股骨近端防旋髓内钉治疗股骨粗隆间骨折隐性失血的临床研究  

Clinical analysis of hidden blood loss in intertrochanteric fractures treated with proximal femoral nail anti-rotation

作　　者：王茂林[1] 易志坚[1] 曹家树[1] 孟宁波[1] 卢明刚[1] 董军[1] 

机构地区：[1]解放军第148医院骨科,山东淄博255300

出　　处：《中国矫形外科杂志》2013年第24期2467-2470,共4页Orthopedic Journal of China

摘　　要：[目的]分析股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年股骨粗隆间骨折的围手术期隐性失血量,提高对隐性失血的认识并探讨其相关因素。[方法]回顾性分析本院2010年3月～2012年1月采取PFNA治疗的43例股骨粗隆间骨折患者。对患者年龄、性别、体重指数、骨折类型进行分析,并使用Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)变化,计算围手术期失血量。[结果]43例患者中围手术期未输血的28例,隐性失血约536 ml,占总失血量的82%。采取输血支持的15例,隐性失血约553 ml,占总失血量的84%。骨折严重组及高体重指数组可增加围手术期失血量,差异有统计学意义,P<0.05;年龄、性别之间围手术期失血比较,差异无统计学意义,P>0.05。[结论]隐性失血是PFNA治疗股骨粗隆间骨折围手术期失血的主要原因,肥胖及严重骨折可加重围手术期失血,临床上需引起足够重视并且及时补充血容量。[ Objective]To analyze the peri-operative hidden-blood loss in geriatric intertrochanteric fractures treated with proximal femoral nail anti-rotation （PFNA）, and to enhance the understanding for hidden blood loss and identify risk factors for increased blood loss. [Method] A retrospective case series of 43 patients,who were treated by PFNA between March 2010 and January 2012 were reviewed. The age, gender, body mass index（BMI） , type of fracture were analyzed. The blood volume and its estimated loss were calculated by Gross formula, according to the body high, weight, and the changes of pre and post-operative haemoefit （Hct）. [ Result] There were 28 cases in the non-blood transfusion group. The hidden blood loss was 536 ml, and oc- cupied about 82% of the total blood loss volume. Fifteen cases received the blood transfusion. The hidden blood loss was 553 ml,and occupied about 84% of the total blood loss volume. There were significant differences in high BMI group and severe fracture type group in peri-operative blood loss. There were no differences between male and femal group, lower age and high age group. [ Conclusion ] Hidden blood loss is the major part of total blood loss for PFNA treated intertrochanter fracture during per- operative period. High BMI, severe fracture type may be risk factors for severe peri-operative blood loss. We should pay enough attention and supplement the blood volume in time.

关 键 词：股骨粗隆间骨折 隐性失血 PFNA 围手术期 老年 

分 类 号：R687.3[医药卫生—骨科学]