股骨近端防旋髓内钉治疗老年外侧壁薄弱型股骨粗隆间骨折隐性失血的相关因素分析  

PFNA in the treatment of hidden blood loss in the elderly with weak lateral femoral intertrochanteric fractures

作　　者：宋春健 周荣[1] 黄永刚[1] SONG Chun-jiari;ZHOU Rong;HUANG Yong-gang(Department of Orthopaedics,Haimen People's Hospital,Haimen,Jiangsu,226100,China)

机构地区：[1]海门市人民医院骨科,江苏226100

出　　处：《中国骨与关节杂志》2020年第9期708-711,共4页Chinese Journal of Bone and Joint

摘　　要：目的分析股骨近端防旋髓内钉 (proximal femoral nail antirotation,PFNA) 治疗老年外侧壁薄弱型股骨粗隆间骨折隐性失血的相关因素。方法选取 2016 年 6 月至 2018 年 6 月我院收治的老年外侧壁薄弱型股骨粗隆间骨折患者 64 例,其中男 30 例,女 34 例,平均年龄 (72.6±9.1) (65~89) 岁,按年龄分为:≥ 80 岁 (36 例) 和<80 岁 (28 例) 两组。肥胖[体质量指数 (BMI):>24.9 kg / m^2]患者 29 例,非肥胖 (BMI:18.5~24.9 kg / m^2) 患者 35 例;合并心脑血管疾病患者 42 例,无心脑血管疾病患者 22 例。根据 Evans-Jenson 分类方法,I 型 17 例,II 型 26 例,III 型 10 例,IV 型 9 例,V 型 2 例。记录本组患者的年龄、性别、体重、术前红细胞压积和隐性失血量,分析发生隐性失血的相关因素。结果≥ 80 岁组隐性失血量明显<80 岁组 (P=0.021),两组相比差异有统计学意义。两组的性别、体重及术前红细胞压积相比,差异无统计学意义(P=0.132,P=0.324)。Logistic 回归分析结果显示,高龄、合并心脑血管疾病是隐性失血发生的独立危险因素。结论 PFNA 治疗老年外侧壁薄弱型股骨粗隆间骨折隐性失血的发生可能与患者年龄及是否合并心脑血管疾病相关,临床上应引起重视。Objective To analyze related factors of proximal femoral nail antirotation (PFNA) in the treatment of hidden blood loss in the elderly with weak lateral femoral intertrochanteric fracture.Methods Sixty-four elderly patients with weak lateral femoral intertrochanteric fracture were selected from June 2016 to June 2018,including 30 males and 34 females with an average age of (72.6±9.1) years (range:65-89 years).All were divided into two groups based on the age:Group A (n=36),age ≥ 80 years;Group B (n=28),age < 80 years.There were 29 patients with obesity (BMI > 24.9 kg / m^2),while 35 patients not (BMI 18.5-24.9 kg / m^2);42 patients with cardiovascular or cerebrovascular diseases,while 22 patients not.Evans-Jenson classification:17 cases were of type I;26 cases of type II;10 cases of type III;9 cases of type IV;2 cases of type V.The age,gender,weight,preoperative hematocrit,and hidden blood loss were recorded to analyze related factors of hidden blood loss.Results The hidden blood loss of Group A was significantly more than that of the Group B (P=0.021).No statistically significant differences in gender,weight,or preoperative hematocrit were noted between the two groups.Logistic regression analysis showed that advanced age,cardiovascular or cerebrovascular diseases were independent risk factors of hidden blood loss.Conclusions The age,cardiovascular or cerebrovascular diseases may be related to hidden blood loss in the PFNA treatment of elderly patients with weak lateral femoral intertrochanteric fracture.

关 键 词：骨折固定术 髓内 老年人(65~79) 老年人 80以上 股骨骨折 失血 手术 

分 类 号：R683.4[医药卫生—骨科学]