绿色通道多学科诊疗模式提高高龄股骨转子间骨折的临床疗效

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摘要目的研究建立绿色通道多学科诊疗模式对高龄股骨转子间骨折患者早期手术的临床疗效。方法统计分析2015年1月至2018年12月在我院经两种治疗模式手术治疗的322例高龄(≥70岁)股骨转子间骨折患者的临床资料，根据诊治模式分为优先组(绿色通道多学科诊疗模式)和常规组(常规诊疗模式)。优先组共160例，男73例，女87例；年龄(82.4±7.3)岁；常规组共162例，男70例，女92例，年龄(82.0±8.6)岁。比较两组患者的术前等待时间、手术时间、术中出血量、住院时间及相关并发症(包括肺部感染、呼吸衰竭、猝死、心力衰竭、深静脉血栓、肺栓塞、脑梗塞、压疮、谵妄)发生情况。结果优先组术前等待时间为38.8 h，常规组为132.4 h，两组比较差异具有统计学意义(P＜0.01)；优先组住院时间为(6.4±2.1)d，常规组为(12.3±6.2)d，二者差异有统计学意义(P＜0.01)；两组的手术时间、术中出血量差异无统计学意义(P＞0.05)。优先组的并发症发生率为18.8%(30例)，常规处理组为56.1%(91例)，优先组的并发症发生率明显低于常规组(P＜0.01)；优先组肺部感染发生率5.6%(9/160)、深静脉血栓为4.4%(7/160)、谵妄为3.7%(6/160)，压疮为1.3%(2/160)，低于常规组的20.4%、12.3%、8.6%、6.8%，差异有统计学意义(P＜0.05)；两组的呼吸衰竭、猝死、心衰、肺栓塞、脑梗死比较，差异无统计学意义(P＞0.05)。结论建立绿色通道多学科诊疗模式，在条件允许下尽早手术可明显降低高龄股骨转子间骨折患者的住院时间和术后并发症，对规范化治疗高龄股骨转子间骨折具有重要的临床指导意义。

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关键词 ：绿色通道, 多学科诊疗模式, 高龄, 股骨转子间骨折

Abstract：Objective To study the clinical effect of green channel and multi-disciplinary diagnosis and treatment modeon the elderly patients with intertrochanteric fracture of femur.Methods The clinical data of 322 elderly patients (≥70 years old) with intertrochanteric fracture of femur treated by two kinds of operation modes were statistically analyzed.According to the diagnosis and treatment modes，they were divided into two groups：the priority group (green channel multidisciplinary diagnosis and treatment mode，160 cases) and the routine group (routine diagnosis and treatment mode，162 cases).The waiting time for operation，operation time，bleeding volume，length of stay and postoperative complications were compared between the two groups.Results The waiting time for operation of patients was significantly different between priority group(38.8 h) and routine group(132.4 h，P＜0.01)，and the hospital stay of patients was significantly different between priority group(6.4±2.1)d and routine group(12.3±6.2)d，P＜0.01).There was no significant difference in the operation time and bleeding volume between the two groups(P＞0.05).The complications of patients in the priority group(30/160，18.8%) was significantly lower than that in the routine group(91/162，56.1%；P＜0.01).The incidences of pulmonary infection，deep vein thrombosis(DVT)，delirium and pressure sore of patients in the priority group was significantly lower than that in the routine group 5.6%(9/160) VS 20.4%(33/162)，4.4%(7/160) VS 12.3%(20/162)，3.7%(6/160) VS 8.6%(14/162)，1.3%(2/160) VS 6.8%(11/162)，P＜0.05.There was no significant difference in the incidences of respiratory failure，sudden death，heart failure，pulmonary embolism and cerebral infarctionbetween the two groups(P＞0.05).Conclusion Through the establishment of green channel and multi-disciplinary diagnosis and treatment mode，early operation，if possible，can significantly reduce the hospitalization time and postoperative complications of the elderly patients with intertrochanteric fracture of femur，which is of great clinical significance for the standardized treatment of hip fracture in the elderly.

