老年患者股骨粗隆间骨折围手术期处理

目的：报告68例85岁以上患者股骨粗隆问骨折围手术期的治疗处理。方法：采用骨水泥型双极人工股骨头置换31例；PFN(Proxmal Femoral Nail股骨近端钉)固定13例；短重建钉固定11例；经皮外固定架固定9例；髋动力钉(dynamic hip screw，DHS)固定4例。68例患者骨折前均并存各种不同程度的内科疾病，患者入院后患肢暂行皮牵引制动，对患者进行全面的查体，尽量缩短术前准备时间。术后缩短卧床时间，有针对性的药物治疗，对每一例患者的不同特点制定康复计划。结果：全部患者的并存病术前经过处理相对稳定，48例平稳的度过了围手术期，出现并发症的患者，经及时对症治疗均逐渐康复。仅1例95岁患者人工股骨头置换术后3周死于呼衰合并肾衰。结论：85岁以上股骨粗隆问骨折患者的围手术期处理非常重要，涉及多学科的综合治疗，直接关系到患者术后能否尽快康复。

The peri-operative management of senile patients over the age of 85 years old with femoral intertrochanteric fracture

Objective:To evaluate the results of peri-operative care in 68 senile cases over 85 years old with femoral intertrochanteric fracture. Methods:26 of them were male and 42 were femal. The ages were from 85 to 96 years old,with an average of 87 years old. 31 cases have been treated with bipolar hemiarthroplasty, 13 with internal fixation of PFN, 11 with short reconstruction screw, 9 with percutaneous external fixtor and 4 with internal fixation of DHS. All patients with femoral intertrochanteric fracture coexisted with different medical diseases. When the patients were in hospital,a series of management were as follow: immobilizing the suffered leg by skin traction in neutral position; comprehending the medical history in detail and finding out therapeutic methods of the coexisting dieases; examing patients all-roundly; finishing consultation and shorting the preoperating time as soon as possible. After operation, in order to short the time of the patient in bed, a pertinence medication and general rehabilitation plan would be done according to the patient's operation method and general conditions. Results:All patients with different coexisting diseases had good results by suitable treatment .48 of them lived through the peri-operation safely. Only one patient with the age of 95 years old died in respiratory and renal failure after the replecement of femoral head.Conclusion:the peri-operative care of patients over the age of 85 years old with femoral intertrochanteric fracture is very important. It is not only concerned a comprehensive treatment of the multidisciplinary cooperation, but also directly involved the early rehabilitation of patients after operation .