两种微创内固定治疗老年股骨转子间骨折失血量比较

Comparison of blood loss in the elderly intertrochanteric fractures treated with percutaneous compression plate and proximal femoral nail antirotation

目的比较经皮加压钢板(PCCP)与股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折围手术期显性及隐性失血量。方法对96例老年股骨转子间骨折患者分别行PCCP(46例)及PFNA(50例)固定,记录术中失血量、引流量、术前及术后血常规数值,通过Gross方程计算出两组患者隐性失血量,比较两者显性及隐性失血量差异。结果 PCCP组失血总量为(484.9±135.2)ml,其中显性失血量为(77.7±12.8)ml,隐性失血量为(407.4±126.1)ml;PFNA组失血总量为(699.7±185.9)ml,其中显性失血量为(77.6±10.5)ml,隐性失血量为(622.1±177.7)ml,两组患者显性失血量差异无统计学意义(P>0.05),隐性失血量差异有统计学意义(P<0.001)。两种微创内固定方式术后隐性失血量均超过显性失血量的5倍以上。结论 PCCP和PFNA虽然都是微创内固定方式,但术后均存在严重的隐性失血,容易引起患者贫血。PCCP内固定较PFNA内固定的隐性失血量要少,是治疗老年股骨转子间骨折相对理想的方法。

Objective To compare the obvious and hidden blood loss in the elderly intertrochanteric fractures treated with percutaneous compression plate（ PCCP） and proximal femoral nail antirotation（ PFNA） . Methods 96 cases of elderly intertrochanteric fractures were treated with PCCP （46 cases） and PFNA （50 cases） respectively,the periop-erative blood loss and postoperative drainage, preoperative and postoperative blood routine were analyzed, the hidden blood in both groups were calculated by Gross equation, and the difference between two sets of the obvious and hidden blood loss was compared. Results The PCCP group：The total blood loss was （484. 9 ± 135. 2）ml, including（77. 7 ± 12. 8）ml obvious blood loss and（407. 4 ± 126. 1）ml hidden blood loss;The PFNA group：The total blood loss was （699. 7 ±185. 9）ml, including（77. 6 ±10. 5）ml obvious blood loss and （622. 1 ±177. 7）ml hidden blood loss, no difference was found at obvious blood loss （P〉0. 05）, and the difference of hidden blood loss was significant （P〈0. 001）. The hidden blood loss of two types of minimally invasive internal fixation surgery were more than 5 times greater than obvious blood loss. Conclusions Although PCCP and PFNA are minimally invasive internal fixation methods, there are still serious hidden blood loss during perioperative operation, and much attention should be paid to the patients after surgery for prevention of the complications. There is less hidden blood loss in PCCP than PFNA, so PCCP is an ideal choice of treatment in treating intertrochanteric fracture in the elderly patients.