PFNA治疗高龄股骨粗隆间骨折隐性失血的发生机制及影响因素初步分析  

Primary analysis of mechanism and affecting factors of hidden blood loss in the elderly femoral intertrochanteric fractures with PFNA

作　　者：史庆轩[1] 胡宏伟[1] 宁廷民[1] 侯存强[1] 赵刚[1] 高胜一 李昊[1] 孙磊[1] 赵汉平[1] 

机构地区：[1]解放军第88医院骨科,山东泰安271000

出　　处：《中国矫形外科杂志》2014年第14期1262-1265,共4页Orthopedic Journal of China

摘　　要：[目的]探讨采用闭合复位股骨近端防旋髓内钉（PFNA）治疗高龄股骨粗隆间骨折患者术后隐性失血的发生机制及其危险因素。[方法]对本院2008年5月～2012年5月所有PFNA病例中抽取的87例高龄股骨粗隆间骨折患者（≥80岁）进行回顾性分析，通过Gross方程计算隐性失血量。记录不同年龄（以80周岁为界），性别，肥胖（BMI30kg／m^2为界），有无心脑内科疾病（高血压病、冠心病、脑中风偏瘫后遗症）等情况下围手术期隐性失血量，分析讨论围手术期隐性失血的发生机制和危险因素。[结果]PFNA围手术期失血总量平均为899ml，隐性失血平均为749ml，占失血总量的83．3％。年龄、有无心脑内科疾病在PFNA手术中隐性失血的量方面差异有统计学意义，而不同性别之间、是否肥胖在PFNA手术中隐性失血的量方面差异无统计学意义。[结论]隐性失血是闭合复位PFNA治疗股骨粗隆间骨折围手术期失血的主要因素。高龄患者、有心脑内科疾病者是隐性失血的危险因素，对高龄患者更应特别重视隐性失血的及时处理，进一步提高PFNA治疗高龄股骨粗隆间骨折的效果。[Objective]To assess the mechanism of hidden blood loss and risk factors of interaction in the elderly femoral intertrochanteric fractures with PFNA. [ Method] We studied 72 cases in 87 elderly patients with femoral intertrochanteric fractures who were treated with closed reduction and internal fixation with PFNA. The amount of hidden blood loss was calculated by the Gross equation. We studied perioperative hidden blood loss difference of PFNA in different ages（80 years for the sector）, gender,obesity（ body mass index BMI 30 kg/mz for the sector） ,with or without medical illness. And we explored the mechanism of hidden blood loss and risk factors of interaction. [ Result] The mean actual perioperative blood loss was 899-ml, hidden blood loss was 749 ml, accounted for 83.3%. The hidden blood loss showed statistically significant difference in age, with medical illness, while the difference was not statistically significant in gender and obesity. [ Conclusion ] The hidden blood loss is the major part of total blood loss of the elderly femoral intertrochanteric fractures with PFNA. It is very important to supplement the blood volume during periopretive period, special attention is in need to elderly patients and patients with medical illness.

关 键 词：隐性失血 股骨近端防旋髓内钉 骨折固定术 内 股骨粗隆间骨折 高龄 影响因素 

分 类 号：R687.3[医药卫生—骨科学]