CAJ | 학술논문

目的：了解老年髋部骨折患者围术期情况及术后1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。方法回顾性地分析复旦大学附属华东医院2010年1月～12月因髋部骨折住院并施行手术治疗的老年患者234例（年龄≥60岁），通过病史查阅及电话随访，记录患者年龄、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%（278/301），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30d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患者各占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，充分进行多学科评估和术前准备，选择合适的手术及麻醉方式，加强围术期管理，降低术后潜在并发症。
목적：료해노년관부골절환자위술기정황급술후1년결국병탐토진일보강저수술풍험、제고수술료효적가능조시。방법회고성지분석복단대학부속화동의원2010년1월～12월인관부골절주원병시행수술치료적노년환자234례（년령≥60세），통과병사사열급전화수방，기록환자년령、성별、관부골절류형、수술전후영양상황（BMI、혈장백단백수평、혈홍단백수평）、일상생활능력、인지공능、주요반발질병、수술방식、마취방식、술후병발증등。결과（1）노년인점관부골절총수92.36%（278/301），녀성다우남성。（2）술전신체상황다처우ASA Ⅱ～Ⅲ급지간，인지공능다재정상혹경도감퇴，심공능다재NYHA Ⅰ～Ⅱ급；술전주요영양지표균처우정상치저한；고혈압병、심혈관병、당뇨병、신경계통질병、만성지기관염、폐부감염등시상견반발질병。（3）술후30d급1년적사망솔분별위2.99%화13.68%；술후생활자리능력완전회복、부분회복급무개선적환자각점64.32%，25.55%화10.13%；골절류형、골절전환자BMI、수술류형、술후병발증급술전신체상황대수술효과구유현저성의의（P＜0.05）。결론노년관부골절응급시진행수술치료，충분진행다학과평고화술전준비，선택합괄적수술급마취방식，가강위술기관리，강저술후잠재병발증。
Objective To investigate the peri-operative conditions of the elderly patients with hip fracture and their 1-year outcomes after surgery in order to reduce the risk of surgery and improve the surgical efficacy. Methods A retrospective analysis was carried out on 234 elderly hip fracture patients (≥60 years) who underwent surgery in our hospital from January to December 2010. Their clinical data and post-operative outcomes were collected through medical records and phone call follow-up. Statistical analysis was performed on the following data: age, gender, type of fracture, nutritional status [body mass index (BMI), and serum levels of albumin and hemoglobin], activities of daily living (ADL) function, cognitive function, preoperative comorbidities, type of surgery, type of anesthesia, and postoperative complications. Results Among all patients suffering from hip fracture admitted to our hospital in 2010, the elderly accounted for 92.36%(278/301), with more females than males. The preoperative health status of the most patients belonged to American Society of Anesthesiologists (ASA) Classes Ⅱ and Ⅲ. They mostly had“normal”or“mild cognitive impairment”in cognitive function preoperatively, and New York Heart Association (NYHA) Class Ⅰ or Ⅱ in cardiac function. Their preoperative nutritional indicators were towards the lower limits of normal. Hypertension, cardiovascular disease, diabetes mellitus, neurological disease, chronic bronchitis, and chest infection were the most common comorbidities. The mortality was 2.99% and 13.68% respectively for 30 d and 1 year postoperatively. There were 64.32%of the cohort having complete recovery of their ADL function, 25.55%having partial recovery and 10.13% having no recovery. Univariate analysis indicated that the type of fracture, preoperative BMI, type of surgery, postoperative complications and preoperative general physical health status were closely related to the efficacy of surgical treatment (P<0.05). Conclusion Timely surgical treatment should be performed for the elderly patients with hip fracture. We need to make a multidisciplinary assessment and adequate preparation preoperatively, select the optimal type of surgical approach and anesthesia,strength the preoperative management, and reduce postoperative complication for the elderly.