背景:随着人均寿命的延长、生活质量要求的提高,越来越多高龄者(年龄≥80岁)有行全髋关节置换术(total hip arthroplasty,THA)的需求.围术期并发症的风险评估对手术安全至关重要,但对高龄患者尚没有有效的评估手段.目的:研究分析非髋部骨折高龄患者行初次THA围术期内科相关并发症.方法:回顾性总结并分析我院2011年11月至2016年11月收治的34例行初次THA的高龄患者(38髋),排除术前诊断为髋部骨折者.记录患者麻醉方式、各系统合并症、术前评估结果、术中情况、术后检查及并发症等.结果:1例患者因急性心肌梗死死亡,其存在稳定性心绞痛、高血压、糖尿病、I°房室传导阻滞及完全性右束支传导阻滞,且长期服用小剂量糖皮质激素.1例患者术后存在组织灌注不足并出现急性肾损伤,经保守治疗后肾功能恢复;统计显示术后肾小球滤过率(glomerular filtration rate, GFR)与术前GFR明显相关,男性患者术后GFR显著低于女性.本研究患者围术期未出现下肢深静脉血栓形成、肺部感染、肝功能异常、症状性脑梗死及切口感染等并发症.结论:目前并无明确证据显示单纯年龄为80岁及以上是围术期内科并发症的独立危险因素,但高龄患者可因合并多种内科疾病而显著增加择期THA围术期内科并发症风险.因此,术前应完善主要器官功能及合并症评估.术前器官功能评估大致正常且无合并症者可考虑行THA,虽然脏器功能评估无明显异常,但合并多种内科疾病者仍应高度警惕围术期并发症.
Background:The demand of total hip arthroplasty (THA) is increasing steadily among elderly patients(≥80 years old)due to expanded lifespan and the need for a higher quality of life. The assessment of the risks of perioperative medical complications, although very important for the safety of operation, has not been established effectively among elderly patients. Objective: To study the perioperative medical complications of primary THA in elderly patients without hip fracture.Methods: A total of 34 patients (38 hips) were retrospectively studied who had received primary THA in our hospital from November 2011 to November 2016. All patients were over 80 years old at the time of surgery. Patients with hip fracture were excluded. Anesthesia, comorbidities of multiple systems, pre-operative organ function assessments, the condition during the operation, postoperative examination and medical complications were summarized. Results: One patient died of acute myocardial infarction. This patient had a long history of small dose glucocorticoid uptake, hypertension, diabetes, stable angina pectoris and right bundle branch block and I° auriculo- ventricular block. One patient had acute kidney injury stage III, which was caused by a postoperative hypoperfusion of kidney and recovered by restoration of perfusion. Postoperative glomerular filtration rate (GFR) was correlated with preoperative GFR, and men also had a significantly lower postoperative GFR than women. No deep vein thrombosis, lung infection, abnormality of liver function, symptomatic cerebral infarction nor incision infection occurred. Conclusions: No evidence indicates that over 80 years old alone is the independent risk factors of perioperative medical complications of primary THA. While multiple medical comorbidities can increase perioperative risks of THA significantly in patients over 80 years old. Organ functions and comorbidities should be systemically assessed preoperatively. THA might be considered in patients with normal preoperative examinations and little comorbidity, while it should be performed with caution in patients with multiple comorbidities, though normal preoperative examinations.