防治老年股骨转子间骨折隐性失血对术后功能恢复影响的随机对照研究

Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative functional recovery： a random controlled trial

目的探讨不同类型股骨转子间骨折之间术后隐性失血量的差异，以及防治隐性失血对股骨转子间骨折患者术后功能恢复的影响。方法将2007年1月至2009年10月期间收治的300例股骨转子间骨折患者随机分为试验组（151例）和对照组（149例）。试验组给予口服铁剂治疗6周，对照组未予任何干预。两组患者均采用髓内固定方法进行手术治疗，分别于入院时、术后1、2、3d、出院时及术后1、2、3、6个月检测血常规，并用功能独立性评分系统（FIM）及Harris评分系统评价两组患者骨折前、入、出院时及术后随访时的功能情况。结果300例患者剔除因输血治疗、失访及术后出现重大并发症等79例，最终进入分析研究的试验组和对照组分别为114例和107例。术前两组血红蛋白量分别为（119．4±8．9）、（120．3±8．0）g／L，差异无统计学意义（P=0．472）。术后3d内两组血红蛋白量均较术前有明显下降，但组间差异无统计学意义（P〉0．05）。术后1、2、3个月试验组血红蛋白增加量和FIM评分增加值均明显高于对照组，差异有统计学意义（P〈0．05）。本研究中AO各型之间术后3d内血红蛋白下降量之间的差异无统计学意义（P〉0．05）。结论股骨转子间骨折不同AO类型间术后隐性失血量无明显差异。口服铁剂能有效防治隐性失血，加快患者术后功能恢复。

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementation is beneficial for the postoperative functional recovery in elderly patients. Methods From January 2007 to October 2009, 300 elderly patients with intertroehanteric fracture were enrolled into the study after screening. They were randomized into a study group receiving oral iron supplementation for 6 weeks, and a control group receiving no anti-anemic intervention. All the patients were treated with closed reduction and intramedullary fixation. Hemoglobin levels were examined and functional recovery was evaluated using the functional independence measure （FIM） method and Harris scoring system preoperation, on 1, 2 and 3 days postoperation, at discharge and the follow-ups of 1, 2, 3 and 6 months. Results A total of 79 patients were excluded because of preoperative or postoperative blood transfusion, loss to follow-up, or major complications. The remaining 114 patients in the study group and 107 ones in the control group were finally analyzed. There were no significant differences in mean perioperative visible blood loss （34.4 mL versus 34. 5 mL, P 〉 0. 05 ） between the 2 groups. Hemoglobin levels declined dramatically in the first 3 days postoperatively as compared with the preoperative values, but no difference in the declined hemoglobin levels was found among different AO fracture types （ P 〉 0. 05）. Significant differences in the increase of hemoglobin levels were found at the follow-ups of 1, 2 and 3 months between patients who received iron therapy and those who did not （ P 〈 0. 05）, but no difference was found at the follow-up of 6 months （ P 〉 0. 05） . Similarly, the increased FIM scores at the follow-ups of 1, 2 and 3 months were significantly higher in patients with iron therapy than in those without （ P 〈 0. 05）, but no difference was found at the follow-up of 6 months （ P 〉 0. 05） . No significant difference in the Harris scores was found at any time between the 2 groups （ P 〉 0. 05） . Conclusions AO classification is not an independent predictor of the hidden blood loss after intertroehanteric fractures. Oral iron supplementation can effectively correct postoperative anemia and accelerate functional recovery in elderly patients.