老人髋部骨折的管理

髋部骨折在入院48小时内手术有利于获得更好的结果
推荐强度：中等
5.ASPIRIN AND CLOPIDOGREL 阿司匹林和氯吡格雷 Limited evidence supports not delaying hip fracture surgery for patients on aspirin and/or clopidogrel. Strength of Recommendation: Limited
不稳定转子间骨折可使用近端髓内钉
推荐强度：中等
16.VTE PROPHYLAXIS 静脉血栓的预防 Moderate evidence supports use of venous thromboembolism prophylaxis (VTE) in hip fracture patients. Strength of Recommendation: Moderate
对服用阿司匹林和/或氯吡格雷的髋部骨折患者无需延迟手术
推荐强度：有限
6.ANESTHESIA 麻醉 Strong evidence supports similar outcomes for general or spinal anesthesia for patients undergoing hip fracture surgery. Strength of Recommendation: Strong
Strength of Recommendation: Strong
区域镇痛可以改善髋部骨折患者的术前疼痛
推荐强度：强烈
3.PREOPERATIVE TRACTION 术前牵引 Moderate evidence does not support routine use of preoperative traction for patients with a hip fracture. Strength of Recommendation: Moderate 不支持对髋部骨折的病例常规行术前牵引
强化的家庭物理治疗可改善功能结果
推荐强度：强烈
20.NUTRITION 营养 Moderate evidence supports that postoperative nutritional supplementation reduces mortality and improves nutritional status in hip fracture patients. Strength of Recommendation: Moderate 可能存在营养缺陷的患者添加营养可改善功能结果、减少死亡 率，因此应对患者营养状况进行评估。 推荐强度：中等
不稳定（移位）的股骨颈骨折应行人工关节置换术
推荐强度：强烈
9.UNIPOLAR VERSUS BIPOLAR 单极还是双极
Moderate evidence supports that the outcomes of unipolar and bipolar hemiarthroplasty for unstable (displaced) femoral neck fractures are similar. 单极和双极人工股骨头置换在治疗非稳定（移位性）股骨颈骨 折时效果相似 推荐强度：中等
22.POSTOPERATIVE MULTIMODAL ANALGESIA 术后多模式镇痛 Strong evidence supports multimodal pain management after hip fracture surgery.
移位性股骨颈骨折行髋关节置换选择后侧入路脱位率更高
推荐强度：中等
13.STABLE INTERTROCHANTERIC FRACTURES 稳定的转子间骨折 Moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures. Strength of Recommendation: Moderate
MANAGEMENT OF HIP FRACTURES IN THE ELDERLY 老人髋部骨折的管理
1.ADVANCED IMAGING 高级影像检查 Moderate evidence supports MRI as the advanced imaging of choice for diagnosis of presumed hip fracture not apparent on initial radiographs.
髋关节骨折患者需要预防静脉血栓栓塞
推荐强度：中等
17.TRANSFUSION THRESHOLD 输血的临界值 Strong evidence supports a blood transfusion threshold of no higher than 8g/dl in asymptomatic postoperative hip fracture patients. Strength of Recommendation: Strong
10.HEMI VS. TOTAL HIP ARTHROPLASTY 半髋还是全髋 Moderate evidence supports a benefit to total hip arthroplasty in properly selected patients with unstable (displaced) femoral neck fractures. Strength of Recommendation: Moderate
稳定的转子间骨折可使用髋关节滑动螺ห้องสมุดไป่ตู้或近端髓内钉
推荐强度：中等
14.SUBTROCHANTERIC OR REVERSE OBLIQUITY FRACTURES 转子下骨折或反斜行骨折 Strong evidence supports using a cephalomedullary device for the treatment of patients with subtrochanteric or reverse obliquity fractures. Strength of Recommendation: Strong
稳定的（非移位）股骨颈骨折应行手术内固定
推荐强度：中度
8.DISPLACED FEMORAL NECK FRACTURES 移位性股骨颈骨折 Strong evidence supports arthroplasty for patients with unstable (displaced) femoral neck fractures. Strength of Recommendation: Strong
股骨颈骨折行关节置换的患者优先选择骨水泥型股骨柄
推荐强度：中等
12.SURGICAL APPROACH 手术入路 Moderate evidence supports higher dislocation rates with a posterior approach in the treatment of displaced femoral neck fractures with hip arthroplasty. Strength of Recommendation: Moderate
转子下骨折或反斜行骨折可使用近端髓内钉
推荐强度：强烈
15.UNSTABLE INTERTROCHANTERIC FRACTURES 不稳定转子间骨折 Moderate evidence supports using a cephalomedullary device for the treatment of patients with unstable intertrochanteric fractures. Strength of Recommendation: Moderate
推荐强度：中等
4.SURGICAL TIMING 手术时机 Moderate evidence supports that hip fracture surgery within 48 hours of admission is associated with better outcomes. Strength of Recommendation: Moderate
Strength of Recommendation: Moderate
疑似髋关节骨折的病例在初步X线检查未见异常时应进一步行MRI检 查。 推荐强度：中等
2.PREOPERATIVE REGIONAL ANALGESIA 术前区域镇痛 Strong evidence supports regional analgesia to improve preoperative pain control in patients with hip fracture.
在整个恢复过程中（包括家中）处于监督下的物理职能治疗可 改善功能并防止摔倒
推荐强度：中等
19.INTENSIVE PHYSICAL THERAPY 强化物理治疗 Strong evidence supports intensive physical therapy post-discharge to improve functional outcomes in hip fracture patients. Strength of Recommendation: Strong
合适的不稳定（移位性）股骨颈骨折患者选择全髋关节置换更 有利
推荐强度：中等
11.CEMENTED FEMORAL STEMS 骨水泥型股骨柄 Moderate evidence supports the preferential use of cemented femoral stems in patients undergoing arthroplasty for femoral neck fractures. Strength of Recommendation: Moderate
21.INTERDISCIPLINARY CARE PROGRAM Strong evidence supports use of an interdisciplinary care program in those patients with mild to moderate dementia who have sustained a hip fracture to improve functional outcomes. Strength of Recommendation: Strong 多学科协作可使髋部骨折的轻中度痴呆症获得更好的功能 推荐强度：强烈
髋部骨折手术的患者行全身麻醉或脊髓麻醉效果相似
推荐强度：强烈
7.STABLE FEMORAL NECK FRACTURES 稳定的股骨颈骨折 Moderate evidence supports operative fixation for patients with stable (nondisplaced) femoral neck fractures. Strength of Recommendation: Moderate
髋部骨折术后无症状贫血的输血临界值为8g/dl以下
推荐强度：强烈
18.OCCUPATIONAL AND PHYSICAL THERAPY 物理职能治疗 Moderate evidence supports that supervised occupational and physical therapy across the continuum of care, including home, improves functional outcomes and fall prevention. Strength of Recommendation: Moderate