CAJ | 학술논문

目的分析80岁以上高龄股骨颈骨折患者的手术治疗过程,总结围术期特点,对今后高龄患者的治疗提供帮助.方法回顾性研究自2000年6月至2008年6月手术治疗的61例80岁以上股骨颈骨折患者的治疗过程,男25例,女36例;平均年龄83.4岁(80～94岁).新鲜骨折53例,其中Garden Ⅰ、Ⅱ型6例,GardenⅢ、Ⅳ型47例;陈旧骨折8例,均为GardenⅣ型.51例(84%)患者术前合并内科或神经科疾病.给予必要的术前检查和处理后,6例Garden Ⅰ、Ⅱ型骨折行空心钉内固定术;55例GardenⅢ、Ⅳ型骨折(47例新鲜骨折和8例陈旧骨折)中,2例患者因髋臼有明显骨关节炎表现而行骨水泥型人工全髋置换术,其余53例均行人工股骨头置换术.结果空心钉内固定组平均手术时间51 min,平均术中出血50 ml;人工股骨头置换组平均手术时间81 min,平均术中出血180 ml;人工全髋置换组平均手术时间105 min,平均术中出血350 ml.15例(25%)患者于术后住院期间出现并发症,其中心血管系统的并发症(低血压、心功能不全、房颤)最多,为12%.空心钉内固定组、股骨头置换组和全髋置换组术后血红蛋白比术前分别平均下降11.9%、17.1%和18.1%,术后自蛋白比术前分别平均下降10.8%、18.1%和20.2%.17例(28%)患者术后血红蛋白<100 g/L,4例(7%)术后白蛋白<30 g/L.结论 80岁以上高龄股骨颈骨折患者常合并多种内科或神经科疾病,手术风险高,充分的术前准备、积极防治围术期各种并发症是保证手术成功的重要因素.
목적 분석80세이상고령고골경골절환자적수술치료과정,총결위술기특점,대금후고령환자적치료제공방조.방법 회고성연구자2000년6월지2008년6월수술치료적61례80세이상고골경골절환자적치료과정,남25례,녀36례;평균년령83.4세(80～94세).신선골절53례,기중Garden Ⅰ、Ⅱ형6례,GardenⅢ、Ⅳ형47례;진구골절8례,균위GardenⅣ형.51례(84%)환자술전합병내과혹신경과질병.급여필요적술전검사화처리후,6례Garden Ⅰ、Ⅱ형골절행공심정내고정술;55례GardenⅢ、Ⅳ형골절(47례신선골절화8례진구골절)중,2례환자인관구유명현골관절염표현이행골수니형인공전관치환술,기여53례균행인공고골두치환술.결과 공심정내고정조평균수술시간51 min,평균술중출혈50 ml;인공고골두치환조평균수술시간81 min,평균술중출혈180 ml;인공전관치환조평균수술시간105 min,평균술중출혈350 ml.15례(25%)환자우술후주원기간출현병발증,기중심혈관계통적병발증(저혈압、심공능불전、방전)최다,위12%.공심정내고정조、고골두치환조화전관치환조술후혈홍단백비술전분별평균하강11.9%、17.1%화18.1%,술후자단백비술전분별평균하강10.8%、18.1%화20.2%.17례(28%)환자술후혈홍단백<100 g/L,4례(7%)술후백단백<30 g/L.결론 80세이상고령고골경골절환자상합병다충내과혹신경과질병,수술풍험고,충분적술전준비、적겁방치위술기각충병발증시보증수술성공적중요인소.
Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.