本文選題：股骨頸骨折　切入點(diǎn)：非骨水泥型人工雙極頭置換術(shù)　出處：《上海交通大學(xué)》2015年博士論文

【摘要】：目的:隨著老齡化的進(jìn)展,股骨頸骨折的發(fā)病率也正呈逐年增高。應(yīng)用人工關(guān)節(jié)置換治療高齡股骨頸骨折患者已經(jīng)得到了越來(lái)越多的肯定。目前,應(yīng)用非骨水泥型人工雙極股骨頭置換術(shù)治療老年患者已經(jīng)成為臨床醫(yī)生們的常規(guī)選擇之一。然而高齡患者往往由于身體機(jī)能退化等諸多因素,合并較多內(nèi)外科基礎(chǔ)疾病,身體耐受性較差。疾病帶來(lái)的創(chuàng)傷常常需要較長(zhǎng)時(shí)間才能恢復(fù),故而手術(shù)的效果也往往不甚理想。在本項(xiàng)研究中,我們回顧了行非骨水泥型人工雙極頭置換的高齡股骨頸骨折患者的臨床資料,包括患者術(shù)前的一般情況,合并的基礎(chǔ)疾病,以及手術(shù)相關(guān)情況,回顧術(shù)后的療效隨訪,以此評(píng)估手術(shù)效果;按術(shù)前基礎(chǔ)疾病將患者分組,討論不同的基礎(chǔ)疾病共同存在時(shí)對(duì)于患者預(yù)后的影響。方法:研究中,我們回顧了2006年1月至2012年12月期間于上海交通大學(xué)附屬第九人民醫(yī)院行非骨水泥型人工雙極股骨頭置換術(shù)治療股骨頸骨折的80歲以上高齡患者258例�；仡櫫税�:年齡、BMI、ASA麻醉評(píng)分、麻醉方式、術(shù)前等待時(shí)間、手術(shù)時(shí)間、術(shù)中出血;術(shù)后并發(fā)癥,包括:人工關(guān)脫位、假體周圍骨折、假體松動(dòng)、二次手術(shù)、深靜脈血栓、術(shù)后感染、傷口愈合不良、術(shù)后三十天及一年死亡率。術(shù)后及隨訪期間關(guān)節(jié)功能Harris評(píng)分。研究中我們根據(jù)患者實(shí)際術(shù)后Harris評(píng)分將患者分為優(yōu)秀組,良好組和尚可組。同時(shí)回顧了患者術(shù)前既往的基礎(chǔ)疾病,按所患疾病數(shù)量將患者分組,同時(shí)將患者術(shù)前各參數(shù)納入研究,進(jìn)行有序Logistic回歸分析,探討患者的一般情況與基礎(chǔ)疾病對(duì)于患者術(shù)后關(guān)節(jié)功能的影響。結(jié)果:患者的平均年齡為85.140±4.37,其中男性患者71例(27.5%),女性患者187例(72.5%)。按Garden分型分類患者,Ⅰ型6例(2.3%),Ⅱ型8例(3.1%),Ⅲ型84例(32.6%),Ⅳ型160例(62.0%)。最常見的術(shù)前合并癥依次為:高血壓98例(40.0%),糖尿病85例(32.9%),COPD39例(15.1%),冠心病36例(14.0%)。其中,無(wú)基礎(chǔ)疾病的患者為68人(26.4%),患有一種疾病的有95人(36.8%),患2種54人(20.9%),患3種及以上者為41人(15.6%)。ASA評(píng)分中Ⅰ級(jí)47例(18.2%),Ⅱ級(jí)145例(56.2%),Ⅲ級(jí)59例(22.9%),Ⅳ級(jí)7例(2.7%)。大部分病人(239,92.6%)在全麻下做了手術(shù),另一小部分(19,7.4%)則在椎管內(nèi)麻醉下完成手術(shù)。患者術(shù)前平均等待時(shí)間為50.678±7.215小時(shí),平均手術(shù)時(shí)間(從切開至縫合完畢)為48.236±12.448分鐘,術(shù)中平均出血為105.937±37.219毫升。術(shù)后脫位3例,3例的患者發(fā)生假體周圍骨折。僅有1例出現(xiàn)癥狀性DVT。術(shù)后一年死亡率為24人。關(guān)節(jié)功能評(píng)分平均為88.71±8.62分。患者年齡、BMI、ASA評(píng)分、麻醉方式、基礎(chǔ)疾病數(shù)量等參數(shù)中,術(shù)前等待時(shí)間、手術(shù)時(shí)間、術(shù)中出血和麻醉方式的選擇與術(shù)后關(guān)節(jié)功能的優(yōu)良并無(wú)直接關(guān)系。年齡越大,術(shù)后Harris評(píng)分越低(P=0.007,OR=1.12)。BMI越大,術(shù)后Harris評(píng)分越低(P=0.005,OR=1.22)。ASA評(píng)分經(jīng)分析后,高分組的預(yù)后比低分組差(P=0.001,OR=3.23)�；A(chǔ)疾病對(duì)于術(shù)后關(guān)節(jié)功能的影響較大,只患1種疾病的患者組,相比無(wú)合并癥的患者組并無(wú)顯著差異(P=0.3090.05),而患2種疾病組和至少3種疾病組中,根據(jù)OR(3.76,8.81)可知,隨著患者術(shù)前基礎(chǔ)疾病數(shù)量的增多,術(shù)后關(guān)節(jié)功能評(píng)分下降,且影響程度逐漸增高。在高血壓、冠心病、COPD和糖尿病中,只有糖尿病患者對(duì)結(jié)果有影響(P0.001,OR=1.19)。在死亡原因中,心血管原因和呼吸系統(tǒng)原因是致死的主要因素。結(jié)論:(1)本研究中隨訪期間患者無(wú)感染患者,脫位率為1.16%,1.16%的患者發(fā)生假體周圍骨折。僅有1例出現(xiàn)癥狀性DVT。