Song Kyung Sub, Yoon Sang Phil, Lee Su Keon, Lee Seung Hwan, Yang Bong Seok, Park Byeong Mun, Yang Ick Hwan, Lee Beom Seok, Yeom Ji Ung
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Hip Pelvis. 2017 Mar;29(1):54-61. doi: 10.5371/hp.2017.29.1.54. Epub 2017 Mar 6.
Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function.
Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared.
Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group.
There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
血液透析患者髋部骨折伴有高并发症和发病率。以往研究主要报道了该患者群体股骨颈骨折的不愈合和缺血性坏死情况。在本研究中，通过与肾功能正常的患者进行比较，对采用股骨近端髓内钉治疗的血液透析患者转子间骨折的并发症及临床结果进行了调查。
纳入47例患者；血液透析组（n = 17）和肾功能正常的对照组（n = 30）。记录病史和临床检查结果，包括术前和术后血液检查、放射学检查及活动状态（采用Koval评分测量）。对并发症和发病率进行调查并比较。
血液透析组术前血红蛋白/血细胞比容较低，但部分凝血活酶时间显著延长。血液透析组的出血量/输血量更高，手术时间更长。放射学检查显示，两组间不稳定骨折和不愈合发生率无显著差异。然而，血液透析组术后Koval评分显著更差，术后无法行走的比值比高出13.5倍。
放射学结果无显著差异，但血液透析组术后无法行走的风险高出13.5倍。血液透析患者有更多并发症且血流动力学不稳定，因此需要特别关注。需要精确复位和牢固固定，并进行精心的术后康复。
