Schaab P C, Murphy G, Tzamaloukas A H, Hays M B, Merlin T L, Eisenberg B, Avasthi P S, Worrell R V
Department of Orthopaedics, Albuquerque Veterans Administration Medical Center, New Mexico 87108.
Clin Orthop Relat Res. 1990 Nov(260):224-31.
The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.
分析11例股骨颈骨折的发病率和死亡率，以比较透析患者股骨颈骨折的手术治疗和保守治疗。所有骨折均发生在患有严重心脏、肺部、胃肠道和神经系统疾病以及晚期肾性骨营养不良的老年男性身上。7例接受手术的患者中有6例术后存活，并实现了不同程度的行走。每例手术髋关节的稳定性均良好。术后并发症包括与麻醉药相关的短暂意识模糊状态、肺炎、褥疮和严重低白蛋白血症。所有4例接受保守治疗的患者均死于骨折并发症。在每例未接受手术的患者中均观察到病情逐渐恶化，出现麻醉药和镇痛药引起的意识模糊、肺炎、肝昏迷、褥疮、严重抑郁和严重低白蛋白血症。因此，对于患有多种内科疾病和晚期肾性骨营养不良的慢性透析患者，股骨颈骨折的手术治疗优于保守治疗。必须极其谨慎地使用麻醉药，并应努力预防营养不良和褥疮。
