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老年髋部骨折快速手术的研究进展

[Research progress of rapid surgery for hip fracture in elderly patients].

作者信息

Han Chao, Li Xiaodan, Sun Xiang, Han Zhe, Liu Jianan, He Weiwei, Dong Qiang

机构信息

Department of Hip Traumatology, Division Ⅱ, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China.

Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, 300192, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Dec 15;37(12):1556-1561. doi: 10.7507/1002-1892.202308038.

Abstract

OBJECTIVE

To review the research progress of rapid surgery for hip fracture in elderly patients.

METHODS

The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice.

RESULTS

Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients.

CONCLUSION

In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.

摘要

目的

综述老年髋部骨折快速手术的研究进展。

方法

从老年人群特点、快速手术的益处、延迟手术的弊端以及现行指南的建议等方面,系统总结国内外已发表的研究、专家共识及指南,以进一步指导临床实践。

结果

髋部骨折是老年人群常见的骨折类型。由于老年患者体质普遍较差,保守治疗时常出现多种基础疾病,如坠积性肺炎、压疮、下肢静脉血栓等并发症,其致残率和死亡率较高,故手术治疗为首选。目前,国内外多数相关研究、专家共识及指南均支持快速手术,即入院后应立即启动术前检查,明确并积极纠正服用抗凝药物、严重心血管疾病、重度贫血等不利因素,尽可能在入院后48小时内完成手术。快速手术不仅可显著降低患者死亡率,还可缩短住院时间,减少围手术期认知功能障碍的发生率,有利于患者住院期间疼痛及术后功能的恢复,改善患者预后。

结论

为避免延迟手术带来的诸多问题,老年髋部骨折患者应在积极纠正不利因素的条件下尽早手术。综合评估与准备,制定个体化手术方案,组建多学科医疗团队,可降低手术风险,提高手术效果。

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[Research progress of rapid surgery for hip fracture in elderly patients].老年髋部骨折快速手术的研究进展
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Dec 15;37(12):1556-1561. doi: 10.7507/1002-1892.202308038.

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