Schuetze Konrad, Eickhoff Alexander, Rutetzki Kim-Sarah, Richter Peter H, Gebhard Florian, Ehrnthaller Christian
Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Department of Trauma Surgery - Campus Innenstadt, Munich University Hospital, Nussbaumstr. 20, 80336, Munich, Germany.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1827-1833. doi: 10.1007/s00068-020-01472-4. Epub 2020 Aug 31.
Operative timing, perioperative management and postoperative rehabilitation are rising challenges in orthopedic geriatric trauma. The aim of this study was to determine the outcome of patients with dementia or with a high number of comorbidities treated with hemiprosthesis after hip fracture. Literature regarding patients with high comorbidities is scarce, leaving nothing but endoprosthetic treatment for even the sickest, immobile patients.
A retrospective chart review of 326 patients (mean age 81 ± 9 years; 230 women and 96 men) with hip fractures treated between 2012 and 2017 with a hemiprosthesis was performed. Primary outcome measures were surgical and nonsurgical complication rates, best achievable mobilisation during the hospital stay and mortality.
Patients with dementia had 20-fold increased risk to be bedridden after surgery and ninefold increased risk of dying (p < 0.005). Furthermore, they needed significantly more revision surgeries because of surgical complications. Patients classified ASA IV and V had significantly lower postoperative mobilization levels with only 10% able to walk with crutches and 53% bedridden. They also had significantly more non-surgical complications while dementia had no effect on non-surgical complication rate.
Patients classified ASA IV and V or suffering dementia show poor outcome after hip fracture treated with hemiprosthesis. Multidisciplinary approaches including surgeons, geriatricians, physiotherapists and psychiatrists are needed to improve the outcome of these patients. Especially in a subgroup of patients, where no mobilization is expected, alternative treatment options may be considered.
手术时机、围手术期管理及术后康复是老年骨科创伤领域日益严峻的挑战。本研究旨在确定髋部骨折后接受半髋关节置换术治疗的痴呆患者或合并症较多患者的治疗结果。关于合并症较多患者的文献稀少，即便对于病情最重、无法活动的患者也只能采用假体治疗。
对2012年至2017年间接受半髋关节置换术治疗的326例髋部骨折患者（平均年龄81±9岁；230例女性，96例男性）进行回顾性病历审查。主要观察指标为手术和非手术并发症发生率、住院期间可达到的最佳活动能力及死亡率。
痴呆患者术后卧床风险增加20倍，死亡风险增加9倍（p<0.005）。此外，由于手术并发症，他们需要更多的翻修手术。美国麻醉医师协会（ASA）分级为IV级和V级的患者术后活动水平显著较低，只有10%的患者能够拄拐行走，53%的患者卧床。他们的非手术并发症也显著更多，而痴呆对非手术并发症发生率没有影响。
ASA分级为IV级和V级或患有痴呆的患者在接受半髋关节置换术治疗髋部骨折后预后较差。需要包括外科医生、老年病医生、物理治疗师和精神科医生在内的多学科方法来改善这些患者的治疗结果。特别是在预计无法活动的患者亚组中，可考虑其他治疗选择。
