股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的疗效及术后隐性失血的影响因素分析  

The Effect of Proximal Femoral Nail Antirotation in the Treatment of Intertrochanteric Fracture and the Influencing Factors of Hidden Blood Loss

作　　者：周建伟 李绍平[1] 潘奕欣 雷栓虎[1] 汪玉良[1] ZHOU Jian-wei;LI Shao-ping;PAN Yi-xin;LEI Shuan-hu;WANG Yu-liang(Department of Orthopaedics,The Second Hospital of Lanzhou University,Lanzhou,Gansu,730000,China)

机构地区：[1]兰州大学第二医院骨科,甘肃兰州730000

出　　处：《现代生物医学进展》2021年第6期1165-1168,1159,共5页Progress in Modern Biomedicine

基　　金：甘肃省青年科技基金计划项目(17JR5RA226)。

摘　　要：目的:观察股骨粗隆间骨折患者经股骨近端防旋髓内钉(PFNA)内固定治疗后的效果,并分析术后隐性失血的影响因素。方法:回顾性选取2018年3月~2020年7月期间来我院就诊的220例股骨粗隆间骨折患者的资料,患者经PFNA内固定治疗,观察其治疗效果及并发症发生情况,记录所有患者术后隐性失血情况,单因素和多元线性回归分析术后隐性失血的影响因素。结果:220例患者均成功完成了手术,按照Harris髋关节功能评分标准,优良率为82.73%(182/220),隐性失血量为(787.07±58.92)mL,并发症发生率为4.09%(9/220)。单因素分析结果显示,股骨粗隆间骨折患者经PFNA内固定治疗后,术后隐性失血的发生与年龄、骨折Evans分型、高血压病、糖尿病、术前抗凝、受伤至手术时间有关(P<0.05),而与性别、体质量指数、手术时间、术后输血无关(P>0.05)。多元线性回归结果显示,年龄>75岁、骨折Evans分型为Ⅲ~Ⅳ型、存在高血压病、存在糖尿病、术前抗凝、受伤至手术时间>5 d是引起术后隐性失血的危险因素(P<0.05)。结论:PFNA内固定治疗股骨粗隆间骨折患者,疗效较好,术后并发症较少,同时患者均存在不同程度的隐性失血,隐性失血的量与糖尿病、年龄、高血压病、骨折Evans分型、术前抗凝、受伤至手术时间等因素密切相关。Objective:To observe the effect of proximal femoral nail antirotation(PFNA)in the treatment of intertrochanteric fracture and analyze the influencing factors of hidden blood loss.Methods:220 patients with intertrochanteric fracture in our hospital from March 2018 to July 2020 were selected retrospectively.The patients were treated with PFNA internal fixation.The therapeutic effect and complications were observed.The hidden blood loss of all patients was recorded.The influencing factors of hidden blood loss were analyzed by single factor and multiple linear regression.Results:According to Harris hip function score,the excellent and good rate was 82.73%(182/220),the hidden blood loss was(787.07±58.92)ml,and the complication rate was 4.09%(9/220).Univariate analysis showed that the incidence of occult blood loss in patients with intertrochanteric fracture after PFNA internal fixation was related to age,fracture Evans classification,hypertension,diabetes mellitus,preoperative anticoagulation,injury to operation time(P<0.05),but not to gender,body mass index,operation time and postoperative blood transfusion(P>0.05).Multiple linear regression results showed that age>75 years old,fracture Evans typeⅢ~Ⅳ,hypertension,diabetes,preoperative anticoagulation,injury to operation time>5 days were risk factors for postoperative hidden blood loss(P<0.05).Conclusion:PFNA internal fixation in the treatment of femoral intertrochanteric fracture has good curative effect and less postoperative complications.At the same time,patients have different degrees of hidden blood loss.The amount of hidden blood loss is closely related to diabetes,age,hypertension,fracture Evans classification,preoperative anticoagulation,injury to operation time and other factors.

关 键 词：股骨近端防旋髓内钉内固定 股骨粗隆间骨折 疗效 术后隐性失血 影响因素 

分 类 号：R683[医药卫生—骨科学]