全髋关节置换和半髋关节置换对创伤性股骨颈骨折患者隐性失血情况影响  

Effect of total hip arthroplasty and hemiarthroplasty on hidden blood loss in patients with traumatic femoral neck fracture.

作　　者：徐鹏飞 胡孔和[2] 陈文杰 XU Peng-fei;HU Kong-he;CHEN Wen-jie(Department of Surgery,419 Hospital of Nuclear Industry,Shaoguan Guangdong 572000,China;Department of Orthopedics,Yuebei People's Hospital,Shaoguan Guangdong 572000,China.)

机构地区：[1]核工业四一九医院外科,广东韶关572000 [2]粤北人民医院骨科,广东韶关572000

出　　处：《临床和实验医学杂志》2021年第9期972-976,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省科技计划资助项目(编号:2011B031300027)

摘　　要：目的分析全髋关节置换和半髋关节置换对创伤性股骨颈骨折患者隐性失血情况的影响。方法回顾性分析2016年6月至2018年6月核工业四一九医院收治的85例老年创伤性股骨颈骨折患者,按照不同手术方法分为观察组(n=43)和对照组(n=42)。观察组进行全髋关节置换术治疗,对照组采用半髋关节置换术治疗。比较2组患者的术中出血量、手术时间、住院时间及术后引流量的差异,比较两种术后髋关节功能及并发症,测定术前和术后的血红蛋白(HGB)、红细胞比容(Hct)等,Gross公式计算2组患者的总失血量,并对比隐性失血量(HHV)和总失血量(THV)差异。结果观察组患者术中出血量、术后引流量、手术时间及住院时间为(386.64±69.87)mL、(230.48±25.82)mL、(125.49±20.67)min、(20.11±3.59)d均明显高于对照组[(338.73±49.82)mL、(207.31±25.77)mL、(110.48±17.64)min、(17.88±3.28)d],差异均有统计学意义(P<0.05);手术后1年随访发现,观察组Harris评分优良率(95.35%)明显高于对照组(80.95%),差异有统计学意义(P<0.05)。观察组术后并发症发生率(16.28%)高于对照组(14.29%),差异无统计学意义(P>0.05)。观察组HHV、THV为(350.62±40.46)、(695.48±96.39)mL明显高于对照组[(331.52±34.18)、(640.22±88.34)mL],观察组术后3 d后HGB、Hct下降值为明显为(18.38±8.27)g/L、(0.20±0.06)%,高于对照组[(14.63±7.29)g/L、(0.17±0.04)%],差异有统计学意义(P<0.05),但2组HHV/THV比值比较[(51.29±16.57)%vs.(48.93±15.65)%],差异无统计学意义(P>0.05)。结论全髋关节置换治疗创伤性股骨颈骨折患者的手术难度、创伤性和隐性失血量大于半髋关节置换,但长期髋关节恢复功能更优,临床应根据患者年龄、体质、骨折程度等综合考虑选取手术方式。Objective To analyze the effect of total hip arthroplasty and hemiarthroplasty on the hidden blood loss in patients with traumatic femoral neck fracture.Methods From June 2016 to June 2018,85 elderly patients with traumatic femoral neck fracture admitted to the 419 Hospital of Nuclear Industry were retrospectively analyzed,and were divided into observation group(n=43)and control group(n=42)according to different surgical methods.The observation group was treated with total hip arthroplasty,and the control group was treated with hemiarthroplasty.The intraoperative blood loss,postoperative drainage,operation time and hospitalization time,postoperative hip function and complications were compared.The preoperative and postoperative hemoglobin(HGB),hematocrit(Hct)was measured.The Gross formula was used to calculate the total blood loss of the two groups of patients,then the difference between hidden blood loss(HHV)and total bleeding volume(THV)was compared.Resluts The intraoperative blood loss,postoperative drainage,operation time and hospital stay in the observation group were(386.64±69.87)mL,(230.48±25.82)mL,(125.49±20.67)min,and(20.11±3.59)d,which were higher than those in the control group[(338.73±49.82)mL,(207.31±25.77)mL,(110.48±17.64)min,(17.88±3.28)d],the differences were statistically significant(P<0.05).The superior rate of Harris score in the observation group(95.35%)was significantly higher than that in the control group(80.95%),and the difference was statistically significant(P<0.05).The postoperative complication rate of the observation group was higher than that of the control group(16.28%vs.14.29%,P>0.05).The HHV and THV in the observation group were(350.62±40.46)and(695.48±96.39)mL,which were significantly higher than those in the control group[(331.52±34.18),(640.22±88.34)mL],and the HGB and Hct decreased values in the observation group 3 days after surgery was(18.38±8.27)g/L,(0.20±0.06)%,which was significantly higher than that in the control group[(14.63±7.29)g/L,(0.17±0.04)%],the d

关 键 词：股骨颈骨折 全髋关节置换 半髋关节置换 隐性出血量 

分 类 号：R687.4[医药卫生—骨科学]