術(shù)后一年死亡率為9.3%。關(guān)節(jié)功能評(píng)分平均為89分�；颊咝g(shù)后康復(fù)良好,生活質(zhì)量較高。對(duì)于一般情況較復(fù)雜的老年患者,本結(jié)果基本令人滿意。(2)在影響預(yù)后的各項(xiàng)因素中,患者年齡越大、BMI越高、ASA評(píng)分越高、合并的基礎(chǔ)疾病越多則術(shù)后關(guān)節(jié)功能越差。而在高血壓、糖尿病、COPD和冠心病四種常見基礎(chǔ)疾病中,糖尿病是影響患者預(yù)后的主要負(fù)面因素。所以,在面對(duì)高齡、偏胖和患有糖尿病的患者時(shí),在術(shù)后康復(fù)中需要更加關(guān)注。為了提高生存率,需要提高心腦血管的監(jiān)護(hù)和預(yù)防肺部感染。
[Abstract]:Objective: with the progress of the aging of the femoral neck fracture incidence is increased year by year. The application of artificial joint replacement in the treatment of elderly patients with femoral neck fracture has been more and more sure. At present, the application of cementless bipolar artificial femoral head replacement in the treatment of elderly patients has become one of the routine selection of clinicians. However, elderly patients often because of many factors such as physical degradation, with more surgical disease, the body tolerance is poor. Diseases caused by trauma often takes a long time to recover, so the operation effect is often not ideal. In this study, we reviewed the clinical data of patients with femoral neck for non cementless bipolar head replacement fractures, including the general situation of the patients with underlying diseases, combined, and related to the operation, the curative effect of postoperative follow-up review, In order to evaluate the effect of surgery; patients were grouped according to the preoperative underlying diseases, discuss the influence for the prognosis of patients with various basic diseases exist together. Methods: in this study, we reviewed during the period from January 2006 to December 2012 in the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University for 258 elderly patients over the age of 80 cemented bipolar hemiarthroplasty. Femoral neck fracture were reviewed. Including: age, BMI, ASA score of anesthesia, anesthesia, waiting time, operative time, intraoperative hemorrhage; postoperative complications included: artificial hip, dislocation, periprosthetic fracture, prosthesis loosening, two surgery, deep vein thrombosis, postoperative infection, wound healing bad, after thirty days and one year mortality. Postoperative Harris score in our study. According to the actual patient postoperative Harris scores were divided into excellent group, good group of monks 鍙粍.鍚屾椂鍥為【浜?jiǎn)鎮(zhèn)ｈ�呮湳鍓嶆棦寰，

本文編號(hào)：1655890