股骨粗隆间骨折应用Intertan固定后隐性失血的初步分析

Primary Analysis on Peri-operative Hidden Blood Loss after Surgery of Intertan Internal Fixation for Intertrochanteric Femur Fractures

目的探讨Intertan治疗股骨粗隆间骨折术后隐性失血的特点和相关影响因素。方法回顾性分析2009年9月-2012年9月应用Intertan治疗股骨粗隆间骨折患者107例，其中男46例，女61例，平均年龄73．08岁。骨折依照OTA／AO分型：A1型41例，A2型66例。均为初次单侧新鲜股骨粗隆间骨折，术后24h补液总量不超过2000ml。通过Gross方程计算隐性失血量。结果本组手术时间平均（65．9±5．6）min，围手术期失血总量平均（1072．0±36．0）ml，其中显性失血量平均（182．0±13．6）ml，隐性失血量平均（917．0±16．3）ml。男女组间隐性失血量比较无统计学差异（P〉0．05），但是在AO／OTA31A1和AO／OTA31A2组间隐性失血量和总失血量存在统计学差异（P〈0．05）。结论Intertan手术虽为微创手术，术中显性失血量较少，但隐性失血量较多，在临床工作中应当注意患者术后的生命体征变化，及时复查血常规和给予相应治疗。

Objective To explore the features and the risk factors of peri-operative hidden blood loss due to the surgery of Intertan fixation for intertroehanteric femur fracture. Methods A total of 107 cases with intertrochanteric femur fracture performed close reduction and Intertan internal fixation were retrospectively ana- lyzed, including 46 males and 61 females, aged 73.08 averagely. According to AO/OTA classification, there was AO/OTA31A1 type in 41 and AO/OTA31A2 type in 66. All the patients were fresh intertrochanteric femur fracture following primary operation,the total infusion volume were less than 2 000 ml. According to Gross for- mulae, the hidden blood loss was calculated and analyzed. Results The operative duration was 65.9 ± 5.6 minutes. The mean total blood loss was 1 072.0 ± 36.0 ml,the mean observed blood loss was 182.0 ± 13.6 ml, and the mean hidden blood loss was 917.0 ± 16.3 ml. There were no statistic difference in hidden blood loss between male group and female group （ P 〉 0.05 ）, but there were more in total blood loss and hidden blood loss of AO/OTA31A2 group than those of AO/OTA31A1 group （P〈0.05）. Conclusions Although Intertan in- ternal fixation is a mini-invasive operation with low observed blood loss volume, but hidden blood loss was the major part of total blood loss after operation for intertrochanteric femur fracture. It is very important to supple- ment the blood volume during peri-operative period. Surgeons should pay more attention to observe the patient＇s condition changes during peri-operation.