股骨粗隆间骨折围手术期隐性失血初步分析  

Primary Analysis of Peri-operative Hidden Blood Loss after Surgery for Intertrochanteric Femur Fractures

作　　者：罗涛[1] 黄伟杰[1] 吴伟[1] 华筠毅[1] 洪成[1] 倪纲[1] 

机构地区：[1]上海市浦东新区浦南医院骨科,上海200125

出　　处：《实用骨科杂志》2011年第9期796-799,862,共5页Journal of Practical Orthopaedics

基　　金：上海市浦东新区科技发展基金创新项目(PKJ2009-Y26)

摘　　要：目的探讨股骨粗隆间骨折患者围手术期隐性失血的特点和影响因素。方法回顾性研究2008年1月至2010年12月我科行手术治疗的股骨粗隆间骨折患者68例,其中男35例,女33例;年龄34～92岁,平均年龄(76.4±3.4)岁。动力髋螺钉内固定(dynamic hip screw,DHS)32例,根据Evans-Jensen分型,Ⅰb型20例,Ⅱa型12;防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)内固定患者36例,其中Ⅱb型16例,Ⅲ型20例。肥胖组38例(BMI大于30),非肥胖组(BMI小于等于30)30例。高龄组(年龄大于等于80岁)32例,非高龄组(年龄小于80岁)36例。所有病例均为初次单侧新鲜股骨粗隆间骨折患者,术后24h补液总量不超过2000mL即可维持正常血压。通过Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)计算患者的失血总量,减去显性失血量即为隐性失血量。结果所有患者平均失血总量为871mL,其中平均显性失血量149mL,平均隐性失血量722mL,显性失血和隐性失血占失血总量的比例分别为17.1%和82.9%,隐性失血量远多于显性失血量。DHS组与PFNA组间、男女组间和肥胖组与非肥胖组间的术后失血无显著性差异,高龄组术后失血总量和隐性失血量大于非高龄组。结论隐性失血是股骨粗隆间骨折手术围手术期失血的主要原因,应予以关注并及时补充血容量,手术方式、性别和肥胖不是隐性失血的危险因素,高龄是隐性失血的危险因素,应特别重视高龄患者的隐性失血,注意及时补充血容量,帮助患者安全度过围手术期。Objective To explore peri-operative hidden blood loss following surgery for intertrochanteric femur fracture and the risk factors.Methods We retrospectively analysised 68 cases performed close reduction and internal fixation for intertrochanteric femur fracture from Jan.2 0 0 8 to Dec.2 0 10,including 3 5 males and 3 3 females,aged （76.4±3.4） years（ranging 34～92 years）,DHS group 32 cases and PFNA group 36 case,obesity group（BMI〉30） 38 cases and normal group（BMI≤30） 30 cases,advanced age group（≥80 years） 32 cases and nonadvangced age group（〈80 years） 36 case.According to Evans-Jensen classification,there were 20 cases of typeⅠb and 12 cases of typeⅡa in DHS group,16 cases of typeⅡb and 20 cases of typeⅢin PFNA group.All the patients were fresh intertrochanteric femur fracture following primary operation,the total infusion volume were less than 2 000 mL.According to Gross formulae,we can calculate the total blood loss with the patients’ height,weight and Hct.The perioperative blood loss after surgery including observed blood loss and hidden blood loss were analyzed.Results The mean total blood loss was 871 mL,the mean observed blood loss was 149 mL,the mean hidden blood loss was 722 mL,each accounts for 17.1%and 82.9%in total blood loss,hidden blood loss was much more than observed blood loss.There were no difference between DHS group and PFNA group,male group and female group,obesity and normal group, there were more total blood loss and hidden blood loss in advanced age group.Conclusion Hidden blood loss was the major part of total blood loss after operation for intertrochanteric femur fracture.It is very important to supplement the the blood volume during peri-operative period.The type of operation,gender and obesity are not the risk factors of the hidden blood loss,but advanced age is a risk factor,special attention is in need.

关 键 词：股骨粗隆间骨折 围手术期 隐性失血 

分 类 号：R683.42[医药卫生—骨科学]