Klein D M, Tornetta P, Barbera C, Neuman D
Department of Orthopaedics, State University of New York Health Science Center at Brooklyn 11203, USA.
Clin Orthop Relat Res. 1998 May(350):174-8.
The conditions of a hip fracture and renal failure cause particularly high mortality. Eight patients (average age, 63 years) who had operative treatment for nine hip fractures were studied retrospectively. Three had intertrochanteric fractures fixed with sliding compression screws, and five had femoral neck fractures (bilateral in one patient): two nondisplaced femoral neck fractures were fixed with percutaneous screws, and four displaced femoral neck fractures were treated with arthroplasties in three and percutaneous screws in one. Operative treatment was done when the patient was in medically stable condition (average, 8 days). Full weightbearing was allowed on the injured limb after surgery. Early morbidity analysis showed no wound infections, thromboembolic events, or hemorrhagic complications. The first year mortality was three (38%). Late morbidity included one nonunion and one sliding screw penetration. Total mortality at 6 years was seven (88%) patients, with an average postoperative survival time of 28 months. Preoperative ambulation was preserved in five of seven (71%) patients. One the basis of this study, it appears that a team approach to operative management including nephrologist and surgeon helps to reduce short term complications and mortality and allows such patients to be mobilized and regain ambulation.
髋部骨折和肾衰竭的情况导致特别高的死亡率。对8例（平均年龄63岁）因9处髋部骨折接受手术治疗的患者进行了回顾性研究。3例转子间骨折采用滑动加压螺钉固定，5例股骨颈骨折（1例为双侧）：2例无移位股骨颈骨折采用经皮螺钉固定，4例移位股骨颈骨折中3例行关节置换术，1例行经皮螺钉固定。手术治疗在患者病情医学稳定时进行（平均8天）。术后允许受伤肢体完全负重。早期发病率分析显示无伤口感染、血栓栓塞事件或出血并发症。第一年死亡率为3例（38%）。晚期发病率包括1例骨不连和1例滑动螺钉穿透。6年时总死亡率为7例（88%）患者，术后平均生存时间为28个月。7例患者中有5例（71%）术前的行走能力得以保留。基于这项研究，看来包括肾病学家和外科医生在内的团队手术管理方法有助于减少短期并发症和死亡率，并使此类患者能够活动并恢复行走能力。
