本文選題：慢性肝衰竭 + 老年髖部骨折��； 參考：《中國矯形外科雜志》2015年16期

【摘要】：[目的]探討和總結(jié)合并慢性肝衰竭(chronic liver failure,CLF)老年髖部骨折的救治方法及圍手術(shù)期管理經(jīng)驗(yàn)。[方法]選取2008年1月~2013年12月于本科連續(xù)收治的12例合并慢性肝衰竭的老年髖部骨折患者,對(duì)其進(jìn)行術(shù)前ASA評(píng)級(jí)、MELD評(píng)分、POSSUM評(píng)分及P-POSSUM評(píng)分并實(shí)施骨科損害控制技術(shù),記錄患者一般資料、肝硬化Child-Pugh分期、術(shù)前天數(shù)、手術(shù)方式、麻醉方法及術(shù)后并發(fā)癥情況。[結(jié)果]所有患者均安全度過圍手術(shù)期,住院期間無死亡病例,術(shù)后手術(shù)傷口均甲級(jí)愈合,相關(guān)并發(fā)癥經(jīng)過內(nèi)科治療均治愈。12例全部獲得隨訪,平均隨訪21.3個(gè)月(3~47個(gè)月),最后一次隨訪髖關(guān)節(jié)Harris評(píng)分平均83.2分(68~93)分,優(yōu)良率77.8%。[結(jié)論]合并慢性肝衰竭的老年髖部骨折患者,經(jīng)過術(shù)前積極風(fēng)險(xiǎn)評(píng)估并結(jié)合骨科損害控制技術(shù),只要選擇恰當(dāng)?shù)氖中g(shù)時(shí)機(jī)、手術(shù)方式以及麻醉方法,圍術(shù)期間采取措施控制貧血、腹水及門脈高壓及相關(guān)并發(fā)癥,必要時(shí)術(shù)后輔助應(yīng)用人工肝支持系統(tǒng),其手術(shù)是安全有效的。
[Abstract]:[objective] to explore and summarize the treatment methods and perioperative management experience of hip fracture in elderly patients with chronic liver failure. [methods] from January 2008 to December 2013, 12 cases of senile hip fracture patients with chronic liver failure were selected. ASA rating meld score and P-POSSUM score and orthopaedic damage control technique were performed. The general data, Child-Pugh stage, preoperative days, operative methods, anesthetic methods and postoperative complications were recorded. [results] all the patients survived the perioperative period safely, there were no cases of death in hospital, all the wounds healed in grade A after operation, and all the 12 cases of related complications were cured by internal medical treatment, all of them were followed up. The average follow-up was 21.3 months from 3 to 47 months, and the average Harris score of hip joint at the last follow-up was 83.2 points (6893). The excellent and good rate was 77.8%. [conclusion] in elderly patients with chronic liver failure, after positive risk assessment before operation and combined with orthopedic damage control technique, we should choose the right operation time, operation method and anaesthesia method. Perioperative measures were taken to control anemia, ascites and portal hypertension and related complications, and to apply artificial liver support system after operation if necessary, the operation was safe and effective.
【作者單位】： 第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所骨科;
【分類號(hào)】：R687.3;R575.3

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本文編號(hào)：2038386