【摘要】 背景:隐性失血是股骨转子间骨折患者,特别是高龄患者存在的一个重要隐患,可导致患者内固定治疗后处于贫血状态,影响切口愈合及患者恢复。目的:比较分析亚洲型股骨近端防旋髓内钉与动力髋螺钉治疗股骨转子间骨折的围术期失血量及其影响因素。方法:回顾性分析采取亚洲型股骨近端防旋髓内钉与动力髋螺钉两种方法治疗的股骨转子间骨折患者70例,其中年龄≥80岁的患者21例,年龄<80岁的患者49例;体质量指数>30kg/m2的患者28例,体质量指数≤30kg/m242例;使用防旋髓内钉固定30例,动力髋螺钉固定40例。根据身高、体质量和内固定治疗前后红细胞压积变化,使用Gross方程计算围术期失血量。结果与结论:患者平均失血量为936mL,其中显性失血量为237mL,隐性失血量为699mL。隐性失血占失血总量达74.7%。动力髋螺钉组显性失血量高于防旋髓内钉组,隐性失血量低于防旋髓内钉组,高龄患者总失血量及隐性失血量均高于非高龄患者,男性与女性患者之间及肥胖与非肥胖患者之间比较差异无显著性意义。结果提示隐性出血是股骨转子间骨折内固定治疗后失血的主要原因;防旋髓内钉术式隐性失血量较动力髋螺钉大;高龄是隐性失血的危险因素。更多还原

【Abstract】 BACKGROUND: Hidden blood loss is an important risk for the intertrochanteric fracture patients, especially the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE: To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedullary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS: We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedullary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age < 80 years; 28 patients with the body mass index > 30 kg/m 2 and 42 patients with the body mass index ≤ 30 kg/m 2 ; 30 patients received anti-rotation intramedullary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION: The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7% in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedullary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedullary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients; there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedullary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.更多还原