老年髋部骨折围手术期治疗

目的总结老年髋部骨折围手术期的治疗方法及疗效。方法回顾分析2007年5月～2010年5月62例72岁以上老年髋部骨折患者的临床资料,经细致围手术期处理,采用不同的手术方式进行治疗。结果62例均手术成功,出现并发症27例,死亡3例,1例术中出现呼吸心跳停止,暂停手术,病情稳定3周后二次手术痊愈。疗效评定：优42例,良10例,可7例,差3例,优良率83．4％。结论对老年髋部骨折患者围手术期要根据患者个体情况制定合适的治疗方案,手术前评估,控制和预防并发症,是提高手术治疗成功的保证。     

高龄髋部骨折患者围手术期护理体会

我科于1996年元月～1999年12月收治47例高龄髋部骨折手术病人,通过加强对围手术期的护理,47例患者均痊愈出院。现将护理体会介绍如下。1 临床资料 47例患者中,股骨颈骨折26例,股骨粗隆间骨折21例,男性28例,女性19例,年龄在60～84岁之间,其中60～69岁26例,70～79岁18例,80岁以上3例。左侧骨折26例,右侧21例,伤前并存心血管系统、肺部疾病者16例。行人工股骨头置换术者15例,多头钉内固定32例,其中3例围手术期发生并发症(褥疮、肺炎)。经治疗47例均痊愈出院。2 护理2.1 入院后及时进行系统检查 老年患者随着年龄的增长,机体各脏器的机能减低,应变能力降低,修复机能减弱,并且大多     

老年髋部骨折围手术期护理

目的探讨老年髋部骨折患者围手术期的护理措施。方法将60例髋部骨折患者随机分为观察组与对照组,对照组采用常规护理模式,观察组根据老年人的生理和心理特点进行护理干预,有针对性地预防和控制并发症,同时加强专科护理和心理护理。结果60例患者顺利通过手术,两组术中出血量、术后疼痛、发热时间、应用抗生素及住院时间观察组显著少于对照组,伤口渗血和并发症两组比较无显著性意义。结论老年患者风险大,根据老年人的生理和心理特点,有针对性地实施围手术期护理,是提高手术成功率,减少并发症和提高治愈率的重要保证。     

髋部骨折并糖尿病患者的围手术期处理

目的探讨髋部骨折合并糖尿病患者围手术期的处理。方法分析32例需行髋部骨折手术的糖尿病患者血糖控制及并发症的预防。结果32例糖尿病患者手术过程顺利,术中、术后因合理使用胰岛素而血糖控制良好,均安全度过围手术期,无严重并发症发生。结论对于糖尿病患者,术前较好地控制血糖,术中、术后积极监测及治疗糖尿病,使围手术期的血糖相对稳定,是手术成功及减少并发症的关键。     

老年髋部骨折患者围手术期的处理方式与手术治疗的研究进展

髋部骨折是老年人较常见的骨折,多为股骨颈骨折与股骨转子骨折.随着人口老龄化趋势的加剧,髋部骨折的发生率不断升高,一旦患病,将对患者的生命质量产生严重影响.对于老年髋部骨折的治疗,符合适应证的患者均建议选择手术方式,但是由于老年患者身体功能有不同程度的减退,对手术的耐受度明显降低,接受手术治疗的患者必须严格做好围手术期处...     

65岁以上老年人髋部骨折围手术期处理

目的探讨老年人髋部骨折围手术期处理特点。方法回顾性分析2000年2月至2007年11月手术治疗167例65岁以上老年人髋部骨折患者的临床资料。其中,股骨颈骨折82例,粗隆骨折85例。结果所有病例麻醉顺利,手术成功。术后5例发生下肢深静脉血栓,应激性溃疡2例,尿潴留2例,谵妄3例,脑梗塞1例,2例全髋置换术患者分别于术后第1、2天发生股骨头脱位,予闭合复位。结论老年人髋部骨折手术治疗是安全有效的,积极的围手术期治疗和精心护理是手术治疗成功的重要条件。     

护理干预在老年髋部骨折患者围手术期护理中的应用

髋部骨折已成为影响老年人健康的主要疾病,是导致老年人行动障碍的首要原因。对老年人髋部骨折的治疗越来越倾向于手术治疗,但由于髋部手术较为复杂,每一个环节的疏忽都会影响到手术的进展,甚至直接导致整个手术的失败,从而严重威胁着患者的生命健康和生活质量。     

老年骨折患者围手术期的护理

目的 了解老年骨折围手术期护理的意义.方法 回顾分析42例骨折患者围手术期护理.结果 42例手术均获取成功,无并发症发生,功能恢复良好.结论 了解手术目的,有针对性进行心理疏导,参与精心护理与治疗,适时功能锻炼,是老年骨折手术成功的关键.     

