[1]马江涛,俞敏,俞高峰,等.快速康复外科理论在老年股骨转子间骨折治疗中的应用[J].中医正骨,2015,27(01):39-40.
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快速康复外科理论在老年股骨转子间骨折治疗中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年01期
页码:
39-40
栏目:
临床报道
出版日期:
2015-01-15

文章信息/Info

作者:
马江涛俞敏俞高峰泮立群竺丛庆张孟超
浙江省新昌县张氏骨伤医院,浙江 新昌 312500
关键词:
髋骨折 转子间骨折 快速康复外科理论 围手术期医护 老年人
摘要:
目的:探讨快速康复外科理论在老年股骨转子间骨折治疗中的应用价值。方法:采用快速康复外科理论指导59例老年股骨转子间骨折患者的治疗,男21例,女38例; 年龄65~92岁,中位数77岁; 左侧27例,右侧32例。骨折Evans-Jenson分型,Ⅰ型8例、Ⅱ型16例、Ⅲ型25例、Ⅳ型7例、Ⅴ型3例。合并心血管疾病36例、呼吸系统疾病30例、脑血管疾病7例、糖尿病11例。受伤至手术时间3~14 d,中位数6 d。观察患者疼痛缓解、髋关节功能恢复及并发症发生情况。结果:本组59例患者,术后住院时间5~15 d,中位数7 d; 均获随访,随访时间5~20个月,中位数15个月; 骨折均愈合,愈合时间3~5个月,中位数3.5个月。术后疼痛缓解、患髋功能改善。参照Harris髋关节功能评分标准评价患髋功能,末次随访时73~90分,中位数79分。术后并发消化系统不良反应8例,经药物对症处理,症状缓解; 并发急性精神障碍7例,经心理治疗及药物治疗,症状缓解; 并发下肢深静脉血栓形成1例,经溶栓药物治疗,栓塞血管再通; 并发泌尿、呼吸系统感染各1例,经抗生素等药物治疗,感染控制,症状缓解。无切口感染、骨折畸形愈合等并发症发生。结论:采用快速康复外科理论指导老年股骨转子间骨折的治疗,有利于疼痛缓解和患髋功能的改善,并发症少,安全可靠。

参考文献/References:

[1] Kehlet H,Wilmore DW.Multimodal strategies to improve surgical outcome[J].Am J Surg,2002,183(6):630-641.
[2] Kim JW,Kim WS,Cheong JH.Safety and efficacy of fast-track surgery in laroscopic distal gastrectomy for gastric cancer:a randomized clinical trial[J].World Journal of Surgery,2012,36(12):2879-2887.
[3] Cao S,Zhao G,Cui J,et al.Fast-track rehabilitation program and conventional care after esophagectomy:a retrospective controlled cohort study[J].Support Care Cancer,2013,21(3):707-714.
[4] Husted H,Troelsen A,Otte KS,et al.Fast-track surgery for bilateral total knee replacement[J].J Bone joint Surg(Br),2011,93(3):351-356.
[5] Maffezzini M,Campodonico F,Capponi G,et al.Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch[J].Surg Oncol,2012,21(3):191-195.
[6] Cascales C PA,Gil M J,Galindo F PJ,et al.Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC)after cytoreductive surgery in advanced ovarian cancer[J].Eur J Surg Oncol,2011,37(6):543-548.
[7] 宋远征,赵建宇,郭亭,等.快速康复外科在高龄髋部骨折患者围手术期的应用[J].中国矫形外科杂志,2012,20(14):1253-1256.
[8] 刘恒旸,乔继红,王华锋,等.快速康复外科理念在全膝关节置换围手术期管理中的应用[J].齐齐哈尔医学院学报,2011,32(20):3374-3376.
[9] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002::26-217.
[10] Ljungqvist O,Nygren J,Thorell A.Insulin resistance and elective surgery[J].Surgery,2001,128(5):757-760.
[11] Rodgers A,Walker N,Schug S,et al.Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia results from overview of randomized trials[J].BMJ,2000,321(7275):1493.
[12] Pacero C,Belden J.Evidence-based perianesthesia care:accelerated postoperative recovery programs[J].J Perianesth Nurs,2006,21(3):168-176.
[13] Peters CL,Shirly B.The effect of a new multimodal perioperative anesthetic regimen on postoperative pain,side effects,rehabilitation,and lenth of hospital stay after total joint arthroplasty[J].J Arthroplasty,2006,21(6 Suppl 2):132-138.
[14] Sessler DI.Mild perioperative hypothermia[J].N Engl J Med,1997,336(24):1730-1737.
[15] 杨迪,金建强,邵海宇,等.股骨近端防旋髓内钉微创治疗高龄转子间骨折的围手术期策略分析[J].中医正骨,2013,25(11):26-30.
[16] 张彬,蔡运火,王芝龙,等.股骨转子间骨折的手术治疗进展[J].中医正骨,2013,25(10):39-42.

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备注/Memo

备注/Memo:
2014-07-17收稿 2014-08-14修回
更新日期/Last Update: 2015-01-30