)。结果可见,痴呆是老年髋部骨折患者发生术后并发症的独立危险因素。应对痴呆患者进行术前风险评估,开展相应的防治措施以减少术后并发症。

BIS指导下丙泊酚联合瑞芬太尼靶控输注对老年髋关节置换患者术中丙泊酚用量和术后谵妄发生率的影响

目的:探讨脑电双频指数(BIS)指导下丙泊酚联合瑞芬太尼靶控输注(TCI)对老年髋关节置换患者术中丙泊酚用量和术后谵妄发生率的影响。方法:回顾性分析老年髋部骨折患者的病例资料,依据患者接受的麻醉方式不同分为两组,即接受BIS指导下丙泊酚联合瑞芬太尼TCI麻醉的髋关节置换患者纳入观察组,接受BIS指导下丙泊酚联合瑞芬太尼持续静脉泵入的同类患者纳入对照组,建立二元Logistics回归分析,构建倾向性评分匹配模型分析得出观察组获取56例病例资料,对照组获取49例病例资料,组间差异无统计学意义(P>0.05)。观察两组不同时间点[入室后(T_(0))、麻醉后(T_(1))、骨水泥后(T_(2))、术毕(T_(3))、出室后(T_(4))、术后3h(T_(5))及术后5h(T_(6))时刻]的平均动脉压(MAP)、心率(HR)、手术一般情况、丙泊酚用量、BIS值维持情况,对比两组不同时间点(术前及术后1h、6h、1d、3d、7d时刻)谵妄评分[谵妄量表分析系统(CAM-CR)],记录两组术后谵妄发生率,比较两组不同时间点(术前及术后1d)的血糖(Glu)及血浆肾上腺素(E)、皮质醇(Cor)水平变化。结果:观察组在T_(1)时刻MAP值相比T_(0)时刻有显著性降低(P<0.05),两组均在T_(2)时刻MAP值相比T_(0)时刻有显著性降低(P<0.05),其中对照组在T_(5)、T_(6)及T_(7)时刻HR值相比T_(4)时刻出现显著性降低(P<0.05);两组手术时间、麻醉时间及术中出血量对比均差异无统计学意义(P>0.05),观察组丙泊酚用量显著少于对照组(P<0.05),观察组BIS值目标范围维持时间比显著高于对照组(P<0.05),观察组苏醒时间、气管拔管时间及定向力恢复时间显著短于对照组(P<0.05);术后1h、6h、1d、3d、7d,两组CAM-CR评分可见先升高后降低,均显著高于术前(P<0.05),观察组术后1h、6h、1d、3d的CAM-CR评分均显著低于对照组(P<0.05),两组术后7d的上述评分较术前和组间同时间点对比均差异无统计学意义(P>0.05);观察组的术后谵妄发生率为5.36%,显著低于对照组的18.37%(P<0.05);术后1d,两组Glu及血浆E、Cor水平相比术前出现显著性升高(P<0.05),但观察组显著低于对照组(P<0.05)。结论:BIS指导下丙泊酚联合瑞芬太尼TCI应用于老年髋关节置换患者术中能稳定血流动力学,改善围手术期指标,并减少丙泊酚用量,改善BIS值维持情况,并促进患者麻醉恢复,减少术后谵妄发生风险,同时能减轻机体应激反应。

老年髋部骨折患者围术期容量管理的最佳证据总结

目的检索、评价和整合老年髋部骨折患者围术期容量管理的最佳证据,为临床医护理人员提供依据。方法按照“6S”证据模型,系统检索国内外数据库和网站。数据库包括:BMJ Best Practice,UpToDate,临床实践指南美国骨科医师协会、美国骨与矿物质研究协会、澳大利亚和新西兰髋部骨折登记处、欧洲创伤与急诊外科学会、英国国家卫生与临床优化研究所网站、苏格兰校际指南网、乔安娜布里格斯研究所、Cochrane Library,CINAHL,Embase,PubMed,Web of Science,中国知网、万方数据库、维普数据库、循证卫生保健中心数据库、医脉通、中国生物医学文献数据库及骨科相关网站。检索关于老年髋部骨折患者围术期容量管理的证据,包括指南、临床决策、最佳实践、专家共识系统评价及原始研究,检索时限为建库至2022年8月。由2名研究人员对文献质量进行评价,并对证据进行提取、评价与整合,独立完成文献质量评价。结果共纳入15篇文献,包括3篇临床决策、1篇最佳实践、2篇指南、7篇专家共识、2篇系统评价,从多学科团队协作、动态评估和监测液体状态、液体复苏、术中和术后容量管理方案、健康宣教7个方面总结证据。结论本研究汇总老年髋部骨折患者围术期容量管理的最佳证据,可为医护人员提供循证依据,医护人员应充分结合临床情景,动态评估液体容量状态变化,制定个性化的容量管理策略,改善患者预后。

老年髋部骨折术前等待时间对术后骨折愈合时间的影响

目的根据江苏大学附属句容医院临床收治的老年髋部骨折患者数据进行分析,来评估老年髋部骨折患者术前等待时间是否对术后骨折愈合时间有影响。方法通过收集2017年9月至2022年11月江苏大学附属句容医院老年髋部骨折的病例资料,筛选出确诊且接受手术治疗的老年髋部骨折患者108例,根据术前等待时间不同,分为早期手术组(60例)和延期手术组(48例),分析两组患者的年龄,性别,住院时间,术后骨折愈合时间是否有区别。结果早期组骨折愈合时间上短于延期组,差异有统计学意义(P<0.05);两组的手术操作时间、手术中出血量、性别、年龄比较,差异无统计学意义(P>0.05)。结论老年髋部骨折患者应在骨折48 h内尽早接受手术,有助于缩短骨折愈合时间,从而减少并发症的发生。

ERAS对老年患者髋部骨折术后1年死亡率的影响

目的:探讨加速康复外科(ERAS)对老年髋部骨折术后1年死亡率的影响。方法:回顾性分析2018年1月1日-2020年12月31日石河子大学医学院第一附属医院关节外科收治的437例70岁以上老年髋部骨折(包括股骨颈骨折和股骨转子间骨折)患者的病例。按入院后48h内是否手术分为ERAS组(244例)和非ERAS组(193例)。比较两组患者的年龄、术中出血量、手术时间、住院时间、围手术期死亡人数、出院3个月内死亡人数、出院1年死亡人数和出院后1年肺部感染、下肢深静脉血栓,褥疮的发生人数。结果:两组患者年龄、手术时间、术中输血量比较,差异无统计学意义(t=1.510,0.388,0.150,P>0.05);ERAS组住院时间较非ERAS组少,差异有统计学意义(t=2.294,P<0.05);两组患者的围手术期死亡人数、褥疮发生人数比较,差异无统计学意义(P>0.05);ERAS组出院3个月、出院1年内死亡人数,出院后1年内肺部感染、深静脉血栓人数较非ERAS组少,差异有统计学意义(P<0.05)。结论:ERAS能减少老年髋部骨折患者的住院天数,减少术后肺部感染和深静脉血栓的发生,降低术后1年内老年髋部骨折患者的死亡率。