Key words： green channel multidisciplinary diagnosis and treatment mode elderly intertrochanteric fracture of femur

基金资助:苏州市科技发展计划(民生科技)项目(SYSD2018006)
张家港市卫计青年科技项目(ZJGQNKJ201701)

通讯作者: 沙卫平

作者简介: 赵理平(1982－ )，男，副主任医师，苏州大学附属张家港医院，215600。

引用本文:

赵理平 1，吴耀刚 1，沙卫平 1*，王黎 1，陈国兆 1，宋锦程 1，严飞 1，徐又佳 2. 绿色通道多学科诊疗模式提高高龄股骨转子间骨折的临床疗效[J]. 实用骨科杂志, 2020, 26(6): 495-498.
Zhao Liping，Wu Yaogang，Sha Weiping，et al. Green Channel Multidisciplinary Diagnosis and Treatment Improvethe Clinical Efficacy of Elderly Intertrochanteric Fracture Patients. sygkzz, 2020, 26(6): 495-498.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I6/495

［1］Cheung CL，Ang SB，Chadha M，et al.An updated hip fracture projection in Asia：The Asian Federation of Osteoporosis Societies study［J］.Osteoporosis & Sarcopenia，2018，4(1)：16-21.
［2］Bohl DD，Sershon RA，Saltzman BM，et al.Incidence，risk factors，and clinical implications of pneumonia after surgery for geriatric hip fracture［J］.J Arthroplasty，2018，33(5)：1552-1556.
［3］Cram P，Yan L，Bohm E，et al.Trends in operative and nonoperative hip fracture management 1990-2014：a longitudinal analysis of manitoba administrative data［J］.J Jm Geriatr Soc，2017，65(1)：27-34.
［4］Ouellet JA，Cooney LM.Hip fracture：can we do better?［J］.J Am Geriatr Soc，2017，65(1)：22-24.
［5］Ercin E，Bilgili MG，Sari C，et al.Risk factors for mortality in geriatric hip fractures：a compressional study of different surgical procedures in 785 consecutive patients［J］.Eur J Orthop Surg Traumatol，2017，27(1)：101-106.
［6］Martin CT，Gao Y，Pugely AJ.Incidence and risk factors for 30-day readmissions after hip fracture surgery［J］.Iowa Orthop J，2016(36)：155-160.
［7］曹烈虎，汪琳，陈晓，等.绿色通道建设提高高龄髋部骨折患者治疗的有效性与安全性［J］.第二军医大学学报，2017，38(4)：421-425.
［8］Strmse K.Fracture fixation problems in osteoporsis［J］.Injury，2004，35(2)：107-113.
［9］Pincus D，Ravi B，Wasserstein D，et al.Association between wait time and 30-day mortality in adults undergoing hip fracture surgery［J］.JAMA，2017，318(20)：1994-2003.
［10］Lizaur-Utrilla A，Martinez-Mendez D，Collados-Maestre I，et al.Early surgery within 2 days for hip fracture is not reliable as healthcare quality indicator［J］.Injury，2016，47(7)：1530-1535.
［11］Clague JE，Craddock E，Andrew G，et al.Predictors of outcome following hip fracture.Admission time predicts length of stay and inhospital mortality［J］.Injury，2002，33(1)：1-6.
［12］Novack V，Jotkowitz A，Proath A.Does delay in surgery after hip fracture lead to worse outcomes?A multicenter survey［J］.Int J Qual Health Care，2007，19(3)：170-176.
［13］Rosso F，Dettoni F，Bonasia DE，et al.Prognostic factors for mortality after hip fracture：Operation within 48 hours is mandatory［J］.Injury，2016，47(Suppl 4)：S91-S97.
［14］Cao LH，Chen X，Weng WZ，et al.Surgical treatment options for hip fractures in elderly patients aged 80 years old and over：a report of 915 cases［J］.Acad J Sec Mil Med Univ，2017，38(7)：409-414.
［15］李成宇，张星晨，郑欣，等.老年髋部骨折术后1年死亡率及危险因素的分析［J］.实用骨科杂志，2017，23(9)：802-806.
［16］Flikweert ER，Wendt KW，Diercks RL，et al.Complications after hip fracture surgery：are they preventable?［J］.Eur J Trauma Emerg Surg，2018，44(4)：573-580.
［17］Kilci O，Un C，Sacan O，et al.Postoperative mortality after hip fracture surgery：A 3 years follow up［J/OL］.PLoS ONE，2016，11(10)：e0162097.
［18］张长青，张伟.我国老年髋部骨折绿色通道建设的现实意义［J］.中华创伤骨科杂志，2014，30(3)：196-198.