髖部骨折中英文混合版陳芒芒

1、Wenzhou central hospital ---chen mangmang,Management of Hip Fractures in the Elderly------2014,區(qū)域鎮(zhèn)痛regional analgesia—更好的術(shù)前鎮(zhèn)痛，療效和全麻，脊髓麻醉general orspinal anesthesia差不多。 對(duì)于不穩(wěn)定的或者移位的股骨頸骨折推薦使用關(guān)節(jié)置換術(shù)arthroplasy。股骨近端髓內(nèi)釘治療粗隆

2、下骨折或者反轉(zhuǎn)子骨折。在無癥狀的患者中，如果患者的血色素低于8 g/dL，應(yīng)輸血。 出院后物理治療。各個(gè)學(xué)科的合作和治療組---對(duì)于輕中度的癡呆患者；術(shù)后multimodal pain管理.,綜述和基本理論以下的指南2014年，美國， AASO.258,000fractures in 2010.The annual United States economic burden formanaging hip fractures

3、 was estimated at $17 to $20 billion in 2010;也就是說：每年的的費(fèi)用是8萬美元。13th of the top 20貴的疾病in 2011.,越來越多。至2030, USA會(huì)達(dá)到289,000。美國的發(fā)生率是降低的，死亡率也是降低的。人口增加，指征放寬，醫(yī)生大量的增多。存在很多的問題：。。。。。。,總結(jié)：the hip fractureguideline involved r

4、eviewing morethan 16,000 abstracts and more than1,700 full-text articles to develop 25recommendations supported by 169research articles that meet stringentinclusion criteria. Each recommendationis based on a system

5、atic reviewof the research literature related to itstopic, 8條強(qiáng)烈推薦，15條一般推薦，2條有限推薦。,所有的這么多，說明，總結(jié)的意義，就是為了為病人更好的管理和治療。1.譫妄。包括：術(shù)前區(qū)域麻醉，多模式鎮(zhèn)痛multimodal pain control，減少麻醉藥物的使用。盡早手術(shù)，獲得早期的活動(dòng)。營養(yǎng)支持。多元治療（物理） 。區(qū)域麻醉在大多數(shù)醫(yī)院沒有做到。

6、多學(xué)科的治療----幫助患者能減少。。。。。再次骨折，肌肉的力量，活動(dòng)，防止摔倒。,減少病人發(fā)生繼發(fā)的骨質(zhì)疏松，---中度推薦。vitamin D and calcium 補(bǔ)充。支持髖部骨折病人，在術(shù)后對(duì)于骨質(zhì)疏松的診斷和治療。,預(yù)防深靜脈血栓和輸血是中度推薦。--包括使用預(yù)防深靜脈血栓藥物。很多人反對(duì)，為什么不是strong rating.綜合考慮了患者的藥物的有效性，使用藥物得到的好處。。。?？紤]了使用藥物后的并發(fā)癥

7、，副作用等等。The work group 推薦在栓塞風(fēng)險(xiǎn)高的病人身上使用In high-risk population.,8g/dl,強(qiáng)烈推薦。（無癥狀病人） Gruber-Baldini et al78 g/dL and 10 g/dL; nosignificant difference,早期手術(shù)---一般推薦。早期-48小時(shí)內(nèi)。reduce mortality. 因?yàn)閠he sickest patients--o

8、ften have the longest delays.Could potentially benefit the most fromearlier surgery.,手術(shù)方法：討論半髖還是全髖。Cemented stems？一般推薦---優(yōu)先使用骨水泥型。supports both the preferentialuse of 骨水泥inpatients undergoing 關(guān)節(jié)成形術(shù)andreports sim

9、ilar outcomes 報(bào)道了使用雙極和單極的相同療效。推薦使用骨水泥型，.和手術(shù)者的經(jīng)驗(yàn)有關(guān)。,一般推薦----it is critical that treatment be predicated on外科醫(yī)生的經(jīng)驗(yàn).Although THA may offer improved function and long-term results inselect patients, 但是需要考慮缺點(diǎn)。。。后側(cè)入路，容易脫位。

10、推薦使用前外側(cè)入路。但是，更需要考慮醫(yī)生的習(xí)慣和經(jīng)驗(yàn)。不推薦使用前方入路。,一般推薦：對(duì)于初始的影像學(xué)檢查不太明確的病人。但是懷疑有髖部骨折的病人。使用MRI。CT scan is not sufficient to exclude the possibility of fracture.,強(qiáng)烈推薦：認(rèn)為：脊髓麻醉和全麻相當(dāng)，盡管各有優(yōu)勢(shì)。,強(qiáng)烈推薦：認(rèn)為：脊髓麻醉和全麻相當(dāng)，盡管各有優(yōu)勢(shì)。,推薦:physician’s

11、expert judgment, andthe patient’s circumstances, values,preferences, and rights. A Strong recommendation = the quality of the supporting evidenceis high.,A Moderate recommendation =the benefits exceed the potential h

12、arm (or that the potential harm clearly exceedsthe benefits, in the case of a negativerecommendation) but the quality/applicability of the supporting evidenceis not as strong. A Limited recommendationmeans = resulted

13、 in an unclear balance between benefits and potential harm.,Advanced ImagingModerate evidence = MRI。But：remain alert to new information and be sensitive topatient preferences.,Preoperative RegionalAnalgesiaStrong ev

14、idence supports regionalanalgesia to improve preoperative paincontrol in patients with hip fracture.Strength of recommendation:Strong.非常有其他特殊情況。,Preoperative TractionModerate evidence Strength of recommendation:

15、Moderate.,Surgical TimingModerate evidence supports that hipfracture surgery within 48 hours ofadmission is associated with betteroutcomes.Implication: Practitioners shouldgenerally follow a Moderate recommendation

16、but remain alert to newinformation and be sensitive to patient preferences.,Aspirin and ClopidogrelLimited evidence。無需為此延誤手術(shù)。,麻醉 脊髓，全身麻醉一樣。,Stable Femoral NeckFracturesOperative fixation Implication: Practitioners

17、 shouldgenerally follow a Moderate recommendationbut remain alert to newinformation and be sensitive to patientpreferences.,Displaced Femoral NeckFracturesStrong evidence supports arthroplastyfor patients with uns

18、table(displaced) femoral neck fractures.,單極，雙極。Moderate evidence 對(duì)于移位的不穩(wěn)定的股骨頸骨折，無區(qū)別。一般推薦。be sensitive to patient preferences.,半髖還是全髖。對(duì)于股骨頸骨折不穩(wěn)定的，移位的，認(rèn)為：全髖治療更佳---一般推薦。,骨水泥型：關(guān)節(jié)置換術(shù)中，使用骨水泥=一般推薦。,Surgical Approach一般推薦

19、：后入路會(huì)有更高的脫位。Stable IntertrochantericFractures一般推薦：使用髖動(dòng)力螺釘還是近端髓內(nèi)釘，在穩(wěn)定的粗隆間骨折。粗隆下或反轉(zhuǎn)子骨折：強(qiáng)烈推薦：近端髓內(nèi)釘。Unstable IntertrochantericFractures中度推薦：股骨近端髓內(nèi)釘。,預(yù)防深靜脈血栓中度推薦：輸血值強(qiáng)烈推薦：8g/dl。輸血。,專業(yè)和物理的治療療法中度推薦：加強(qiáng)物理治療：強(qiáng)烈推薦：在出院