老年髋部骨折围术期风险及术后一年效果评价-欢迎访问中华老年多.doc

·临床研究· 老年髋部骨折围术期风险及术后一年效果评估 陆文良1，Dewan Sheilesh Kumar1，林伟龙2，沈海敏2，程 群3，郑松柏1* （复旦大学附属华东医院：1老年医学科，2骨科，3骨质疏松科，上海 200040） 【摘 要】目的 了解髋部骨折老年患者围术期情况及术后一年结局并探讨进一步降低手术风险、提高手术疗效的可能措施。方法 回顾性分析我院2010年1月～12月因髋部骨折入住我院并施行手术治疗的老年病人（年龄≥60岁），通过病史查阅及电话随访，记录患者患者年龄、性别、髋部骨折类型、手术前后营养状况（BMI、血浆白蛋白水平、血红蛋白水平）、日常生活能力、认知功能、主要伴发疾病、手术方式、麻醉方式、术后并发症等。结果 （1）老年人占髋部骨折总数92.36%，女性多于男性。（2）术前身体状况多处于ASA II~III级之间，认知功能多在正常或轻度减退，心功能多在NYHA Ⅰ～Ⅱ级；术前主要营养指标均处于正常值低限；高血压病、心血管病、糖尿病、神经系统疾病、慢性支气管炎、肺部感染等是常见伴发疾病。（3）术后30天及1年的死亡率分别为2.99%和13.68%；术后生活自理能力完全恢复、部分恢复及无改善的病人各占64.32%、25.55%和10.13%；骨折类型、骨折前患者BMI、手术类型、术后并发症及术前身体状况对手术效果具有显著性意义（P＜0.05）。结论 老年髋部骨折应及时进行手术治疗，充分多学科评估和术前准备，选择合适的手术及麻醉方式，加强围手术期管理，降低术后潜在并发症。 【关键词】老年人；髋部骨折；手术，预后 【中图分类号】 R？ 【文献标识码】 A 【DOI】 ? The assessment of medical risk and one year postoperative outcomes in elderly patients with hip fracture LU Wen-Liang1, Dewan Sheilesh Kumar1, LIN Wei-Long2, SHEN Hai-Min2, CHENG Qun3, ZHENG Song-Bai1* (1Department of Geriatric Medicine, 2Department of Orthopedics, 3Department of Osteoporosis, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China) 【Abstract】 Objective To investigate the retrieved data on elderly patients who underwent surgery for hip fracture and to explore measures to further reduce the risks of hip fracture surgery while also improving surgical efficacy. Methods A retrospective survey of elderly (age≥60 years) hip fracture patients who underwent surgery at our hospital was carried out. Statistical analysis of the following data was performed: age, gender, type of fracture, nutritional status [Body Mass Index (BMI), serum albumin level, hemoglobin level etc], Activities of Daily Living function, cognitive function, preoperative co morbidities, type of surgery, type of anesthesia, postoperative complications. Results Elderly people accounted for 92.36% of hip fracture admissions. The female to male ratio was 2.5:1. The preoperative health status of most patients belongs to American Society of Anesthesiologists (ASA)