80岁以上股骨颈骨折髋关节置换术围手术期安全性和疗效观察

Perioperative safety and efficacy of hip arthroplasty for femoral neck fracture in patients aged 80 and over

摘要:

目的评价高龄(≥80岁)股骨颈骨折患者接受髋关节置换术围手术期的安全性和有效性。方法1997年11月至2007年11月,应用全髋关节置换术(11例)或半髋关节置换术(67例)治疗78例≥80岁股骨颈骨折患者,对其术前危险因素、围手术期并发症和术后2周临床效果等临床资料进行回顾性分析。结果本组患者平均年龄(83.7±3.59)岁,其中GardenⅢ型骨折42例、GardenⅣ型骨折36例。术前应用美国麻醉医师协会分级标准评价,80.8%为高危患者;采用统计死亡率和并发症发生率的生理学和手术严重程度评分系统预测主要并发症发生32例,术后实际发生24例,观察值与预测值之间无统计学差异(P=0.205),全髋关节置换组与半髋关节置换组均无统计学差异;术后2周疼痛缓解满意率为96.2%,76.9%的患者独立或辅助下自行室内活动。结论在高龄股骨颈骨折患者,围手术期针对生理状况及手术操作的可改变指标进行有效的干预措施,采取髋关节置换术,可获得安全、有效的临床结果。

Abstract:

Objective To evaluate the perioperative safety and efficacy of hip arthroplasty in elderly(≥80) femoral neck fracture.Methods Seventy-eight patients over 80 years old who received hip arthroplasty,including total hip arthroplasty(THA,11 cases)and hemiarthroplasty(HA,67 cases),between Nov 1997 and Nov 2007 were analyzed retrospectively.Results Of the patients,aged(83.7±3.59) years in average,with Garden Ⅲ(42 cases) and Garden Ⅳ(36 cases) respectively,ASA classification showed that 80.8% patients belonged to high risk group preoperatively.There was no statistical difference between predicted values and observed values by Physiological and Operative Severity Score for the Enumeration of Mortality and Mobility scoring system(32 cases and 24 cases,P=0.205),and THA group or HA group had no statistical difference.The satisfaction index of easement of pain was 96.2%,and indoor activities with or without brace rate was 76.9% at two weeks after operation.Conclusion By the necessary intervention to the physiological status and operation methods for improving the prognosis,hip arthroplasty is a safe and effective procedure to treat the femoral neck fracture in elderly patients.