背景：骨科老年髋部手术患者常常合并有多种疾病，植入物置入后易发生并发症。 目的：不同骨科植入物修复老年髋部疾病患者的特点及置入后并发症和死亡影响因素的研究。 方法：249例老年患者分别接受全髋关节置换、股骨头置换、股骨近端髓内钉、Gamma钉、空心钉置入治疗。对不同植入物的患者的年龄、性别、髋部疾病类型、麻醉风险评估、心理精神因素、入院血红蛋白、置入前白蛋白、置入前合并症察尔森合并症指数、麻醉方式、骨科植入物、手术持续时间、术中出血、住院时间、并发症、死亡与存活进行分析。 结果与结论：5种骨科植入物修复老年髋部疾病：①不同骨科植入物在患者年龄、麻醉风险评估评分、入院血红蛋白、置入前白蛋白水平方面差异有显著性意义，在住院时间、手术持续时间、术中出血量差异有显著性意义，与并发症及死亡差异无显著性意义。②住院时间、置入前白蛋白及置入前合并症察尔森合并症指数≥3是影响并发症最显著的指标。年龄、入院血红蛋白和置入前合并症察尔森合并症指数≥3是影响死亡最显著的指标。③置入前全面评估患者情况的意义：老年髋部疾病患者行手术治疗时，骨科植入物虽然不是影响置入后并发症及死亡发生的影响因素，但是实施人工关节置换的患者可早期下床负重活动，降低置入后并发症及死亡率；对于高龄、贫血、低白蛋白血症及察尔森合并症指数≥3的患者，要给予高度重视，尽早评估患者察尔森合并症指数，积极处理合并症，纠正贫血和低蛋白血症，预防置入后并发症的发生，可缩短住院时间，降低置入后死亡率。%BACKGROUND:Elderly patients with hip surgery in the department of orthopedics are often associated with a variety of diseases, and easily suffer from complications after implantation. OBJECTIVE:To analyze the characteristics and the factors of complications and mortality of the elderly patients with hip disease by different orthopedic implants. METHODS:249 patients accepted total hip arthroplasty, femoral head replacement, proximal femoral nail, Gamma nail, and holow screw fixation. We analyzed patients’ age, sex, hip disease type, anesthesia risk assessment, psychological and psychiatric factors, admission hemoglobin, preoperative albumin, Charlson comorbidity index, ways of anesthesia, orthopedic implants, operation time, intraoperative bleeding, length of stay, postoperative complications, mortality and survival. RESULTS AND CONCLUSION:Hip disease in the elderly was repaired with five kinds of implants. (1) There were significant differences in age, anesthesia risk assessment, hemoglobin on admission and preoperative albumin, length of stay, duration and intraoperative bleeding. No significant difference in complications and death was found. (2) The most significant indicators affecting complications were length of stay and albumin on admission and preoperative Charlson comorbidity index. The most significant indicators affecting death were age and hemoglobin on admission and preoperative Charlson comorbidity index. (3) Significance of comprehensive assessment of patients before placement: during hip operation, implants were not the factors that affected the complications and mortality after placement, patients with artificial joint replacement could get out of bed early, and complications and mortality could be reduced. Elderly patients with anemia, hypoalbuminemia and Charlson comorbidity index≥3 should be given a high degree of attention. We should assess Charlson comorbidity index as early as possible, positively treat complications, correct anemia and hypoproteinemia, prevent the occurrence of complications, shorten the length of hospital stay, and reduce the mortality after placement.
展开▼
