高龄股骨粗隆间骨折患者股骨近端髓内钉内固定治疗与术后贫血的关系

Relationship between internal fixation of proximal femoral nails and postoperative anemia in elderly patients with intertrochochanteric fractures

目的:探讨股骨近端髓内钉(PFN)内固定与高龄股骨粗隆间骨折患者术后贫血的关系,阐明PFN固定是否为高龄股骨粗隆间骨折术后贫血的主要危险因素。方法:选择股骨粗隆间骨折行PFN内固定治疗患者43例,男性23例,女性20例,年龄71～95岁,平均年龄(82±3)岁,按Evans分型:ⅢA20例、ⅢB17例、Ⅳ型6例;受伤原因:滑倒摔伤25例,车祸摔伤15例,其他疾病晕倒摔伤3例。对照组19例,男性11例,女性8例,年龄70～85岁,平均年龄(80±5)岁,按Evans分型:ⅢA9例、ⅢB6例、Ⅳ型4例;受伤原因:滑倒摔伤11例,车祸摔伤7例,其他疾病晕倒摔伤1例。对照组患者行患肢皮牵引固定保守治疗。比较PFN手术组手术前后的红细胞数(RBC)、血红蛋白(HB)和红细胞压积(HCT),并与对照组比较。结果:手术组患者术前RBC、HB和HCT与对照组比较差异均无显著性(P>0.05),手术组术后第2、3天患者RBC、HB和HCT较术前降低且低于对照组(P<0.05);对照组入院后1周3项指标较入院时有所降低,但差异无显著性(P>0.05)。结论:高龄股骨粗隆间骨折患者经PFN内固定治疗后容易出现术后贫血,隐性失血是术后贫血的主要原因。

Objective To investigate the relationship between the proximal femoral nail（PFN） fixation and postoperative anemia in the elderly patients with intertrochanteric fractures,and clarify whether the elderly PFN fixation of intertrochanteric fractures is the main risk factor for postoperative anemia.Methods From January 2006 to August 2009,43 patients with intertrochanteric fractures were selected（PFN treatment group）,aged 71-95 years,with an average age of 82 years,23 male and 20 female,according to Evans classification：ⅢA 20 cases,ⅢB 17 cases,Ⅳ type 6 cases;cause of injuries：25 cases of slip and fall,15 cases of traffic accident fall,3 cases of other diseases induced fall in a fainted.Control group,19 cases,aged 70-85 years,mean 80 years old,11 males and 8 females;according to Evans classification：ⅢA 9 cases,ⅢB 6 cases,Ⅳ type 5 cases;cause of injuries：11 cases of slip and fall,7 cases of traffic accident fall,1 case of other diseases induced fall in a fainted.The number of red blood cells（RBC）,hemoglobin（HB） and hematocrit（HCT） in PFN treatment group before and after operation were compared with control group.Results The number of preoperative RBC,HB,HCT before operation in PFN treatment group had no significant difference compared with control group（P〉 0.05）;the number of RBC,HB,HCT 2 and 3 d after operation in PFN treatment group were significantly decreased compared with before surgery（P〈0.05）.The number of RBC,HB,HCT 1 week after admission in control group were lower compared with admission,but there was no significant difference（P 〉0.05）.Conclusion The internal fixation of PFN in elderly patients with intertrochanteric fracture can lead to postoperative anemia,and recessive loss of blood is the main reason for postoperative anemia.