3麻醉方式对高龄股骨粗隆问骨折患者术后恢复效果的影响

目的比较椎管内麻醉和全身麻醉对高龄股骨粗隆间骨折患者术后恢复效果的影响。方法56例高龄股骨粗隆间骨折手术患者随机分为椎管内麻醉组和全身麻醉组，椎管内麻醉组31例，平均年龄78．2岁，全身麻醉组25例，平均年龄79．5岁。手术方式全部采用闭合复位，y3型髓内钉内固定术。观察比较两组患者术后早期功能恢复情况，包括下地活动时间、术后住院时间以及术后并发症。结果全部骨折患者手术均得到良好复位及固定，无死亡及感染病例。椎管内麻醉组术后下地活动所需时间为（79．6士23．1）h，而全身麻醉组为（106．4±35．6）h，差异具有统计学意义（P〈0．05）。椎管内麻醉组术后平均住院日为（9．1±3．3）d，而全身麻醉组为（11．6±4．2）d，差异具有统计学意义（P〈0．05）。全身麻醉组术后在认知障碍及呼吸系统感染等并发症方面明显高于椎管内麻醉组。结论对于高龄股骨粗隆间骨折患者，闭合复位、y3型髓内钉内固定可获得较理想的治疗效果；椎管内麻醉患者术后在下地活动时间、术后住院天数以及术后并发症方面明显优于全身麻醉组。

The Influence of Anesthesia on the Postoperative Recovery Eldly Patients with Intertrochanteric Facture of Femur

Objective To compare the influence of different eldly patients with intertrochanteric fracture of femur. Methods anesthesia methods on the postoperative recovery of 56 old femur intertrochanteric fracture patients were randomized divided into intraspinal anesthesia group and general anesthesia group. The intraspinal anesthesia group includes 31 patients with the average age of 78.2 years old,while the general anesthesia group includes 25 patients with the average age of 79.5 years old. All the patients accepted the surgery of closed reduction and internal fixation with73 intramedullary pin. The early functional rehabilitation of the two groups,including the time needed for early mobilization,the postoperative length of stay,and the postoperative complications were cpmpared. Results All the 56 patients achieved proper reduction and internal fixation,without any death or wound infection cases. In intraspinal anesthesia group ,the mean time needed for active postoperative mobilization was 79.6士23.1 h,while in the general anesthesia group ,it was 106.4士35.6 h ,the difference was significant （P〈0.05）. In intraspinal anesthesia group ,the mean postoperative length of stay was 9.1士3.3 d,while in the general anesthesia group,it was 11.6士4.2 d,the difference was significant （P〈0.05）. The general anesthesia group got much higher postoperative complications than the intraspinal anesthesia group ,especially in the aspects of cognitive disorders and respiractory tract infections. Con- clusion To the eldly age patients with fracture of femurs haft,closed reduction and internal fixation with 73 intramedullary pin can achieve ideal therapeutic effectiveness. The intraspinal anesthesia has much better effects than general anesthesia in the aspects of active postoperative mobilization ,the postoperative length of stay ,and the postoperative complications.