高龄患者股骨粗隆间骨折围手术期处理.docVIP

高龄患者股骨粗隆间骨折围手术期处理 　 作者：杨开锦，高堂成，王力群 【关键词】 股骨粗隆 Perioperative management of elderly patients with intertrochanteric femoral fracture 　　【Abstract】 AIM: To explore the components and methods of perioperative management of elderly patients with intertrochanteric femoral fracture. METHODS: A retrospective analysis was performed in 45 aged patients with intertrochanteric femoral fracture. The complications, preoperative preparation, operative indications, internal fixation devices and postoperative management were reviewed. RESULTS: Fortytwo cases were followedup. The treatment effect was evaluated by fracture healing, joint motion, patients selfevaluation and ability to manage the daily life, and excellent or good recovery was found in 35 cases (83.3%). No operationcaused deterioration of complications was found and no patients died of operations. CONCLUSION: The perioperative management should include accurate evaluation of general condition, sufficient preoperative preparation, appropriate choice of internal fixation devices and operation procedure, reasonable medication and functional training after operation, all of which are the key to diminishing the risks for postoperative complications and to improving the surgery success of intertrochanteric femoral fracture in elderly patients. 　　【Keywords】 fractures, femoral trochanter; fracture fixation, internal; intraoperative period; aged 　　【摘要】 目的： 探讨高龄患者股骨粗隆间围手术期处理的内容和方法. 方法： 对45例高龄患者股骨粗隆间骨折的合并症、术前准备、手术适应症与内固定的选择、以及术后处理进行回顾性分析. 结果： 术后随访42例，根据患者骨折愈合、关节活动、主观感觉与生活能力恢复等因素评定疗效，优良率为83.3%(35/42例). 未发生因手术所致内科合并症加重或患者死亡. 结论： 准确的术前全身状况评估、积极充分的术前准备、内固定器械和术式的选择、术后的合理用药和功能锻炼是高龄患者股骨粗隆间骨折围手术期处理的重要内容，是减少手术并发症、提高手术疗效的关键. 　　【关键词】 骨折，股骨粗隆；骨折固定术，内；手术期间；老年人 　 　　0引言 　　股骨粗隆部骨折多见于老年人. 近年来，由于手术治疗具有能早期功能锻炼、关节运动恢复好、减少了长期卧床导致的心肺功能下降、褥疮和坠积性肺炎及泌尿系感染等并发症等优点，多主张采用内固定术以缩短治疗时间. 高龄患者常并存各种内科合并症，强调该类手术的围手术期处理是确保高龄患者生命安全和手术成功的关键. 　　1对象和方法 　　1.1对象 　　200201/200412收治高龄股骨粗隆间骨折患者45例，男31例，女14例；年龄80～91（平均85.6）岁. 左侧44例，右侧51例. 骨折类型：按Evan’s法分型，Ⅰ类顺粗隆骨折41例，其中Ⅰ型1例，Ⅱ型4例，Ⅲ