DHS与PFNA治疗骨粗隆间骨折的隐性失血量对比及股骨髓腔直径/PFNA直径比值与隐性失血的相关性分析  

Comparison of occult blood loss in treatment of intertrochanteric fractures by DHS and PFNA and analysis of correlation between ratio of femoral medullary diameter/PFNA diameter and occult blood loss

作　　者：韩杰[1] 张鹏[1] 斯焱[1] 朱江伟[1] 李钟[1] 毕梦娜[1] 张上上[1] 陈经勇[1] 马士辉[1] HAN Jie;ZHANG Peng;SI Yan;ZHU Jiang-wei;LI Zhong;BI Meng-na;ZHANG Shang-shang;CHEN Jing-yong;MA Shi-hui(Department of Geriatric Orthopedics 1,Sichuan Orthopedic Hospital,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院老年骨科一,四川成都610041

出　　处：《生物医学工程与临床》2022年第5期588-593,共6页Biomedical Engineering and Clinical Medicine

基　　金：四川省干部保健科研基金资助课题(干研2016-604)。

摘　　要：目的 对比动力髋螺钉(DHS)与股骨近端防旋股骨近端髓内钉(PFNA)治疗骨粗隆间骨折的隐性失血量,并分析股骨髓腔直径/PFNA直径比值与隐性失血的相关性。方法 前瞻性选择2019年12月至2021年1月收治的93例股骨粗隆间骨折患者,其中男性50例,女性43例;年龄50~82岁,平均年龄64.4岁;美国麻醉医师协会(ASA)分级标准Ⅰ型3例,Ⅱ型48例,Ⅲ型39例,Ⅳ型3例;致伤原因摔伤63例,交通事故伤23例,其他7例。依照治疗方案不同分为DHS组和PFNA组。依照患者隐性失血量进行分组,即隐性失血量≥500 mL组和隐性失血量<500 mL组。记录患者手术时长、术中和围手术期失血量;分析隐性失血量与股骨髓腔直径/PFNA直径比值相关性,确定影响隐性失血量的危险因素。结果 术后第3天两组患者血中白细胞计数、肌肝清除率、丙氨酸氨基转移酶、天冬氨酸氨基转氨酶、尿素均明显升高,红细胞(RBC)计数、血红蛋白(Hb)均明显降低,且PFNA组患者血中RBC、Hb水平明显低于DHS组(15.43×10~9±4.95×10~9vs 15.39×10~9±4.27×10~9;153.12μmol/L±32.19μmol/L vs 155.02μmol/L±28.93μmol/L;22.38 U/L±4.91 U/L vs 22.41 U/L±3.94 U/L;39.08 U/L±8.38 U/L vs 38.98 U/L±7.39 U/L;5.43μmol/L±1.81μmol/L vs 5.48μmol/L±1.79μmol/L;4.32×10±1.01×10vs 3.94×10±1.14×10;114.81 g/L±21.21 g/L vs 100.01 g/L±19.83 g/L。P<0.05)。DHS组隐性失血量为(581.43±38.93) mL,PFNA组患者平均隐性失血量为(577.49±40.95) mL,两组患者平均隐性失血量差异无统计学意义(P>0.05);PFNA组隐性失血量≥500 mL组25例,平均隐性失血量为(700.44±49.58) mL;而隐性失血量<500 mL组21例,平均隐性失血量为(433.12±51.02) mL。隐性失血量≥500 mL组患者股骨干峡部、漏斗起始部和终止部股骨髓腔直径/PFNA直径比值均明显高于隐性失血量<500 mL组(1.45±0.20 vs 1.24±0.19;1.71±0.18 vs 1.54±0.11;1.52±0.15 vs 1.37±0.19。P<0.05);股骨干峡部、漏斗起始部和终止部股骨�Objective To compare the occult blood loss of dynamic hip screw(DHS) and proximal femoral nail antirotation(PF-NA) in treatment of intertrochanteric fractures,and analyze the correlation between ratio of femoral bone marrow cavity diameter/PFNA diameter and occult blood loss.Methods From December 2019 to January 2021,a total of 93 patients with femoral intertrochanteric fracture were enrolled,which included 50 males and 43 females,aged 50-82 years old with mean age of64.4 years old.According to classification standard of American Association of Anesthesiologists(ASA),there were 3 cases of typeⅠ,48 of typeⅡ,39 of typeⅢand 3 of typeⅣ.Among those patients,there were 63 cases of falling injury,23 of traffic accident injury and 7 of other causes.All of them were divided into DHS group and PFNA group according to different treatment schemes.According to the amount of occult blood loss,all of them were divided into≥500 mL group and<500 mL group.The operation time,intraoperative and perioperative blood loss of patients were recorded,the correlation between blood loss and ratio of femoral canal diameter/intramedullary nail diameter was analyzed,and risk factors affecting occult blood loss were determined.Results On the 3 days post operation,white blood cells(WBC) count,creatinine clearance rate(CCr),alanine aminotransferase(ALT),aspartate aminotransferase(AST) and urea of 2 groups were significantly increased,while red blood cells(RBC)count and hemoglobin(Hb) were significantly decreased,and levels of RBC and Hb in PFNA group were significantly low er than those in DHS group (15.43×10~9±4.95×10~9vs 15.39×10~9±4.27×10~9;153.12μmol/L±32.19μmol/L vs155.02μmol/L±28.93μmol/L;22.38 U/L±4.91 U/L vs 22.41 U/L±3.94 U/L;39.08 U/L±8.38 U/L vs 38.98 U/L±7.39 U/L;5.43μmol/L±1.81μmol/L vs 5.48μmol/L±1.79μmol/L;4.32×10±1.01×10vs 3.94×10±1.14×10;114.81 g/L±21.21 g/L vs 100.01 g/L±19.83 g/L.P<0.05).The mean occult blood loss in DHS group was (581.43±38.93) mL and in PFNA group was (577.49±40.95) m

关 键 词：股骨粗隆间骨折 动力髋螺钉(DHS) 股骨近端防旋股骨近端髓内钉(PFNA) 隐性失血量 治疗方法 股骨髓腔直径/PFNA直径比值 

分 类 号：R687.3[医药卫生—骨科学]