ABSTRACT
Objective To investigate the prevention and management of perioperative complications of intertrochanteric fractures in elderly in-hospital patients(aged≥80 years).Methods Clinical data of 103 intertrochanteric fracture patients(31 male and 72 female)undergoing surgical treatment at our hospital from May 2010 to Nov.2015 were retrospectively analyzed.Their ages ranged from 80 to 99 years,with an average of 86.2 years.There were 3 Evan type Ⅰ cases,25 type Ⅱ cases,36 type Ⅲ cases,37 type Ⅳ cases and 2 type V cases.Of these,82 received epidural anesthesia and 21 had general anesthesia.Intertrochanteric fractures were treated with proximal femoral nail(PFN) internal fixation in 101 patients and dynamic hip screw(DHS)internal fixation in 2 patients.Results The average operation duration and blood loss were 30 min and 60 ml in the PFN internal fixation group and 60 min and 150 ml in the DHS internal fixation group,respectively.The average hospitalization time was 16.7 days.One patient (0.9％) died after operation,10 (9.7％) had preoperative complications of bed rest with 3 cases involving the central nervous system and 4 cases involving the respiratory system,and 38 cases (36.9％)had postoperative complications with 13 involving the central nervous system.The average time from admission to operation was 6 days,with 65 cases above the average and 38 cases below the average,and there was a statistically significant difference in the incidence of postoperative complications between the two subgroups(30/65 or 46.2 ％for the former and 8/38 or 21.1％ for the latter,x2＝6.49,P＜0.05).Conclusions Elderly patients with intertrochanteric fractures should undergo surgery as soon as possible,preferably with epidural anesthesia.Proficiency in surgical kills,short operation time,close monitoring of preoperative and postoperative conditions,and proper and timely treatment are the key to ensuring surgical success.
ABSTRACT
Objective To investigate the effect of ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia on knee joint surgery in elderly patients.Methods The 110 elderly patients with spinal anesthetic contraindication and undergoing lower extremity surgery from June 2014 to June 2015 were randomly divided into observation group (n =55) and control group (n =55).The observation group received both ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block,and the control group was given general anesthesia.Anesthesia procedure,sensory block onset time,changes in heart rate and mean artery pressure (MAP) after anesthesia,the total quantity of fluids infusion,dosage of vasopressor and hypotensor,adverse anesthetic reactions,anesthetic fees,anesthetic effect were recorded.Results Anesthetic preparation and practicing time had no difference between the two groups [(8.3 ± 1.7) min vs.(7.7 ± 1.2) min,(t =1.661,P=0.139)].The block onset time was longer in observation group than in control group [(10.3 ± 1.4) min vs.(3.2±0.6) min,t=50.180,P＜0.01].The changes in MAP had significant difference between the two groups [5 min after anesthesia:(89.24 ± 8.30) mmHg and (77.90 ± 8.05) mmHg;after operation:(96.60±8.03) mmHg and (106.22±8.88) mmHg;P＜0.05].There were significant differences in the fluid infusion quantity,dosage of vasopressor and hypotensor,adverse reactions during or after anesthesia,and anesthetic fees between the two groups [(1150.9± 231.6) ml vs.(1400.0±256.5) ml,(3.91±1.21) mg vs.(10.83±2.19)mg,(1.80±0.37) mg vs.(8.27±1.25)mg,3.6％ vs.18.2％,(1239.1±202.9) Yuan vs.(2307.2±205.6) Yuan,all P＜0.05].No significant difference was found in anesthesia effect between the two groups (P =0.198).Conclusions The ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia is more simple and safe for the knee joint surgery in elderly patients,with less complications,lower cost and higher satisfaction of patients.