应用髓外和髓内固定物治疗股骨转子间骨折显性和隐性失血量的比较

Comparative study on blood loss between extramedullary and intramedullary fixation for femoral intertrochanteric fracture

背景:股骨转子间骨折的微创治疗已广泛应用于临床,但隐性失血尚未得到广泛重视,对其研究较少。目的:比较应用髓外固定物动力髋螺钉(DHS)和髓内固定物(PFNA、InterTan)治疗股骨转子间骨折围手术期的显性和隐性失血量,分析隐性失血的影响因素,为内固定物的选择提供临床依据。方法:回顾性分析2010年1月至2011年12月应用DHS或PFNA、InterTan治疗的股骨转子间骨折患者89例,记录患者年龄、性别、身高、体重,记录术中及术后显性失血量,手术时间,手术前后的血红蛋白(Hb)和红细胞压积(Hct)。应用Gross方程计算总失血量和隐性失血量,对统计数据进行比较分析。结果:应用DHS 24例,总失血量平均为832 ml,其中显性失血量为187 m(l22.5%),隐性失血量为645m(l77.5%);应用PFNA 38例,总失血量平均为210 ml,其中显性失血量为123 m(l58.5%),隐性失血量为87 m(l41.4%);应用InterTan 27例,总失血量平均为1054 ml,其中显性失血量为153m(l14.5%),隐性失血量为901 m(l85.5%)。结论:股骨转子间骨折患者常存在严重的隐性失血,极易引起术后贫血,需严密监控患者的失血量。髓外和髓内固定方法的出血量基本一致,髓内固定方法具有更强的力学稳定性,髓内固定物PFNA的操作简单,出血量相对较少,可作为治疗股骨转子间骨折的首选方法。

Background： Minimally invasive treatment for femoral intertrochanteric fractures is popular in clinic. However, there are few researches on the hidden blood loss during surgery. Objective： To evaluate external and hidden blood loss and to identify the influential factor of hidden blood loss in femoral intertrochanteric fracture treated with extramedullary （DHS） or intramedullary fixation （PFNA and InterTan）. Methods： We retrospectively studied 89 cases of femoral intertrochanteric fractures treated with DHS, PFNA or InterTan from January 2010 to December 2011. The collected information included age, gender, body height, body weight, intraoperative and postoprerative external blood loss, and preoperative and postoperative hemoglobin and hematocrit. The total blood loss and hidden blood loss was calculated by Gross formula. Results： The mean total blood loss was 832 ml in 24 patients treated with DHS; external blood loss and hidden blood loss was 187 ml （22.5%） and 645 ml （77.5%）, respectively. The mean total blood loss was 210 ml in 38 patients treated with PFNA; external blood loss and hidden blood loss was 123 ml （58.5%） and 87 ml （41.4%）, respectively. The mean total blood loss was 1054 ml in 27 patients treated with InterTan; external blood loss and hidden blood loss was 153 ml （14.5%） and 901 ml （85.5%）, respectively, Conclusions： Patients with femoral intertrochanteric fractures suffer heavy hidden blood loss, which may result in postopera- tive anemia. There is no significant difference in the total blood loss between extramedullary and intramedullary fixation. But intramedullary fixation is more stable than extramedullary one. So PFNA can be the first choice for femoral intertro- chanteric fractures due to simple procedure and less blood loss.