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[目的]探讨和总结合并慢性肝衰竭(chronic liver failure,CLF)老年髋部骨折的救治方法及围手术期管理经验。[方法]选取2008年1月~2013年12月于本科连续收治的12例合并慢性肝衰竭的老年髋部骨折患者,对其进行术前ASA评级、MELD评分、POSSUM评分及P-POSSUM评分并实施骨科损害控制技术,记录患者一般资料、肝硬化Child-Pugh分期、术前天数、手术方式、麻醉方法及术后并发症情况。[结果]所有患者均安全度过围手术期,住院期间无死亡病例,术后手术伤口均甲级愈合,相关并发症经过内科治疗均治愈。12例全部获得随访,平均随访21.3个月(3~47个月),最后一次随访髋关节Harris评分平均83.2分(68~93)分,优良率77.8%。[结论]合并慢性肝衰竭的老年髋部骨折患者,经过术前积极风险评估并结合骨科损害控制技术,只要选择恰当的手术时机、手术方式以及麻醉方法,围术期间采取措施控制贫血、腹水及门脉高压及相关并发症,必要时术后辅助应用人工肝支持系统,其手术是安全有效的。
[Objective] To discuss and summarize the treatment and perioperative management experience of elderly patients with hip fracture complicated with chronic liver failure (CLF). [Methods] A total of 12 consecutive patients with hip fracture with chronic hepatic failure admitted to our department from January 2008 to December 2013 were enrolled in this study. The preoperative ASA, MELD, POSSUM and P-POSSUM scores The implementation of orthopedic damage control technology, record the general information of patients, cirrhosis Child-Pugh staging, preoperative days, surgical methods, anesthesia and postoperative complications. [Results] All the patients were safely perioperatively and there were no deaths during hospitalization. All the patients underwent surgical treatment of grade A healed. The related complications were cured after medical treatment. All 12 cases were followed up for an average of 21.3 months (range 3 to 47 months). The mean hip score was 83.2 (68-93) at the last follow-up. The excellent and good rate was 77.8%. [Conclusion] Patients with senile hip fracture with chronic hepatic failure undergo preoperative positive risk assessment combined with orthopedic damage control techniques. Only by selecting the appropriate timing of surgery, surgical procedure and anesthesia, measures should be taken during perioperative period to control anemia, ascites and Portal hypertension and related complications, if necessary, after the application of artificial liver support system, the surgery is safe and effective.