老年股骨粗隆间骨折PFNA术后隐性失血量的相关因素及术后隐性失血量对髋关节功能恢复的影响  

Factors associated with postoperative recessive blood loss after PFNA for intertrochanteric femoral fractures in the elderly and the effect of postoperative recessive blood loss on the recovery of hip joint function

作　　者：杨昊 王传良 黄俊涛 刘常青 YANG Hao;WANG Chuanliang;HUANG Juntao;LIU Changqing(Department of Orthopaedics,the Eighth People’s Hospital of Hefei,Hefei 238000,China)

机构地区：[1]安徽省合肥市第八人民医院骨科,238000

出　　处：《中国煤炭工业医学杂志》2024年第5期500-506,共7页Chinese Journal of Coal Industry Medicine

基　　金：安徽省健康发展战略研究中心资政项目(编号:2021szk00121)

摘　　要：目的 探讨老年股骨粗隆间骨折(FIF)股骨近端防旋髓内钉(PFNA)术后隐性失血量的相关因素,并分析术后隐性失血量对髋关节功能恢复的影响。方法 选取2018年11月—2022年12月老年FIF患者98例,均接受PFNA内固定术治疗,统计所有患者术后失血情况,分析术后隐性失血量的影响因素,对比术后不同隐性失血量患者髋关节功能恢复情况,分析术后隐性失血量与髋关节功能的关系。结果 98例患者均顺利完成PFNA手术,平均总失血量为(918.47±82.33)ml,平均显性失血量为(235.94±34.51)ml,平均隐性失血量为(682.53±74.49)ml,隐性失血量占总失血量的74.31%。Lasso回归分析筛选出7个变量,分别为年龄、骨折类型、手术时间、高血压、糖尿病、术前抗凝、术后输血;经多元线性回归分析,年龄、不稳定型骨折、手术时间、高血压、糖尿病、术前抗凝是老年FIF患者PFNA术后隐性失血量的危险因素,术后输血是老年FIF患者PFNA术后隐性失血量的保护因素(P<0.05);以98例患者术后平均隐性失血量为界分为少量隐性失血与大量隐性失血患者。大量隐性失血患者与少量隐性失血患者术后3个月、6个月、12个月髋关节功能Harris评分均呈逐渐升高趋势(P<0.05);大量隐性失血患者术后3个月、6个月、12个月髋关节功能Harris评分低于少量隐性失血患者(P<0.05);术后隐性失血量与术后3个月、6个月、12个月髋关节功能Harris评分呈负相关(P<0.05)。结论 老年FIF患者PFNA术后隐性失血量较多,影响因素包括年龄、不稳定型骨折、手术时间、高血压、糖尿病、术前抗凝、术后输血等,且与髋关节功能恢复密切相关。Objective To explore the factors associated with the recessive blood loss after proximal femoral nail antirotation(PFNA)surgery for intertrochanteric fractures(FIF)in the elderly,and to analyze the impact of recessive blood loss on the recovery of hip joint function.Methods A total of 98 elderly patients with FIF were selected from November 2018 to December 2022,all of which were treated with PFNA internal fixation.The postoperative blood loss of all patients was statistically analyzed,the influencing factors of postoperative recessive blood loss were analyzed,the recovery of hip joint function in patients with different postoperative recessive blood loss was compared,and the relationship between postoperative recessive blood loss and hip joint function was analyzed.Results All the 98 patients successfully completed PFNA operation.The average total blood loss was(918.47±82.33)ml,the average dominant blood loss was(235.94±34.51)ml,and the average recessive blood loss was(682.53±74.49)ml.The recessive blood loss accounted for 74.31%of the total blood loss.Seven variables were selected by Lasso regression analysis,which were age,fracture type,operation time,hypertension,diabetes,preoperative anticoagulation and postoperative blood transfusion.Multiple linear regression analysis showed that age,unstable fracture,time of operation,hypertension,diabetes,and preoperative anticoagulation were risk factors for implicit blood loss after PFNA in elderly FIF patients,and postoperative transfusion was protective factors for implicit blood loss after PFNA in elderly FIF patients(P<0.05).The average hidden blood loss of 98 patients was divided into small recessive blood loss and large recessive blood loss.The Harris scores of hip joint function in patients with a large amount of hidden blood loss and a small amount of hidden blood loss showed a gradual increase trend at 3,6,and 12 months after surgery(P<0.05).The Harris score of hip joint function at 3 months,6 months and 12 months after operation in patients with large amou

关 键 词：老年股骨粗隆间骨折 股骨近端防旋髓内钉内固定术 隐性失血量 影响因素 髋关节功能 

分 类 号：R683.4[医药卫生—骨科学]