1、Wenzhou central hospital -chen mangmang,Management of Hip Fractures in the Elderly-2014,区域镇痛regional analgesia更好的术前镇痛，疗效和全麻，脊髓麻醉general orspinal anesthesia差不多。 对于不稳定的或者移位的股骨颈骨折推荐使用关节置换术arthroplasy。股骨近端髓内钉治疗粗隆下骨折或者反转子骨折。在无症状的患者中，如果患者的血色素低于8 g/dL，应输血。 出院后物理治疗。各个学科的合作和治疗组-对于轻中度的痴呆患者；术后multimodal pain管理
2、.,综述和基本理论以下的指南2014年，美国， AASO.258,000fractures in 2010.The annual United States economic burden formanaging hip fractures was estimated at $17 to $20 billion in 2010;也就是说：每年的的费用是8万美元。13th of the top 20贵的疾病in 2011.,越来越多。至2030, USA会达到289,000。美国的发生率是降低的，死亡率也是降低的。人口增加，指征放宽，医生大量的增多。存在很多的问题：。,总结：the hip fr
3、actureguideline involved reviewing 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 systematic reviewof the research literature related to itstopic, 8
4、条强烈推荐，15条一般推荐，2条有限推荐。,所有的这么多，说明，总结的意义，就是为了为病人更好的管理和治疗。1.谵妄。包括：术前区域麻醉，多模式镇痛multimodal pain control，减少麻醉药物的使用。尽早手术，获得早期的活动。营养支持。多元治疗（物理） 。区域麻醉在大多数医院没有做到。多学科的治疗-帮助患者能减少。再次骨折，肌肉的力量，活动，防止摔倒。,减少病人发生继发的骨质疏松，-中度推荐。vitamin D and calcium 补充。支持髋部骨折病人，在术后对于骨质疏松的诊断和治疗。,预防深静脉血栓和输血是中度推荐。-包括使用预防深静脉血栓药物。很多人反对，为什么不是s
5、trong rating.综合考虑了患者的药物的有效性，使用药物得到的好处。考虑了使用药物后的并发症，副作用等等。The work group 推荐在栓塞风险高的病人身上使用In high-risk population.,8g/dl,强烈推荐。（无症状病人） Gruber-Baldini et al78 g/dL and 10 g/dL; nosignificant difference,早期手术-一般推荐。早期-48小时内。reduce mortality. 因为the sickest patients-often have the longest delays.Could potenti
6、ally benefit the most fromearlier surgery.,手术方法：讨论半髋还是全髋。Cemented stems？一般推荐-优先使用骨水泥型。supports both the preferentialuse of 骨水泥inpatients undergoing 关节成形术andreports similar outcomes 报道了使用双极和单极的相同疗效。推荐使用骨水泥型，.和手术者的经验有关。,一般推荐-it is critical that treatment be predicated on外科医生的经验.Although THA may offer
7、improved function and long-term results inselect patients, 但是需要考虑缺点。后侧入路，容易脱位。推荐使用前外侧入路。但是，更需要考虑医生的习惯和经验。不推荐使用前方入路。,一般推荐：对于初始的影像学检查不太明确的病人。但是怀疑有髋部骨折的病人。使用MRI。CT scan is not sufficient to exclude the possibility of fracture.,强烈推荐：认为：脊髓麻醉和全麻相当，尽管各有优势。,强烈推荐：认为：脊髓麻醉和全麻相当，尽管各有优势。,推荐:physicians expert jud
8、gment, andthe patients circumstances, values,preferences, and rights. A Strong recommendation = the quality of the supporting evidenceis high.,A Moderate recommendation =the benefits exceed the potential harm (or that the potential harm clearly exceedsthe benefits, in the case of a negativerecommend
9、ation) but the quality/applicability of the supporting evidenceis not as strong. A Limited recommendationmeans = resulted in an unclear balance between benefits and potential harm.,Advanced ImagingModerate evidence = MRI。But：remain alert to new information and be sensitive topatient preferences.,Pre
10、operative RegionalAnalgesiaStrong evidence supports regionalanalgesia to improve preoperative paincontrol in patients with hip fracture.Strength of recommendation:Strong.非常有其他特殊情况。,Preoperative TractionModerate evidence Strength of recommendation:Moderate.,Surgical TimingModerate evidence supports t
11、hat hipfracture surgery within 48 hours ofadmission is associated with betteroutcomes.Implication: Practitioners shouldgenerally follow a Moderate recommendationbut remain alert to newinformation and be sensitive to patient preferences.,Aspirin and ClopidogrelLimited evidence。无需为此延误手术。,麻醉 脊髓，全身麻醉一样。
12、,Stable Femoral NeckFracturesOperative fixation Implication: Practitioners shouldgenerally follow a Moderate recommendationbut remain alert to newinformation and be sensitive to patientpreferences.,Displaced Femoral NeckFracturesStrong evidence supports arthroplastyfor patients with unstable(displac
13、ed) femoral neck fractures.,单极，双极。Moderate evidence 对于移位的不稳定的股骨颈骨折，无区别。一般推荐。be sensitive to patient preferences.,半髋还是全髋。对于股骨颈骨折不稳定的，移位的，认为：全髋治疗更佳-一般推荐。,骨水泥型：关节置换术中，使用骨水泥=一般推荐。,Surgical Approach一般推荐：后入路会有更高的脱位。Stable IntertrochantericFractures一般推荐：使用髋动力螺钉还是近端髓内钉，在稳定的粗隆间骨折。粗隆下或反转子骨折：强烈推荐：近端髓内钉。Unstable IntertrochantericFractures中度推荐：股骨近端髓内钉。,预防深静脉血栓中度推荐：输血值强烈推荐：8g/dl。输血。,专业和物理的治疗疗法中度推荐：加强物理治疗：强烈推荐：在出院后加强物理治疗。改善疗效。Nutrition中度推荐,多学科的综合治疗强烈推荐：针对那些痴呆的患者。术后多模式镇痛强烈推荐：术后使用。Calcium and Vitamin D中度推荐。Screening有限推荐：评估血清，肌酐。手术与否无需受其限制。,骨质疏松的评估和治疗中度推荐：,谢谢！,
