老年股骨粗隆间骨折患者股骨近端防旋髓内钉内固定术后隐性失血相关因素分析  

Factors related to hidden hemorrhage after proximal femoral nail antirotation fixation in elderly patients with femoral intertrochanteric fracture

作　　者：李政道 戴醒明[1] 刘大诚[1] 张秀伟 LI Zhengdao;DAI Xingming;LIU Dacheng;ZHANG Xiuwei(Department of Orthopedics,The First People's Hospital of Xuzhou,Xuzhou 221006,Jiangsu,China)

机构地区：[1]徐州市第一人民医院骨科,江苏徐州221006

出　　处：《外科研究与新技术》2022年第3期152-155,共4页Surgical Research and New Technique

摘　　要：目的 探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨粗隆间骨折(femoral intertrochanteric fracture,FIF)患者术后发生隐性失血的相关因素。方法 选取2017年5月—2021年5月于徐州市第一人民医院骨科接受PFNA治疗的120例老年股骨粗隆间骨折患者为研究对象。计算PFNA术后显性失血量、隐性失血量及总失血量;统计分析所有患者临床资料,并将可能的影响因素纳入,经单因素与多因素分析找出老年FIF患者行PFNA内固定术后发生隐性失血的影响因素。结果 PFNA手术显性、隐性及总失血量分别为(235.87±70.65)mL、(712.58±134.25)mL、(947.77±208.91)mL。单因素及多因素logistic分析显示,年龄≥75岁、不稳定性骨折、合并高血压、糖尿病、手术时间>60min、术前抗凝治疗均为影响老年FIF患者行PFNA内固定术后发生隐性失血的危险因素(P<0.05)。结论 隐性失血是导致老年FIF患者经PFNA内固定治疗后围术期失血的主要原因,其中年龄≥75岁、不稳定性骨折、合并高血压、糖尿病、手术时间>60min、术前抗凝治疗均为重要的危险因素,因此,临床可采取相应措施防治行PFNA内固定术治疗的老年FIF患者,以改善预后,减少隐性失血发生。Objective To investigate the related factors affecting postoperative hidden hemorrhage in elderly patients with femoral intertrochanteric fracture(FIF) treated with proximal femoral nail antirotation(PFNA).Methods A total of 120 elderly FIF patients who received PFNA treatment in the Department of Orthopedics of The First People’s Hospital of Xuzhou from May 2017 to May 2021 were selected as study subjects.Apparent,hidden,and total blood loss volumes after PFNA were calculated.The clinical data of all patients were statistically analyzed,and possible influencing factors were included.Univariate and multivariate analyses were used to find out the influencing factors of hidden hemorrhage after PFNA internal fixation in elderly FIF patients.Results The apparent,hidden,and total blood loss volumes after PFNA were(235.87±70.65) mL,(712.58±134.25) mL,and(947.77±208.91) mL,respectively.Univariate and multivariate logistic analysis results showed that age≥75 years old,unstable fractures,being complicated with hypertension or diabetes,operation time>60 min,and preoperative anticoagulation therapy were all risk factors for the occurrence of hidden hemorrhage after PFNA internal fixation in elderly FIF patients(P<0.05).Conclusion Hidden hemorrhage is the main cause of perioperative blood loss in elderly FIF patients treated with PFNA internal fixation,and age≥75 years,unstable fractures,being complicated with hypertension or diabetes,operation time>60 min,and preoperative anticoagulation therapy are important risk factors for hidden hemorrhage.Therefore,relevant clinical measures are suggested for elderly patients with FIF undergoing PFNA internal fixation to improve prognosis and reduce the occurrence of hidden hemorrhage.

关 键 词：股骨粗隆间骨折 股骨近端防旋髓内钉 隐性失血 危险因素 

分 类 号：R684[医药卫生—骨科学]