【摘要】 [目的]分析股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年股骨粗隆间骨折的围手术期隐性失血量,提高对隐性失血的认识并探讨其相关因素。[方法]回顾性分析本院2010年3月～2012年1月采取PFNA治疗的43例股骨粗隆间骨折患者。对患者年龄、性别、体重指数、骨折类型进行分析,并使用Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)变化,计算围手术期失血量。[结果]43例患者中围手术期未输血的28例,隐性失血约536 ml,占总失血量的82%。采取输血支持的15例,隐性失血约553 ml,占总失血量的84%。骨折严重组及高体重指数组可增加围手术期失血量,差异有统计学意义,P<0.05;年龄、性别之间围手术期失血比较,差异无统计学意义,P>0.05。[结论]隐性失血是PFNA治疗股骨粗隆间骨折围手术期失血的主要原因,肥胖及严重骨折可加重围手术期失血,临床上需引起足够重视并且及时补充血容量。更多还原

【Abstract】 [Objective]To analyze the peri-operative hidden-blood loss in geriatric intertrochanteric fractures treated with proximal femoral nail antirotation( PFNA),and to enhance the understanding for hidden blood loss and identify risk factors for increased blood loss.[Method]A retrospective case series of 43 patients,who were treated by PFNA between March 2010 and January 2012 were reviewed.The age,gender,body mass index( BMI),type of fracture were analyzed.The blood volume and its estimated loss were calculated by Gross formula,according to the body high,weight,and the changes of pre and postoperative haemocrit( Hct).[Result]There were 28 cases in the non-blood transfusion group.The hidden blood loss was 536 ml,and occupied about 82% of the total blood loss volume.Fifteen cases received the blood transfusion.The hidden blood loss was 553 ml,and occupied about 84% of the total blood loss volume.There were significant differences in high BMI group and severe fracture type group in peri-operative blood loss.There were no differences between male and femal group,lower age and high age group.[Conclusion]Hidden blood loss is the major part of total blood loss for PFNA treated intertrochanter fracture during peroperative period.High BMI,severe fracture type may be risk factors for severe peri-operative blood loss.We should pay enough attention and supplement the blood volume in time.更多还原