Neumann J, Morscher E
Orthopädische Universitätsklinik, Felix Platter-Spital, Basel.
Orthopade. 1994 Feb;23(1):50-9.
Ninety-five primary elective total hip prosthesis procedures were carried out in patients over 80 years of age (average 82.9 years). The results were studied retrospectively to determine the individual risk-advantage relationship and the general cost-advantage relationship taking the social aspects into consideration. Fractures and emergency procedures were excluded. Ninety-three percent of the patients had preexisting general illnesses. There were no local or general complications in the peri- and postoperative courses of 86% and 85%, respectively. The general complications included urological (6%), cardiovascular (5%) and abdominal (3%) problems. The only death (myocardial infarction) took place 4 weeks after the operation during the rehabilitation phase. The average hospital stay was 23.3 days; 20% of the patients were then able to return home, while 80% were sent to another institution for further care (geriatric department, rehabilitation), where the average stay was 36.7 days. The total inpatient treatment period was on average 52.3 days. At the time of the last follow-up, an average of 4.6 years postoperatively, 75% of the patients were alive with an average age of 87.4 years. Seventy-nine percent were still able to live alone and look after themselves; 81% were independent or only partially dependent (living in a retirement home). Ninety-three percent had no pain or only mild pain. If indicated, the operation risk factor for total hip prostheses in patients over 80 years is obviously low, and the results are good. This operation permits the patient to have many years free of pain, to remain independent, and to achieve a clearly higher quality of life. In this way one can also save on the high cost of many years of nursing care.
对95例80岁以上(平均82.9岁)患者进行了初次择期全髋关节置换手术。回顾性研究结果,以确定个体风险-获益关系以及考虑社会因素后的总体成本-获益关系。排除骨折和急诊手术病例。93%的患者术前存在全身性疾病。围手术期和术后分别有86%和85%的患者未出现局部或全身并发症。全身并发症包括泌尿系统(6%)、心血管系统(5%)和腹部(3%)问题。唯一的死亡病例(心肌梗死)发生在术后4周的康复阶段。平均住院时间为23.3天;20%的患者随后能够回家,而80%的患者被送往另一机构接受进一步护理(老年科、康复科),平均停留时间为36.7天。总的住院治疗期平均为52.3天。在最后一次随访时,平均术后4.6年,75%的患者存活,平均年龄为87.4岁。79%的患者仍能独自生活并自理;81%的患者独立或仅部分依赖他人(住在养老院)。93%的患者无疼痛或仅有轻微疼痛。如果有指征,80岁以上患者行全髋关节置换术的手术风险因素明显较低,且效果良好。该手术使患者能够多年无痛,保持独立,并明显提高生活质量。通过这种方式,还可以节省多年护理的高昂费用。