两种内固定方式治疗老年稳定型股骨粗隆间骨折显性及隐性失血分析

Analysis of The Dominant and Recessive Hemorrhage in Stabilizing Femoral Intertrochanteric Frac-tures in Elder Patients Treated with two Type Internal Fixations

【目的】探讨动力髋螺钉（DHS）及股骨近端防旋髓内钉（PFNA）治疗老年（≥65岁）稳定型股骨粗隆间骨折显性及隐性失血特点。【方法】选取本院2010年1月至2014年1月收治的老年稳定型股骨粗隆间骨折患者134例，分别采用 DHS 及 PFNA 方式进行手术治疗。通过 Gross 方程，依据患者身高、身体质量、术前及术后血常规检测计算患者的围手术期失血量。Logistic 回归分析影响老年稳定型股骨粗隆间骨折隐性失血的危险因素。【结果】DHS 组平均手术时间[（77.23±26.33）min]明显长于 PFNA 组[（61.05±19.29）min]；显性失血量[（141.53±79.51）]mL 明显多余 PFNA 组[（97.05±86.19）]；而隐性失血量[（387.67±311.05）mL]和总失血量[（529.20±442.24）mL]均明显少于 PFNA 组[（655.71±492.90）和（752.76±597.69）]，差异均有统计学意义（P＜0.05）。DHS 组骨折或 PFNA 组骨折4个分型间隐性失血量比较均无明显差异（P ＞0.05）。DHS 组各分型隐性失血量均明显低于 PFNA 组，差异具有统计学意义（P ＜0.05）。Logistic 回归分析表明，年龄、手术时间及内固定方式均为老年稳定型股骨粗隆间骨折隐性失血的独立危险因。【结论】对于大于75岁的稳定型股骨粗隆间骨折患者宜选择 DHS 手术方式，并加强术后护理及监护，尽量缩短手术时间，可有效避免大量失血引发的术后并发症。

[Objective]To analyze the dominant and recessive blood loss in stabilizing femoral intertrochanteric frac-tures in elder patients treated with two types of internal fixations （DHS versus PFNA）.[Methods]A total of 134 elder pa-tients with stabilizing femoral intertrochanteric fractures treated with DHS or PFNA were selected from our hospital from January 2010 to January 2014.The total perioperative blood loss was conculated by Gross equation based on patients＆#39; heights,weights,and pre-and postoperative complete blood counts.The risk factors that impact the recessive hemorrhage in elder patients with stabilizing femoral intertrochanteric fractures were analyzed.[Results]The average operation time （77.23±26.3 minutes）of DHS group was significantly longer than that （61.05 ±19.29 minutes）of PFNA group;the dominant hemorrhage of DHS group （141.53±79.51 mL）was markedly more than that of PFNA group （97.05±86.19 mL）;the recessive blood loss（387.67±311.05）mL and total amount hemorrhage（529.20±442.24 mL）of DHS group were statistically significant less than those （655.71±492.90 mL and 752.76±597.69 mL,respectively）of PFNA group （P 〈0.05）.There is no statistically significance of the recessive blood loss among the 4 subtypes in both DHS and PF-NA groups （P 〉0.05）;However,the recessive blood loss in each subtype of DHS group was significantly less than that of each corresponding subtype of PFNA group （P 〈0.05）.Age,operation time,and internal fixation methods were the independent risk factors that resulted in recessive hemorrhage in stabilizing femoral intertrochanteric fractures in elder pa-tients.[Conclusion]The complications caused by massive hemorrhage in patients older than 75 years who had stabilizing femoral intertrochanteric fractures,if DHS is used for internal fixation with shortening the operation time and intensifying postoperative cares.