Gamma3治疗老年股骨转子间骨折围手术期隐性失血的初步分析  

Preliminary research on hidden blood loss in perioperative period of femoral intertrochanteric fractures treated with Gamma3 in elderly patients

作　　者：李志国[1] 邢更彦[1] 赵斌[1] 王明波[1] 刘运晃[1] 

机构地区：[1]武警总医院关节四肢科,北京100039

出　　处：《中国骨与关节外科》2012年第3期224-227,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:随着社会人口的老龄化,老年人骨折逐渐增多,其中髋部骨折所占比例较大,微创手术治疗已成为目前公认的首选治疗方案。目的:分析Gamma3交锁髓内钉系统治疗老年股骨转子间骨折的围手术期失血量,提高对隐性失血的重视并初步分析原因。方法:回顾性分析2010年3月至2012年1月采取Gamma3治疗的133例股骨转子间骨折患者。使用Gross方程,根据身高、体重和手术前后红细胞压积(Hct)变化计算围手术期失血量。结果:133例患者中11例围手术期未输血,男7例,女4例;平均年龄68.5岁;平均手术时间为57.6min,术中手术记录出血量及术后引流量平均121.4ml。术前血红蛋白(Hb)平均118.7g/L,术后平均91.2g/L,平均降低了27.5g/L;术前Hct平均35.73%,术后平均27.24%,平均降低了8.49%。122例采取输血支持,男52例,女70例;平均年龄82.7岁,平均手术时间为68.2min,术中记录出血量及术后引流量平均172.5ml,平均输血量636ml。术前Hb平均109.4g/L,术后平均104.6g/L,平均降低了4.8g/L;术前Hct平均33.28%,术后平均31.69%,平均降低了1.59%。按Gross方程计算,两组围手术期平均失血量分别为712ml和883ml,其中隐性失血分别占82.95%和80.46%,隐性失血量是显性失血量的4倍多。结论:Gamma3手术切口虽小,但围手术期隐性失血量却不少,临床上应予以足够的重视。Background： Along with the aging of the population, fracture is increasing gradually in the elderly, especially hip fracture Minimally invasive surgical treatment has become the first choice for the disease. Objective： The aim of the study is to evaluate the perioperative blood loss in geriatric intertrochanteric fractures treated with Gamma3, to enhance the understanding for hidden blood loss and analyze the reasons. Methods： Clinical data of 133 patients with intertrochanteric fractures, who were treated by Gamma3 between March 2010 and January 2012 were retrospectively analyzed. According to the body height, body weight and changes of pre- and post-operative haemocrit （Hot）, the blood loss was calculated by Gross formula. Results： There were 11 cases in the non-blood transfusion group （7 males and 4 females） with an average age of 68.5 years. The mean operation time was 57.6 min. The mean blood loss during operation and drainage after operation was 121.4 ml. The mean hemoglobin （Hb） was 118.7 g/L and 91.2 g/L before and after surgery, which was decreased by 27.5 g/L. The mean Hot was 35.73% and 27.24% before and after surgery, which was decreased by 8.49%. There were 122 patients in the blood transfusion group （52 males and 70 females） with an average age of 82.7 years. The mean operation time was 68.2 min. The mean blood loss during operation and drainage after operation was 172.5 ml. The mean blood transfusion volume was 636 ml. The mean Hb was 109.4 g/L and 104.6 g/L before and after surgery, which was decreased by 4.8 g/L. The mean Hot was 33.28% and 31.69% before and after surgery, which was decreased by 1.59%. However, the mean perioperative blood loss was 712 ml and 883 ml according to Gross folanula. Conclusions： Gamma3, a rapid procedure with small incision, can cause onsiderable hidden blood loss. It should be paid enough attention in clinics.

关 键 词：股骨转子间骨折 隐性失血 围手术期 GAMMA3 

分 类 号：R687.3[医药卫生—骨科学]