老年人髖部骨折手術前後的考量

Perioperative Considerations for Elderly Patients with Hip Fractures

黃喜南(Hee-Nun Ng) ； 楊榮森(Rong-Sen Yang)

《台灣老年醫學暨老年學雜誌》 5卷1期 (2010/02) Pp. 22-35

https://doi.org/10.29461/TGG.201002.0003

摘要

台灣社會已經步入高齡化，令髖部骨折有日漸增多的趨勢。老年人常會合併多種內科疾病，因此一旦發生髖部骨折，則會造成高罹病率和死亡率，約有30%的患者在受傷後1年死亡，台灣的統計資料則顯示，老年女性髖部骨折病患在1年內的死亡率為15%，男性則為22%。雖然醫療環境、手術內固定和治療髖部骨折技術都有改善和進步，但是病人死亡率還是居高不下。目前有很多因子都可供預測病患早期的死亡率，其中包括年齡大於85歲、無法自立行動、營養不良、術前ASA(American Society of Anesthesiologists)生理狀態分類屬3和4類。此外，當髖部骨折術後出現內科方面併發症時，死亡率更是會上升。
老年人常會合併複雜的內科疾病，所以在處理骨折時，必須具備完善的治療流程。治療骨折的主要宗旨是早期活動，減少病人因臥床而產生之併發症，及早恢復日常生活功能。本篇論文主要是回顧現今文獻及根據實證醫學證據，探討老年人髖部骨折手術前後的考量事項，和處理此類老年病患的複雜議題。

關鍵字

老年人 ； 髖部 ； 骨折 ； 手術前後考量

並列摘要

With the aging of the Taiwan population, the incidence of hip fracture is steadily increasing. Elderly patients with hip fracture are associated with substantial morbidity and mortality due to the presence of several coexisting medical condition; 30% of the elderly patients die within 1 year of hip fracture. The elderly female patients with hip fracture in Taiwan were reported to have a mortality rate of 15% within one year of the fracture while the rate read 22% for their male counterparts. Despite improvements in medical management, surgical implant, and treatment techniques, hip fracture in elderly patients remains a condition associated with a significant mortality. Several factors have been shown to be predictive of early mortality following a hip fracture, including age older than 85 years, disability, poor nutrition, and preoperative ASA class Ⅲ and Ⅳ. Moreover, occurrence of significant postoperative medical complications may trigger increase in the rate of mortality following hip fracture.
The elderly patients with hip fracture are usually associated with complex medical conditions that require a specialized treatment algorithm. The treatment should aim at facilitating early mobilization, avoiding the complications associated with prolonged recumbency, and heping patients return to functional activity. The current article reviews the literature and takes an evidence-based look at the perioperative considerations associated with hip fractures in elderly patients and the complex issues involved in managing these patients.

並列關鍵字

elderly ； hip ； fracture ； perioperative consideration