高龄患者髋部骨折的治疗(附149例分析)

目的：通过对149例70岁以上老人髋部骨折的治疗分析，探讨其治疗方法的选择、手术的必要性、方式及特点，手术前的准备及良复治疗的重要性。方法：回顾性分析了149例高龄患者髋部骨折的临床资料；其中牵引保守治疗21例，手术治疗128例。结果：本组无1例术中或住院期间死亡。随访病人116例，时间平均14个月。功能优良者94例，占81％；可14例，占12％；差8例，占7％。讨论：高龄患者的年龄不应作为治疗方法选择的条件，在无心、脑、肺、肾等失代偿情况下，可将手术视为主要的治疗方法；而牵引治疗仅适用于术前制动、不能耐受手术或不愿接受手术治疗者。在目前诸多的手术方法中；如Ender's钉、多根钉或可折螺纹钉、角型或L型钢板、人工股骨头置换等，各有其优缺点，应根据骨折类型及手术者的操作熟练程度而定。手术时机以伤后3d左右为宜。术前准备、麻醉和术中监护是手术成功及保证生命的关键。而术后护理与功能锻炼是患者平稳过度围手术期和早日康复的重要措施。结论：高龄老人的髋部骨折在无手术禁忌证情况下，应积极采取手术治疗，手术方法要合理选择，手术前准备及康复治疗要予以重视。

The Treatment of Hip Fracture in Advanced age:Report of 146 Cases

Objective: The treatment of hip fracture in 149 geriatric patients(over 70 years old)were analyzed.The study was done regarding treatment,the necessity and success of surgery,the importance of pre operative and post operative management.Methods:The clinical data of 149 cases of advanced patients were reviewed.21 cases were treated by traction,128 cases by operation.Results:No patients died during surgery.116 patients received follow up for an average of 14 months.Among them,there were 94 cases in excellent condition with a recovery rate of 81 percent;14 cases with good recovery(12.1%),8 cases with poor results(7%).Discussion:The age of geriatric patients should not be regarded as contraindication.The operation should be considered as a main way in the treatment without any decompensation in the heart,brain,lung and so on.However,the traction only is used as immobiligation in preoperative condition,in case of unable or unacceptable to the operation.At present,there are many operative methods for treating hip fracture such as Ender's nail,multiple nail of flexible nail,L plate and artificial replacement for hip joint.Of those,there are different advantage and defect.So,the operation should depend on the type of fracture and operator who master the skills by themselves in varying degrees,The operative time should be in three days or so.It is a key that operative preparation,anesthesia,monitoring during operation should be done.But it is also important that nursing and rehabilitation can improve condition and recover early after operation.Conclusions:If there are no contraindications in the geriatric patients health,the operation should be done actively.The type of surgery should be chosen carefully.The monitored preoperative,post operative condition and rehabilitation should be emphasized on.