中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2014年
12期
1196-1200
,共5页
王蒙%周雪峰%白克文%鲍磊%彭军%马晓明%周家宁%伍佳剑
王矇%週雪峰%白剋文%鮑磊%彭軍%馬曉明%週傢寧%伍佳劍
왕몽%주설봉%백극문%포뢰%팽군%마효명%주가저%오가검
股骨骨折%高龄%损害控制骨科
股骨骨摺%高齡%損害控製骨科
고골골절%고령%손해공제골과
Femoral fractures%Aged%Damage control orthopedics
目的 探讨应用损害控制技术治疗高龄股骨转子间骨折的临床疗效.方法 选择2008年12月-2013年12月应用损害控制治疗的166例高龄股骨转子间骨折患者,其中男68例,女98例;年龄(85.23±3.19)岁.AO分型:A1型18例,A2型89例,A3型59例.围术期实施损害控制治疗,运用改良生理学与手术严重度评分系统(physiological and operative severity scorefor the enumeration of mortality and morbidity,POSSUM)预测并发症率,用朴茨茅斯改良的POSSUM(Portsmouth modified POSSUM,P-POSSUM)预测病死率,观察预测效价及患者术后预后情况.结果 入院时POSSUM评分＜20分的并发症低风险患者61例,实施损害控制治疗;POSSUM评分评分≥20分的并发症高风险患者105例,完成生理学控制后行损害控制性手术治疗.损害控制前预测并发症发生率为(48.6±6.8)％,病死率为(10.1±1.9)％;损害控制后并发症发生率为(35.6±4.5)％,病死率为(4.6±1.4)％;实际并发症发生率为37.4％,病死率为1.8％,与损害控制前比较,差异均有统计学意义(P均＜0.05).结论 对高龄股骨转子间骨折患者实施损害控制措施,能够规避手术风险,降低术后并发症率及病死率.
目的 探討應用損害控製技術治療高齡股骨轉子間骨摺的臨床療效.方法 選擇2008年12月-2013年12月應用損害控製治療的166例高齡股骨轉子間骨摺患者,其中男68例,女98例;年齡(85.23±3.19)歲.AO分型:A1型18例,A2型89例,A3型59例.圍術期實施損害控製治療,運用改良生理學與手術嚴重度評分繫統(physiological and operative severity scorefor the enumeration of mortality and morbidity,POSSUM)預測併髮癥率,用樸茨茅斯改良的POSSUM(Portsmouth modified POSSUM,P-POSSUM)預測病死率,觀察預測效價及患者術後預後情況.結果 入院時POSSUM評分＜20分的併髮癥低風險患者61例,實施損害控製治療;POSSUM評分評分≥20分的併髮癥高風險患者105例,完成生理學控製後行損害控製性手術治療.損害控製前預測併髮癥髮生率為(48.6±6.8)％,病死率為(10.1±1.9)％;損害控製後併髮癥髮生率為(35.6±4.5)％,病死率為(4.6±1.4)％;實際併髮癥髮生率為37.4％,病死率為1.8％,與損害控製前比較,差異均有統計學意義(P均＜0.05).結論 對高齡股骨轉子間骨摺患者實施損害控製措施,能夠規避手術風險,降低術後併髮癥率及病死率.
목적 탐토응용손해공제기술치료고령고골전자간골절적림상료효.방법 선택2008년12월-2013년12월응용손해공제치료적166례고령고골전자간골절환자,기중남68례,녀98례;년령(85.23±3.19)세.AO분형:A1형18례,A2형89례,A3형59례.위술기실시손해공제치료,운용개량생이학여수술엄중도평분계통(physiological and operative severity scorefor the enumeration of mortality and morbidity,POSSUM)예측병발증솔,용박자모사개량적POSSUM(Portsmouth modified POSSUM,P-POSSUM)예측병사솔,관찰예측효개급환자술후예후정황.결과 입원시POSSUM평분＜20분적병발증저풍험환자61례,실시손해공제치료;POSSUM평분평분≥20분적병발증고풍험환자105례,완성생이학공제후행손해공제성수술치료.손해공제전예측병발증발생솔위(48.6±6.8)％,병사솔위(10.1±1.9)％;손해공제후병발증발생솔위(35.6±4.5)％,병사솔위(4.6±1.4)％;실제병발증발생솔위37.4％,병사솔위1.8％,여손해공제전비교,차이균유통계학의의(P균＜0.05).결론 대고령고골전자간골절환자실시손해공제조시,능구규피수술풍험,강저술후병발증솔급병사솔.
Objective To evaluate the clinical efficacy of damage control measures in treatment of femoral intertrochanteric fracture among the elderly.Methods A total of 166 patients with intertrochanteric fracture treated with damage control measures from December 2008 to December 2013 were included in the retrospective study.There were 68 men and 98 women at age of (85.23 ±3.19) years.Fracture classification using the AO system was type A1 in 18 cases,type A2 in 89 cases and type A3 in 59 cases.Mortality and incidences of postoperative complications were predicted respectively by the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modified POSSUM (P-POSSUM).The validity of damage control measures was evaluated by comparing the predicted risks and observed outcomes.Results On admission,there were 61 patients with low risk of complications (POSSUM ＜ 20 points) treated with damage control surgery but 105 patients with high risk of complication (POSSUM ≥20 points) treated with physiological control following damage control surgery.Predicted incidences of complications and mortality were (48.6 ± 6.8) ％ and (10.1 ±1.9) ％ respectively prior to damage control,but they were (35.6 ± 4.5) ％ and (4.6 ± 1.4) ％ after damage control.Observed incidences of complications and mortality were 37.4％ and 1.8％ respectively,with significant differences in comparison with those before damage control (all P ＜ 0.05).Conclusion For the elderly patients with intertrochanteric fracture,damage control measures can avoid surgical risks and reduce the incidences of postoperative complications and death.
