三种不同内固定方式治疗股骨转子间骨折术后隐性失血及血栓形成的比较  

Comparison of postoperative hidden blood loss and deep venous thrombosis between dynamic hip screw, InterTan and proximal femoral nail antirotation- Ⅱ in treatment of femoral intertrochanteric fracture

作　　者：应霁翀[1] 刘观燚[1] 张勇[1] 方贤土[1] 校佰平[1] 

机构地区：[1]宁波市第六医院创伤骨科,315040

出　　处：《中华创伤骨科杂志》2016年第5期442-446,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较动力髋螺钉（DHS）、InterTan髓内钉和亚洲型股骨近端防旋髓内钉（PFNA—11）固定治疗股骨转子间骨折的术后隐性失血及血栓形成情况。方法回顾性分析2011年11月至2015年11月采用内固定治的133例股骨转子间骨折患者资料，按照手术方式不同分为3组：DHS组42例，男22例，女20例；InterTan髓内钉组43例，男21例，女22例；PFNA-Ⅱ组48例，男25例，女23例。分别于术前、术后1d、3d、7d检测患者的血红蛋白（Hb）、红细胞比容（Hct）、血小板（PLT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）和D．二聚体等。术后7d用彩色多普勒超声检查患者是否有深静脉血栓形成（DVT）。结果术后1、3、7d，DHS组患者的Hb、Hct、TT、PT和APTT数值最小，PFNA-Ⅱ组患者的数值最大；DHS组患者的术中出血量、PLT、FIB和D-二聚体数值最大，PFNA-Ⅱ组患者的数值最小，除InterTan髓内钉组与PFNA-Ⅱ组之间术后7dTT及术后1、7dAPTT比较差异无统计学意义（P〉0．05）外，其余项目3组之间两两比较差异均有统计学意义（P〈0．05）。InterTan髓内钉组、PFNA-Ⅱ组患者DVT的发生率[2．3％（1／43）、0]显著低于DHS组患者[7．1％（3／42）]，差异均有统计学意义（P〈0．05）。结论在股骨转子间骨折内固定术中，PFNA-Ⅱ较InterTan髓内钉和DHS在减少术后隐性失血和血栓风险的控制方面更有优势。Objective To compare dynamic hip screw （DHS）, InterTan and proximal femoral nail antirotation- Ⅱ （PFNA- Ⅱ） in the treatment of femoral intertroehanteric fracture in terms of their effects on post- operative hidden blood loss （HBL） and deep venous thrombosis （DVT）. Methods We retrospectively analyzed the 133 patients with femoral intertrochanteric fracture who had been treated in our hospital from November 2011 to November 2015. Of them, 42 received DHS treatment, including 22 males and 20 females; 43 underwent InterTan fixation, including 21 males and 22 females; 48 had PFNA- Ⅱ treatment, including 25 males and 23 females. At preoperation, 1, 3 and 7 days postoperation, all of them had tests of hemoglobin （Hb）, hematocrit value （Hct）, blood platelet （PLT）, thrombin time （TT）, activated partial thromboplastin time （APTT）, prothrombin time （PT）, human fibrinogen （FIB） and D-dimer. DVT was detected using color Doppler ultrasound at 7 days postoperation. Results At 1, 3 and 7 days postoperation, the DHS patients had the smallest values of Hb, Het, TT, PT and APril while the PFNA- Ⅱ patients the largest. The DHS patients had the largest values of intraoperative bleeding, PLT, FIB and D-dimer while the PFNA- II patients the smallest. There were significant differences between the 3 groups in all the indexes （ P 〈 0.05） except in Tl＇ at 7 days post- operation and APTT at 1 and 7 days postoperation between the InterTan and PFNA- Ⅱ groups （ P 〉 0.05）. The incidence of DVT in the InterTan group （2.3%, 1/43） and in the PFNA-Ⅱ group （0） was significantly lower than in the DHS group（7.1%, 3/42） （ P 〈 0.05）. Conclusion In the treatment of femoral intertrochanteric fracture, PFNA- Ⅱ may be superior to InterTan and DHS in reducing postoperative HBL and control of DVT.

关 键 词：髋骨折 骨折固定术 内 骨钉 手术后出血 栓塞和血栓形成 

分 类 号：R687.3[医药卫生—骨科学]