不同骨折类型的老年股骨转子间骨折围术期隐性失血分析

Analysis on perioperative hidden blood loss in different fracture types of elderly intertrochanteric fracture

目的探讨Evans-Jensen分型与老年股骨转子间骨折围术期隐性失血的相关性。方法回顾性分析2009年5月至2013年8月246例老年股骨转子间骨折采用闭合复位股骨近端抗旋髓内钉(PFNA)内固定治疗患者的资料,骨折按Evans-Jensen分型,其中Ⅱ型40例,Ⅲ型93例,Ⅳ型69例,Ⅴ型44例。根据Gross方程计算隐性失血量,对以上4组隐性失血量进行相关分析。结果 4组隐性失血量分别为Ⅱ型(404±7.38)mL,Ⅲ型(425±3.93)mL,Ⅳ型(487±4.35)mL,Ⅴ型(535±5.96)mL;隐性失血量在总失血量中占的比例分别为Ⅱ型82.60%、Ⅲ型81.00%、Ⅳ型82.70%、Ⅳ型82.10%,Evans-JensenⅣ、Ⅴ型与Evans-JensenⅡ、Ⅲ型相比,隐性失血量差异有统计学意义(P<0.05)。结论应用PFNA治疗老年股骨转子间骨折,Evans-JensenⅣ、Ⅴ型相对于Ⅱ、Ⅲ型隐性失血量明显增加,应引起术者的重视。

Objective To investigate the correlation between the Evans-Jensen type with the perioperative hidden blood loss in elderly intertrochanteric fractures.Methods The clinical data in 246 cases of elderly intertrochanteric fractures treated by the closed reduction and proximal femoral nail anti-rotation（PFNA）internal fixation in our hospital from May 2009 to August 2013 were retrospectively analyzed,including 40 cases of typeⅡ,93 cases of type Ⅲ,93 cases of type Ⅳ and 69 cases of typeⅤ by the Evans-Jensen typing.The hidden blood loss amount was calculated by the Gross equation.The hidden blood loss amount in 4groups were performed the correlation analysis.Results The hidden blood loss amounts were（404±7.38）mL for the typeⅡ,（425±3.93）mL for the type Ⅲ,（487±4.35）mL for the type Ⅳ and（535±5.96）mL for the typeⅤ;the proportions of hidden blood loss amount to total blood loss amount were 82.60%for the typeⅡ,81.00% for the type Ⅲ,82.70% for the typeⅣ and 82.10% for the typeⅤ;the hidden blood loss amount had statistical differences between the Evans-Jensen type Ⅳ and Ⅴ with the Evans-Jensen typeⅡ and Ⅲ（P〈0.05）.Conclusion Applying the PFNA in the treatment of intertrochanteric fracture,the hidden blood loss in Evans-Jensen type Ⅳ and Ⅴis significantly increased compared with the type Ⅱand Ⅲ,which should cause the surgeon′s attention.