PFNA、DHS治疗老年股骨粗隆间骨折围手术期隐性失血的分析  

Analysis on perioperative hidden blood loss and related influence factors in use of （PFNA） and （DHS） internal fixation for surgical treatment of elderly femoral intertrochanteric fracture

作　　者：安志军[1] 史立强[1] 王晓岩[2] 孙毅[2] 吕松岑[1] 

机构地区：[1]首都医科大学丰台教学医院骨科,北京100071 [2]哈尔滨医科大学附属第二临床医院骨外四科

出　　处：《中国伤残医学》2016年第8期1-5,共5页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：老年股骨粗隆间骨折患者围手术期存在高比例的隐性失血，具有隐蔽性而易被临床忽视，可造成严重贫血，是老年粗隆间骨折患者死亡的主要原因之一。对应用股骨近端防旋髓内钉（proxim al femoral nail anti—rotation，PFNA）和动力髋螺钉（dynamic hipscrew，DHS）为内固定的手术方法治疗的老年股骨粗隆间骨折围手术期的显性、隐性失血量及相关影响因素进行分析。为老年粗隆间骨折围手术期处理提供参考依据。方法：回顾性分析2009年1月～2014年12月间采用PFNA及DHS内固定手术治疗老年股骨粗隆间骨折患者43例及42例的临床资料，收集所有患者的性别、年龄、身高、体重、骨折类型、术前和术后血常规、术中和术后失血量及输血量。使用Gross方程计算围术期隐性失血量，用SPSS18．0统计学软件进行统计学处理分析影响因素。结果：2组病例平均失血总量为951mL，其中平均显性失血量仅186mL，平均隐性失血则为765mL，显性失血和隐性失血占失血总量的比例分别为19．61％和80．4％，隐性失血量远多于显性失血量。影响因素分析：高龄、不稳定的复杂骨折类型对围手术期失血量的影响P值〈0．05，有统计学意义。结论：PFNA和DHS为内固定手术治疗老年股骨粗隆问骨折均存在高比例的术后隐性失血量，是围手术期出血主要原因。高龄、不稳定的复杂骨折类型是隐性失血的影响因素。加强临床医生对隐性失血的认识。制定个体化的治疗方案，及时补充血容量，预防和及时治疗术后严重的贫血。Objective：Perioperative patients with intertrochanteric fracture exists high proportion of the recessive loss of blood, concealment and easily overlooked in clinical, can cause severe anemia, and also one of the main reasons of death in elderly patients with intertrochanteric fractures. Operation treatment of intertrochanteric fracture in the peri operation period of hidden highproportion of the blood loss, because of its concealment is neglected for a long time. Also caused severe anemia, is the main reason for elderly intertrechanteric fracture patients＇death. To analyze perioperative visible, hidden blood loss and related influence factors in use of proximal femoral nail anti - rotation（PFNA） and dynamic hip screw （DHS） internal fixation for surgical treatment of elderly femoral intertrochanteric fracture in order to provide a referencebasis in treating the elderly femoral intertrechanteric fracture. Methods： A retrospective analysis was made by collecting all of the patient~ gender, age, height, weight, fracture type, and preoperative and postoperative routine blood, intraoperative and postoperative blood loss, amount of blood transfusion in PFNA and DI-IS internal fixation surgery treatment of 43 patients with intertre- chanteric fractures and the clinical data of 42 cases from January 2009 to December 2014. Gross equation is used to calculate perioperative blood loss and processed by SPSS 18.0 statistical software for statistical analysis of influencing factorsResults：The average total blood loss was 951rnl, two groups of cases in which the average visible blood loss only 186 ml and hidden blood loss is an average of 765 ml, visible and hidden blood loss accounted for 19.61% and 80.4% respectively of the total blood loss and hidden blood loss than visible blood loss so far. Influence factors analysis ： age, unstable complex fracture type impact on perioperative blood loss p values 〈 O. 05, with statistical significance. Conclusion：The high rates of hidden blood loss was occurred in tre

关 键 词：股骨粗隆间骨折 股骨近端防旋髓内钉(PFNA) 动力髋螺钉(DHS) 老年 围手术期隐性失血 

分 类 号：R683.42[医药卫生—骨科学]