老年髋部骨折手术时机选择与术后疗效分析

目的 探讨老年髋部骨折患者手术时机选择对术后疗效的影响.方法 选择2006年7月至2008年6月手术治疗的髋部骨折患者267例,入组后根据手术时机将患者分为早期手术组(入院2 d内手术)和晚期手术组(入院2 d后手术),详细记录患者的并存症、手术细节、术后并发症等.观察两组患者住院期间并发症发生率和死亡率、住院时间、出院时功能恢复情况、术后6和12个月的死亡率以及功能恢复情况.结果 符合入选标准116例,早期手术组45例,晚期手术组71例.两组性别、年龄、并存症等一般情况差异无统计学意义,术中麻醉方式、出血量、固定方式两组亦无统计学意义.早期手术组住院时间、住院期间肺部并发症发生率较晚期手术组明显减少;住院期间、术后6、12个月死亡率和晚期手术组相比差异不统计学意义;出院时、术后6个月日常生活能力评分(the activities of daily living,ADL)较晚期手术组高,差异有统计学意义.术后12个月晚期手术组ADL评分和早期手术相似,差异无统计学意义.结论 在排除自身情况差异后,术后早期(出院时、术后6个月)早期手术患者独立生活能力较晚期手术者恢复好,但从远期来看(术后12个月)二者差异无统计学意义.早期手术者和晚期手术者死亡率的差异无统计学意义.

The impact of operative timing on clinical outcomes in elderly hip fracture

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture. Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008. The patients who had an operation within two days (the early surgery group) were compared with the outcome for those who had an operation more than two days (the later surgery group). Outcomes measured were mortality, post-operative complications, operative details, the comorbidity and the activities of daily living of patients. Results One hundred and sixteen patients were included in the study. There were 45 cases in the early surgery group, including 13 males and 32 females. The patients ranged from sixty-five to eightyeight years old, with an average age of 78.76 years. While there were 71 patients in the late surgery group,including 24 males and 47 females. The patients ranged from sixty-six to one hundred and three years old,with an average age of 80.00 years. The demographic data of patients show no significant difference in two groups. There was no difference in intraoperative conditions such as anesthesia, amount of bleeding, type of fixation between two groups. Patients in early surgery group experienced shorter length of hospital stay, and fewer pulmonary complications. The mortality of early surgery group do not show a significant increase at discharge, 6 month, 12 month postoperatively compared to that of the later surgery group. However patients in the early surgery group show a significant increase of ADL scores at discharge, 6 month postoperatively,but not at 12 month. Conclusion The timing of surgery has an impact on clinical outcome in elderly hip fracture. Early surgery was associated with improved function in the first 6 month postoperatively, but not 12months, but it was not associated with mortality.