Ochs M
Department of Veterans Affairs Medical Center, Memphis, Tennessee.
Clin Geriatr Med. 1990 Aug;6(3):571-87.
Hip surgery is the most common major orthopedic procedure performed in the elderly. The indications are fracture and pain secondary to degenerative arthritis. Patients undergoing hip replacement for arthritis have excellent outcomes with decreased pain, increased mobility, and a low mortality. Age should not be a contraindication to hip replacement, with patient selection being made on the basis of symptomatology and overall health. In hip fracture, the prognosis is more guarded. Poor functional outcome results from complications of the fracture, such as avascular necrosis of the femoral head and fracture nonunion in femoral neck fractures and instability with delayed weight bearing in intertrochanteric fractures. In addition, patients sustaining hip fracture are more likely to have significant comorbidity and subsequent perioperative complications. Pressure ulcers, delirium, deep venous thrombosis, urinary retention and urinary tract infection, and cardiac events are the most frequent complications seen. These complications can be anticipated and prevented with careful preoperative assessment and post-operative prophylactic management. A team approach including the orthopedic surgeon, primary care physician, nursing staff, and physical therapists is essential for optimal outcome.
髋关节手术是老年人中最常见的主要骨科手术。其适应症为骨折以及退行性关节炎继发的疼痛。因关节炎接受髋关节置换术的患者预后良好，疼痛减轻、活动能力增强且死亡率较低。年龄不应成为髋关节置换术的禁忌证，应根据症状和整体健康状况来选择患者。对于髋部骨折，预后则更需谨慎。功能预后不良是由骨折并发症导致的，如股骨颈骨折时股骨头缺血性坏死和骨折不愈合，以及转子间骨折时负重延迟导致的不稳定。此外，发生髋部骨折的患者更可能有严重的合并症及随后的围手术期并发症。压疮、谵妄、深静脉血栓形成、尿潴留和尿路感染以及心脏事件是最常见的并发症。通过仔细的术前评估和术后预防性管理，可以预测并预防这些并发症。包括骨科医生、初级保健医生、护理人员和物理治疗师在内的团队协作对于实现最佳预后至关重要。
