Ginsel Bastiaan L, Taher Ahmad, Ottley Michael C, Jayamaha Sepalika, Pulle Chrys R, Crawford Ross W
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia & Orthopaedic Research Unit, Prince Charles Hospital, Brisbane, Queensland, Australia.
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
J Orthop Surg (Hong Kong). 2014 Dec;22(3):279-81. doi: 10.1177/230949901402200302.
To review hospital mortality after hemiarthroplasty or total hip arthroplasty (THA) using a cemented stem for displaced femoral neck fractures.
Medical records of 284 hips in 70 men and 209 women aged 45 to 106 (mean, 81.3) years who underwent hemiarthroplasty (n=232) or THA (n=52) with a cemented stem using third-generation cementing techniques (including use of a plug, lavage, and cement pressurisation) for displaced femoral neck fractures were retrospectively reviewed. According to the American Society of Anesthesiologists (ASA) grading, 6 patients were classified preoperatively as grade 1, 77 as grade 2, 148 as grade 3, 47 as grade 4, and one as grade 5. Patients were operated on within 48 hours. Patients were rehabilitated in the hospital until discharge. The primary outcome measure was hospital mortality, including the cause of death.
The mean length of hospital stay was 9.2 (standard deviation, 4.1) days. The hospital mortality was 5.7% (n=16). Of the 16 patients who died, 3 were classified preoperatively as ASA grade 2, 6 as grade 3, and 7 as grade 4. One patient died during the operation. One patient died in the recovery room within 6 hours. Both died from a cardiac arrest and were classified as ASA grade 4. Six patients died within the first 5 days. The causes of death were aspiration pneumonia (n=5), cardiac arrest (n=3), bowel perforation (n=2), multiple organ failure (n=3), type 2 respiratory failure (n=1), heart failure (n=1), and subarachnoid bleeding after a hospital fall (n=1).
Hemiarthroplasty or THA using a cemented stem resulted in low hospital mortality in our hospital dedicated to the treatment of geriatric hip fractures. Hospital mortality was higher in patients with ASA grade 3 or higher.
回顾使用骨水泥型股骨柄行半髋关节置换术或全髋关节置换术（THA）治疗移位型股骨颈骨折后的医院死亡率。
回顾性分析70例男性和209例女性（年龄45至106岁，平均81.3岁）的284例髋关节的病历，这些患者接受了半髋关节置换术（n = 232）或THA（n = 52），采用第三代骨水泥技术（包括使用塞子、冲洗和骨水泥加压）治疗移位型股骨颈骨折。根据美国麻醉医师协会（ASA）分级，术前6例患者被分类为1级，77例为2级，148例为3级，47例为4级，1例为5级。患者在48小时内接受手术。患者在医院接受康复治疗直至出院。主要结局指标是医院死亡率，包括死亡原因。
平均住院时间为9.2（标准差，4.1）天。医院死亡率为5.7%（n = 16）。在死亡的16例患者中，术前3例被分类为ASA 2级，6例为3级，7例为4级。1例患者在手术期间死亡。1例患者在恢复室内6小时内死亡。两人均死于心脏骤停，被分类为ASA 4级。6例患者在头5天内死亡。死亡原因包括吸入性肺炎（n = 5）、心脏骤停（n = 3）、肠穿孔（n = 2）、多器官功能衰竭（n = 3）、2型呼吸衰竭（n = 1）、心力衰竭（n = 1）以及医院跌倒后蛛网膜下腔出血（n = 1）。
在我们这家专门治疗老年髋部骨折的医院，使用骨水泥型股骨柄行半髋关节置换术或THA导致的医院死亡率较低。ASA 3级或更高分级的患者医院死亡率更高。
