股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析  

Clinical analysis of obvious and hidden blood loss in inter-trochanter fracture patients treated with proximal femoral nail anti-rotation and dynamic hip screw

作　　者：张培训[1] 薛峰[1] 安帅[1] 顾航宇[1] 芦浩[1] 徐小东[1] 付中国[1] 张殿英[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,北京100044

出　　处：《北京大学学报（医学版）》2012年第6期891-894,共4页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(31171150;31271284;81171146;30971526;30801169);"十一五"国家科技支撑计划项目(2007BAI04B06);北京市科技新星计划(A-2008-10);新世纪优秀人才支持计划(BMU 20110270);北京市科技支撑;市政府重点工作项目(Z101107052210001)资助~~

摘　　要：目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方法:回顾性分析2001年12月30日至2010年9月30日间采用PFNA内固定手术治疗的216例及采用DHS内固定手术治疗的168例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时对围手术期的显性、隐性失血情况做出评估。结果:采用PFNA治疗的患者平均术中失血(48.9±2.8)mL;术后平均显性失血量为(62.3±3.8)mL,平均隐性失血量为(385.0±6.2)mL。采用DHS治疗的患者平均术中失血(124.9±7.8)mL;术后平均显性失血量为(73.9±4.7)mL,平均隐性失血量为(243.4±6.3)mL。两组相比,DHS术中出血量及术后的显性出血量均多于PFNA(P<0.01),但PFNA术后隐性出血量及PFNA总体出血量均多于DHS(P<0.01)。结论:PFNA和DHS内固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,提醒临床医生注意术后患者的生命体征监测以减少并发症的发生。Objective：To analyze the obvious and hidden blood loss before and after operations in the inter-trochanter fracture patients treated with proximal femoral nail anti-rotation（PFNA） and dynamic hip screw（DHS） to provide the data support for clinical per-operative period treatment.Methods：The cli-nical data of 216 cases of inter-trochanter fracture patients treated with PFNA and 168 cases of inter-trochanter fracture patients treated with DHS from Dec.30,2001 to Sep.30,2010,and the obvious,hidden blood loss and blood transfusion before and after operations were retrospectively analyzed,using SPSS 13.0 statistical package.Results：The PFNA group：The mean blood loss of（48.9±2.8） mL was found in 216 cases of inter-trochanter fracture patients during operation.The mean obvious blood loss was（62.3±3.8） mL while the hidden blood loss was（385.0±6.2） mL.The DHS group：The mean blood loss of（124.9±7.8） mL was found in 168 cases during operation.The mean obvious blood loss was（73.9±4.7） mL and the hidden blood loss was（243.4±6.3） mL after operation.The blood loss du-ring operation and obvious blood loss after operation of DHS was larger than that of PFNA,while the hidden blood loss of DHS was smaller than that of PFNA.The gross total blood loss and the hidden blood loss of group PFNA was bigger than that of DHS group.Conclusion：There were much hidden blood loss in both PFNA and DHS group for inter-trochanter fracture internal fixation after operation.This reminds surgeons to monitor the life vital signs after PFNA or DHS internal fixation operation in order to decrease the complication.

关 键 词：髋骨折 手术后出血 失血 手术 骨钉 血量 

分 类 号：R683.42[医药卫生—骨科学]