损伤控制技术在老年股骨颈骨折治疗中的应用(1)
[摘要] 目的 探討应用损伤控制技术治疗老年人股骨颈骨折的临床疗效。 方法 选择2016年1月～2017年12月老年股骨颈骨折患者117例，其中男35例，女82例;年龄65～96(82.7±7.0)岁;Garden分型：Garden Ⅰ型3例，Garden Ⅱ型3例，GardenⅢ型51例，Garden Ⅳ型60例。围手术期实施损伤控制技术治疗，运用生理学与手术严重度评分系统(physiological and operative severity score for the enumeration of mortality and morbidity，POSSUM)预测并发症发生率，用朴茨茅斯改良POSSUM (Portsmouth modified POSSUM，P-POSSUM)预测死亡率。 结果 入院时POSSUM评分<20分的并发症低风险患者43例，根据患者病情实施骨科手术;POSSUM评分≥20分的并发症高风险患者74例，采用损伤控制内科技术稳定内环境后行损伤控制骨科手术。损伤控制前预测并发症发生率为(49.3±5.9)%，死亡率为(11.4±1.5)%;损伤控制后并发症发生率为(35.2±5.1)%，死亡率为(4.5±1.9)%;实际并发症发生率为35.9%，死亡率为3.4%，与损伤控制前比较，差异有统计学意义(P<0.05)。 结论 对老年股骨颈骨折患者实施损伤控制技术能够规避手术风险，降低术后并发症发生率及死亡率。
[关键词] 损伤控制;股骨颈骨折;老年人;POSSUM;P-POSSUM
[中图分类号] R683.4 [文献标识码] B [文章编号] 1673-9701(2019)01-0112-04
Application of injury control technique in the treatment of femoral neck fracture in the elderly
KANG Gengjie1 LI Yonggang2
1.Medical Administration Division，Fuxing Hospital，Capital Medical University，Beijing 100038，China;2.Department of Orthopaedics，Fuxing Hospital，Capital Medical University，Beijing 100038，China
[Abstract] Objective To investigate the clinical efficacy of injury control technique in the treatment of femoral neck fractures in the elderly. Methods 117 elderly patients with femoral neck fractures from January 2016 to December 2017 were selected. Among them， there were 35 males and 82 females， aged 65-96(82.7±7.0)years old， and there were 3 cases of Garden Ⅰ type， 3 cases of type Ⅱ， 51 cases of Garden Ⅲ and 60 cases of Garden Ⅳ. Injury control techniques were applied in perioperative period. The physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM) was used to predict the incidence of complications. Portsmouth modified POSSUM was used to predict mortality. Results There were 43 patients with complication low risk of POSSUM score <20 at admission， and orthopedic surgery was performed according to the patient's condition.There were 74 patients with complication high risk of POSSUM score ≥20， who underwent Injury control orthopedic surgery after using damage control medical technique to stabilize the internal environment. The predicted incidence of complications was(49.3±5.9)%， and the mortality rate was(11.4±1.5)% before injury control. And the incidence of complications after injury control was(35.2±5.1)% and the mortality rate was(4.5±1.9)%. The actual complication rate was 35.9%， and the mortality rate was 3.4%， and the difference was statistically significant compared with before the injury control(P<0.05). Conclusion Injury control technology for elderly patients with femoral neck fracture can avoid the risk of surgery and reduce the incidence of postoperative complications and mortality., http://www.100md.com(康更洁 李永刚)
[关键词] 损伤控制;股骨颈骨折;老年人;POSSUM;P-POSSUM
[中图分类号] R683.4 [文献标识码] B [文章编号] 1673-9701(2019)01-0112-04
Application of injury control technique in the treatment of femoral neck fracture in the elderly
KANG Gengjie1 LI Yonggang2
1.Medical Administration Division，Fuxing Hospital，Capital Medical University，Beijing 100038，China;2.Department of Orthopaedics，Fuxing Hospital，Capital Medical University，Beijing 100038，China
[Abstract] Objective To investigate the clinical efficacy of injury control technique in the treatment of femoral neck fractures in the elderly. Methods 117 elderly patients with femoral neck fractures from January 2016 to December 2017 were selected. Among them， there were 35 males and 82 females， aged 65-96(82.7±7.0)years old， and there were 3 cases of Garden Ⅰ type， 3 cases of type Ⅱ， 51 cases of Garden Ⅲ and 60 cases of Garden Ⅳ. Injury control techniques were applied in perioperative period. The physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM) was used to predict the incidence of complications. Portsmouth modified POSSUM was used to predict mortality. Results There were 43 patients with complication low risk of POSSUM score <20 at admission， and orthopedic surgery was performed according to the patient's condition.There were 74 patients with complication high risk of POSSUM score ≥20， who underwent Injury control orthopedic surgery after using damage control medical technique to stabilize the internal environment. The predicted incidence of complications was(49.3±5.9)%， and the mortality rate was(11.4±1.5)% before injury control. And the incidence of complications after injury control was(35.2±5.1)% and the mortality rate was(4.5±1.9)%. The actual complication rate was 35.9%， and the mortality rate was 3.4%， and the difference was statistically significant compared with before the injury control(P<0.05). Conclusion Injury control technology for elderly patients with femoral neck fracture can avoid the risk of surgery and reduce the incidence of postoperative complications and mortality., http://www.100md.com(康更洁 李永刚)