股骨粗隆间骨折PFNA内固定股骨髓腔直径与髓内钉直径比值对失血量的影响  

Effect of ratio of marrow cavity diameter to intramedullary nail diameter on perioperative blood loss in femoral intertrochanteric fractures with PFNA internal fixation

作　　者：陈轲 殷振华 张亚军 韩健 何学军 CHEN Ke;YIN Zhen-hua;ZHANG Ya-jun;HAN Jian;HE Xue-jun(Department of Orthopedics,Xianyang First People's Hospital,Xianyang,Shaanxi 712000,China)

机构地区：[1]咸阳市第一人民医院骨一科,陕西712000 [2]咸阳市第一人民医院骨二科,陕西712000

出　　处：《中国骨与关节损伤杂志》2020年第8期785-787,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨股骨髓腔直径与髓内钉直径比值对股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定手术失血量的影响。方法回顾性分析自2016-01—2018-12采用PFNA内固定手术治疗的249例股骨粗隆间骨折,根据术后正侧位X线片测量并计算漏斗起始部、漏斗终止部、股骨干峡部股骨髓腔直径与髓内钉直径的比值。通过Pearson相关分析不同层面股骨髓腔直径和髓内钉直径比值与失血量的相关性,通过多元线性回归分析确定影响隐性失血量的危险因素。结果本组总失血量为(694.2±159.3)mL,术中显性失血量为(198.5±54.9)mL,隐性失血量为(495.7±79.5)mL。股骨髓腔直径与髓内钉直径比值:漏斗起始部为1.39±0.27,漏斗终止部为1.61±0.25,股骨干峡部为1.44±0.25。Pearson相关分析结果显示,漏斗起始部、漏斗终止部和股骨干峡部股骨髓腔直径与髓内钉直径比值与总失血量、隐性失血量呈正相关(P<0.05),与术中显性失血量无相关性(P>0.05)。多元线性回归分析结果显示,体重指数、漏斗起始部和漏斗终止部股骨髓腔直径与髓内钉直径比值是影响隐性失血量的危险因素。结论股骨粗隆间骨折PFNA内固定术中股骨髓腔直径与髓内钉直径比值越小,患者的隐性失血量与总失血量越少。Objective To investigate the effect of the ratio of marrow cavity diameter to intramedullary nail diameter on the perioperative blood loss of proximal femoral anti-rotational intramedullary nail(PFNA)internal fixation for femoral intertrochanteric fractures.Methods Two hundred and forty-nine patients with femoral intertrochanteric fractures who underwent PFNA internal fixation from January 2016 to December 2018 were retrospectively analyzed.The ratio of marrow cavity diameter to intramedullary nail diameter at the funnel start,funnel end and femoral isthmus were measured and calculated according to the postoperative lateral X-ray.Pearson correlation was used to analyze the correlation between the ratio of marrow cavity diameter to intramedullary nail diameter at different levels and blood loss,and multiple linear regression analysis was used to determine the risk factors affecting hidden blood loss.Results The total blood loss of 249 patients was(694.2±159.3)mL,the intraoperative blood loss was(198.5±54.9)mL,and the hidden blood loss was(495.7±79.5)mL.The ratio of marrow cavity diameter to intramedullary nail diameter at the funnel start,funnel end and femoral isthmus were 1.39±0.27,1.61±0.25,and 1.44±0.25,respectively.Pearson correlation analysis showed that the ratios of marrow cavity diameter to intramedullary nail diameter at the funnel start,funnel end and femoral isthmus were positively correlated with the total blood loss and hidden blood loss(P<0.05),but there was no statistical correlation with intraoperative blood loss(P>0.05).Multiple linear regression analysis showed that the body mass index,the ratio of marrow cavity diameter to intramedullary nail diameter at the funnel start and funnel end were the risk factors affecting the hidden blood loss.Conclusion The ratio of marrow cavity diameter to intramedullary nail diameter is lower,the less hidden blood loss and total blood loss in patients with femoral intertrochanteric fractures who underwent PFNA internal fixation.

关 键 词：股骨粗隆间骨折 股骨近端防旋髓内钉 内固定 隐性失血 股骨髓腔直径 髓内钉直径 

分 类 号：R687.3[医药卫生—骨科学]