老年糖尿病患者伴髋部骨折的围手术期护理

目的：分析老年糖尿病伴髋部骨折患者的围手术期护理效果。方法：从2011年8月-2014年4月我院收治老年糖尿病伴髋部骨折患者60例作为本组对象,按抽样法将其分成两组：对照组患者实施病情观察、饮食指导等基础护理,干预组患者则实施围手术期的护理措施,评定预后的护理满意程度。结果：干预组护理满意者29例,占比96.7%,高于66.7%（20/30）的对照组,P<0.05,有区别。结论：临床针对老年糖尿病伴髋部骨折患者实施围手术期护理作用显著,可预防术后并发症,提高护理满意度,值得学习。     

高龄患者髋部骨折围手术期的护理

髋部骨折包括股颈骨折和股骨粗隆间骨折,是一种较常见的、多发于老年人的骨折,其发生率随着年龄的增长而上升.我科共收住院手术治疗高龄髋部骨折患者106例.现就围手术期的护理谈几点体会.     

68例高龄患者髋部骨折的围术期护理

目的探讨高龄患者髋部骨折的围术期护理要点。方法回顾性总结2005年1月至2007年7月68例85岁以上髋部骨折手术患者的护理措施。结果手术一般在伤后3~5天进行,平均住院21天,出院定期随访,患者骨折愈合良好。结论高龄老人髋部骨折术前应加强心理护理、术前评估、并存疾病的处理和关节锻炼等;术后应加强病情观察、术后制动和固定,并发症的预防以及康复指导等。     

心理干预对老年髋部骨折患者术后的影响

目的探讨心理干预对老年髋部骨折术后抑郁和功能恢复的影响。方法选择我院2007年7月～2009年7月老年髋部骨折患者81例,将患者随机分为观察组和对照组。对照组给予髋关节术后常规护理,观察组在对照组护理基础上给以心理干预。对患者心理干预前、出院时、出院后1个月、出院后3个月采用老年抑郁量表(GDS)测量老年人的抑郁症状减轻程度和抑郁缓解率。患者出院时、出院后1个月、出院后3个月采用Harris髋关节评分对患者髋关节功能进行评定。结果出院后3个月,观察组GDS评分与对照组比较,差异有统计学意义,P<0.05;观察组在出院后3个月Harris评分与对照组相比,差异有统计学意义,P<0.05。结论采用心理干预可以改善老年髋部骨折患者术后的抑郁状态,有利于患者功能恢复。     

心理干预对老年髋部骨折患者术后的影响

目的探讨心理干预对老年髋部骨折术后抑郁和功能恢复的影响。方法选择我院2007年7月-2009年7月老年髋部骨折患者81例,将患者随机分为观察组和对照组。对照组给予髋关节术后常规护理,观察组在对照组护理基础上给以心理干预。对患者心理干预前、出院时、出院后1个月、出院后3个月采用老年抑郁量表（GDS）测量老年人的抑郁症状减轻程度和抑郁缓解率。患者出院时、出院后1个月、出院后3个月采用Harris髋关节评分对患者髋关节功能进行评定。结果出院后3个月,观察组GDS评分与对照组比较。差异有统计学意义,P〈0．05;观察组在出院后3个月Harris评分与对照组相比。差异有统计学意义．P〈0．05。结论采用心理干预可以改善老年髋部骨折患者术后的抑郁状态．有利于患者功能恢复。     

Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture

ObjectivesThis study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value of factors affecting the short-term rate of recovery of independence in activities of daily living was assessed for the resilient portion of the population.DesignAn inception cohort was recruited between 2016 and 2019.Setting and ParticipantsOnly community-dwelling older patients admitted with a proximal femoral fracture were included.MeasuresFollow-up was performed at 6 weeks and 3 months, when the patients' living situation and level of independence were recorded. Multistate modeling was used to study the transition rates of the population through prespecified states of the recovery process. Using this model, prognostic factors for the recovery of independence were identified for resilient patients (defined as those patients who managed to return home at any point in the follow-up after discharge).ResultsA total of 558 patients were included, and 218 (40.9%) recovered to prefracture levels of independence. Of the resilient patients, 20.7% were discharged home directly, and 79.3% via a rehabilitation home. In this patient group, a more favorable American Society of Anesthesiologists classification, better prefracture mobility, and the absence of a prefracture fear of falling were statistically significantly associated with a successful recovery. A low level of prefracture independence was inversely associated, meaning that patients with a low level of prefracture independence had a higher chance of successful recovery.Conclusions and ImplicationsThis study identified 4 factors with an independent prognostic value for the recovery of independence in resilient patients after a proximal femoral fracture. These factors could be used to construct clinical profiles that contribute to the assessment of the patient's post-acute care needs and recovery capacity. In addition, multistate modeling has been shown to be an effective and versatile tool in the study of recovery prognostics.     

Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

老年髋部骨折患者围术期“2P-3R”营养管理模式构建

目的构建老年髋部骨折患者围术期营养管理模式,促进患者早手术、早下地、早康复。方法针对老年髋部骨折患者营养管理现状,采用课题研究型品管圈活动进行改进。经过科学循证、专家指导等,从术前、术后及家庭三个环节,骨科、营养科、家庭三个维度,人员、制度、材料设备、方法、信息五个方面,制定三大对策群组并予以实施,包括组建营养支持团队、构建营养管理策略、搭建多维信息交互平台等。结果老年髋部骨折患者首次下地时间缩短为26.7 h,平均住院日缩短为5.6 d,实现了早手术、早下地、早康复的目标。结论对老年髋部骨折患者实施个性化、全流程的序贯性营养干预具有重要意义。后续还需开展大样本多中心研究以进一步验证成效,数据自动采集与智能反馈也是今后研究重点。     

动力髋螺钉治疗老年人股骨转子间骨折的疗效评价

目的评价动力髋螺钉（DHS）治疗老年人股骨转子间骨折的临床疗效。方法对天津医科大学第二医院收治并采用DHS治疗的43例老年股骨转子间骨折患者进行随访,分析其治疗效果。结果随访6～18个月,术后6月所有患者骨折愈合良好,平均临床愈合时间为3．9个月,患髋关节功能优27例（62．8％）,良15例（34．9％）,差1例（2．3％）,优良率达97．7％。结论运用DHS治疗老年人股骨转子间骨折,能取得理想的治疗效果,是值得推广的内固定方法。     

髋关节骨折的治疗体会

目的探讨髋关节骨折的治疗方法,提高患者的生活质量。方法针对50例髋关节患者,采用可吸收性内固定物,观察临床疗效。结果术后第6、l2及48周行临床X线摄片,骨折复位和愈合情况良好。随访10～32个月,平均l6个月。Ⅱ型骨折病人20例均为优;Ⅳ型、Ⅴ型患者21例中,12例为优,10例为良,总优良率达100%。结论采用可吸收性内固定物治疗髋关节骨折,临床疗效良好,生活质量提高。采用可吸收性内固定物治疗髋关节骨折,临床疗效良好,生活质量提高。     

The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery

ObjectivesTo examine the associations of prefracture psychological resilience and prefracture general mental health with physical function among older adults with hip fracture surgery.DesignSingle-center observational study.InterventionNone.Setting and participantsPatients aged ≥50 years who underwent first hip fracture surgery between January 2017 and December 2017 (N = 152).MethodsWe used data collected prospectively from the hospital's hip fracture registry. We performed generalized estimating equations to examine the associations of prefracture psychological resilience (10-item Connor-Davidson Resilience Scale) and prefracture general mental health (Short Form–36 mental health subscale) with physical function (Short Form–36 physical functioning subscale) at 4 time points—prefracture (based on recall), and 1.5, 3, and 6 months after surgery.ResultsPrefracture psychological resilience had an association with physical function; a 1-unit increase in psychological resilience score was associated with 1.15 units [95% confidence interval (CI) 0.71, 1.59] higher physical function score across 4 time points. In contrast, the association between general mental health and physical function varied over time; a 1-unit increase in general mental health score was associated with 0.42 units (95% CI 0.18, 0.66) higher physical function score at prefracture, 0.02 units (95% CI –0.18, 0.22) lower at 1.5 months, 0.23 units (95% CI –0.03, 0.49) higher at 3 months, and 0.39 units (95% CI 0.09, 0.68) higher at 6 months after surgery.Conclusions and implicationsPsychological resilience is associated with physical function among older adults with hip fracture surgery, independent from general mental health. Our findings suggest the potential for interventions targeting psychological resilience for these patients and call for more studies on psychological factors affecting physical function recovery after hip fracture surgery.