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[1]呂國(guó)強(qiáng),黃淑明,蘭樹(shù)華,等.合并慢性腎功能不全的股骨轉(zhuǎn)子間骨折的治療體會(huì)[J].中醫(yī)正骨,2013,25(07):46-48.
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合并慢性腎功能不全的股骨轉(zhuǎn)子間骨折的治療體會(huì)()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期數(shù):
2013年07期
頁(yè)碼:
46-48
欄目:
髖部損傷
出版日期:
2013-07-31

文章信息/Info

作者:
呂國(guó)強(qiáng)黃淑明蘭樹(shù)華吳泉州鄭榮宗鄭崇武葉方
浙江省麗水市中心醫(yī)院,浙江 麗水 323000
關(guān)鍵詞:
腎功能不全慢性 髖骨折 股骨轉(zhuǎn)子間骨折 骨折固定術(shù)髓內(nèi) 血液透析
摘要:
的:探討合并慢性腎功能不全的股骨轉(zhuǎn)子間骨折的治療策略。方法:在維持血液透析的基礎(chǔ)上應(yīng)用股骨近端防旋髓內(nèi)釘治療合并慢性腎功能不全的股骨轉(zhuǎn)子間骨折患者17例,男12例,女5例。年齡43~92歲,中位數(shù)71歲。所有患者均為單側(cè)新鮮閉合性骨折,左側(cè)10例,右側(cè)7例。骨折AO分型A1型4例,A2型11例,A3型2例。腎功能不全繼發(fā)于慢性腎小球腎炎6例,慢性間質(zhì)性腎炎2例,糖尿病腎病3例,高血壓腎病4例,多囊腎1例,梗阻性腎病l例。血液透析史3~72個(gè)月,中位數(shù)46個(gè)月。合并其他1種內(nèi)科疾病者6例,合并其他2種以上內(nèi)科疾病者8例。合并肋骨骨折、肺挫傷1例,合并顴弓骨折、腦挫傷、皮膚挫裂傷1例,合并橈骨遠(yuǎn)端骨折1例,合并皮膚挫裂傷2例。術(shù)后隨訪觀察患者的骨折愈合情況及髖關(guān)節(jié)功能。結(jié)果:本組患者手術(shù)時(shí)間35~145 min,中位數(shù)72 min; 術(shù)中出血量80~550 mL,中位數(shù)177 mL。術(shù)后1例患者發(fā)生切口感染,經(jīng)加強(qiáng)換藥及應(yīng)用敏感抗生素治療后治愈; 2例患者發(fā)生泌尿系統(tǒng)感染,經(jīng)抗感染治療后治愈; 3例患者肺部病情較術(shù)前加重,其中1例因病情危重治療無(wú)效后死亡,其余2例經(jīng)呼吸科會(huì)診對(duì)癥處理后改善; 1例患者術(shù)后心臟疾病加重,經(jīng)心內(nèi)科會(huì)診處理后改善。術(shù)后隨訪期間死亡5例,其中術(shù)后第1年死亡3例,術(shù)后第2年死亡2例,死亡原因分別為心臟病發(fā)作、血栓栓塞、腦血管意外及肺部疾病加重致呼吸衰竭。術(shù)后1年存活的13例患者的骨折均達(dá)到臨床愈合標(biāo)準(zhǔn),骨折愈合時(shí)間10~22周,中位數(shù)16周。未發(fā)生內(nèi)固定物松動(dòng)、螺旋刀片切割股骨頭、髖內(nèi)翻畸形、股骨骨折及股骨頭壞死等并發(fā)癥。按照自報(bào)告髖關(guān)節(jié)Harris評(píng)分量表評(píng)定,患者術(shù)后1年的疼痛、坐、上下樓情況及穿鞋襪情況評(píng)分與骨折前比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(41.38±3.95)分,(42.00±4.00)分,t=1.477,P=0.165;(4.69±0.75)分,(4.85±0.55)分,t=1.000,P=0.337;(2.62±1.26)分,(2.92±1.04)分,t=1.000,P=0.337;(3.23±1.30)分,(3.69±0.75)分,t=1.897,P=0.082]; 術(shù)后1年的助行器使用、跛行、行走距離評(píng)分及總分低于骨折前[(6.77±3.06)分,(8.38±2.63)分,t=2.941,P=0.012;(7.62±2.99)分,(8.77±3.49)分,t=2.739,P=0.018;(7.77±2.86)分,(9.15±1.95)分,t=3.207,P=0.008;(73.46±14.98)分,(79.62±13.02)分,t=2.975,P=0.012]。結(jié)論:對(duì)于合并慢性腎功能不全的股骨轉(zhuǎn)子間骨折,股骨近端防旋髓內(nèi)釘是一種較有效的固定方法,而維持性血液透析改善腎功能及積極處理內(nèi)科系統(tǒng)疾病是減少圍手術(shù)期相關(guān)并發(fā)癥、降低死亡率的關(guān)鍵。

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更新日期/Last Update: 1900-01-01