Clinical Assistant Professor of Medicine, and Section Leader for Specialty Services, Division of Hospital Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
Associate Professor of Anesthesiology and Orthopedic Surgery, and Director, Orthopedic Anesthesia, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Cleve Clin J Med. 2021 Apr 1;88(4):237-247. doi: 10.3949/ccjm.88a.20149.
Morbidity and mortality rates associated with acute hip fracture remain high. Over the past decade, the management of hip fracture has shifted to emphasize prompt surgical treatment, multimodal analgesia to reduce opioid use, and incorporation of enhanced recovery pathways. Preoperative evaluation focuses on acutely correctable problems, with the understanding that delaying surgery may worsen the outcome. Prophylaxis of venous thromboembolism, treatment of preoperative anemia and acute kidney injury, and cardiac stabilization are important measures to reduce morbidity. Multimodal analgesia incorporating regional anesthesia techniques may help prevent delirium and facilitate early participation in physical therapy to reduce complications.
髋部骨折相关的发病率和死亡率仍然很高。在过去的十年中，髋部骨折的治疗已经转向强调及时的手术治疗、多模式镇痛以减少阿片类药物的使用，以及采用强化康复途径。术前评估侧重于急性可纠正的问题，并认识到延迟手术可能会使结果恶化。预防静脉血栓栓塞、治疗术前贫血和急性肾损伤以及心脏稳定是降低发病率的重要措施。包括区域麻醉技术的多模式镇痛可能有助于预防谵妄并促进早期参与物理治疗以减少并发症。
