【摘要】 目的 探討人工雙極股骨頭置換術治療老老年（gt;80歲）股骨頸骨折的臨床療效。 方法 2006年1月－2009年12月采用人工雙極股骨頭置換術治療23例老老年股骨頸骨折患者，其中男8例，女15例；年齡81~100歲，平均88歲。左側10例，右側13例。致傷原因：走路摔傷20例，交通事故傷3例。骨折按Garden分型：Ⅲ型14例，Ⅳ型9例。均為新鮮骨折，受傷至手術時間3~12 d。術前均合并慢性內科疾病。 結果 術后切口均I期愈合，3例發生肺部感染，1例發生深靜脈血栓形成，無切口感染及假體脫位。2例患者分別于術后5個月死于急性心肌梗死及術后1年死于高血壓性腦溢血。余21例均獲隨訪，隨訪時間12~48個月，平均26個月。X線片示假體位置良好。根據Harris髖關節評分標準：優12例，良6例，可2例，差1例，優良率為85.7%。 結論 人工雙極股骨頭置換術治療老老年股骨頸骨折手術時間短，可早期髖關節活動，減少了臥床并發癥，提高了生存率，改善了患者生活質量，是一種較理想的治療手段。【Abstract】 Objective To discuss the clinical effects of bipolar hemiarthroplasty for treatment of femoral neck fracture in super-aged patients who were over 80 years old. Methods From January 2006 to December 2009, 23 cases of femoral neck fracture were operated by bipolar hemiarthroplasty. Among the patients, there were 8 males and 15 females, with their age ranged from 81 to 100 years old averaging at 87.5 years. Ten patients had left femoral neck fracture, and 13 had right femoral neck fracture. Twenty patients had the injury because of falling on the ground while walking, and 3 due to car accident. Based on Garden classification, there were 14 cases of type Ⅲ and 9 of type Ⅳ fractures. All fractures were fresh. The interval between the injury and operation was 3 to 12 days. Before operation, all patients had concomitant chronic diseases. Results All incisions healed in the first stage with 3 cases of lung infection and 1 case of deep venous thrombus, and without incision infection or prosthesis dislocation. One patient died of acute myocardial infarction 5 months after operation and the other one died of hypertensive cerebral hemorrhage 1 year after operation. All the remaining 21 patients were followed up for 12 to 48 months averaging at 26 months. X-ray result showed a good location of the prosthesis. According to the Harris scoring system, the results were very good in 12 cases, good in 6 cases, fair in 2 cases and poor in 1 cases, with a total effective rate of 85.7％. Conclusions Bipolar hemiarthroplasty is an ideal method to treat femoral neck fracture in super-aged patients. It can shorten operation time, facilitate early movements of the hip joint, decrease complication rate due to lying in bed, and improve survival rate and quality of life.
【摘要】 目的 探討老老年患者留置尿管內壁細菌生物被膜形成情況及其對導管相關感染(CRI)的影響。〖HTH〗方法〖HTSS〗 分析2007年2月—2009年10月住院的175例留置尿管患者,均為男性,年齡75~96歲,平均86歲。不同留置時間(7~15 d 53例、16~30 d 49例、31~45 d 44例、gt;45 d 29例)的尿管,于拔出尿管后運用超聲震蕩使尿管內表面生物被膜完全脫落,梯度稀釋后進行生物被膜活菌計數,細菌的培養分類及構成比分析；采用掃描電鏡觀察尿管內壁細菌生物被膜形成的情況；觀察尿管留置時間與生物被膜CRI的關系。結果 隨著尿管留置時間的延長,尿管內表面生物被膜活菌計數呈指數趨勢增長,CRI發生率有升高趨勢,各置管時段組間尿管內表面生物被膜活菌計數及CRI發生率比較差異均有統計學意義(Plt;0.05)。掃描電鏡見生物被膜的形成隨時間的延長而明顯增多。結論 細菌生物被膜形成是老老年患者留置尿管相關性尿路感染的重要致病因素,尿管留置時間越長,尿管生物被膜感染的危險性及幾率越高。更換尿管或縮短留置時間仍是防止尿管生物被膜感染的主要方法。
