【摘要】 目的 :探讨局麻闭合复位外固定架治疗老年人高危股骨转子间骨折的临床疗效。方法 :自2013年3月至2015年3月,采用局麻闭合复位外固定架治疗老年高危股骨转子间骨折患者10例,其中男4例,女6例;年龄69~88岁,平均75.2岁。均为外伤所致。骨折按Evans分型,Ⅰ型5例,Ⅱ型3例,Ⅴ型2例。术前按美国麻醉医师协会ASA分级,Ⅲ级6例,Ⅳ级4例。观察术中失血量、手术时间、住院天数、术后并发症及患者下地时间、骨折愈合时间,并采用Harris髋关节评分评价髋关节功能。结果 :所有患者获得随访,时间3~23个月,平均13.1个月。1例慢阻肺患者术后4个月非手术原因死亡,其余患者骨折Ⅰ期愈合,平均愈合时间5.6个月。术后无髋内翻、下肢静脉血栓及针道松动等并发症。患者平均手术时间46 min,术中失血量(35.00±8.46)ml,均未输血。术后第2、3天发生肺部感染和针道感染1例,经积极抗感染和换药后好转,余患者平均术后4.2 d下地;所有患者平均住院10.6 d。末次随访Harris评分,总分83.42±3.27;优3例,良5例,一般1例,差1例。结论 :局麻下闭合复位外固定架治疗老年人高危股骨转子间骨折具有手术时间短、术中出血量少、术后功能恢复好的优点,是一种安全、可靠、经济的手术方式。更多还原

【Abstract】 Objective:To explore clinical efficacy of closed reduction and external fixation under local anesthesia for the treatment of high-risk elderly patients with intertrochanteric fracture. Methods:From March 2013 to March 2015,10 patients with intertrochanteric fractures treated with closing reduction and external fixator under local anesthesia were analyszed,including 4 males and 6 females,aged from 69 to 88 years old with an average of 75.2 years old. All fractures were caused by injury and classified to typeⅠ(5 cases),Ⅱ(3 cases),andⅤ(2 cases) according to Evans classification. According to American Society of Anesthesiologists(ASA),6 cases were type Ⅲ and 4 cases were type Ⅳ. Blood loss,operative time,hospital stays,postoperative complications,ambulation time and fracture healing time were observed,and Harris scoring were used to evaluate hip joint function. Results:All patients were followed up from 3 to 23 months with an average of 13.1 months. One patient with chronic obstructive pulmonary disease died for non -operation reason at 4 months after operation,the other fractures were healed at stageⅠ,the mean fracture healing time was 5.6 months. There were no coxa vara,lower limb venous thrombosis,loosen and remove of needle passage. The average operative time was 46 min,blood loss was(35.00±8.46) ml without blood transfusion.One patient was occurred pulmonary infection and stent-tract infection on the 2 nd and 3 rd day after operation,and improved with active anti-infection and dressing change;the other patients gone to ground activity at 4.2 d after operation. The patients stayed hospital for 10.6 d on average. According to Harris scoring at final following up,the total score was 83.42±3.27,3 cases obtained excellent results,5 cases good and 1 case poor. Conclusion:Closed reduction and external fixation under local anesthesia in treating high-risk elderly patients with intertrochanteric fracture,which has advantages of shorter operative time,less blood loss,good recovery of postoperative function,is a safe,stable and economic method.更多还原