隐性失血量对老年股骨转子间骨折术后临床疗效影响的分析

How much does hidden blood loss affect postoperative clinical effect in elderly femoral intertrochanteric fractures

[目的]探讨老年股骨转子间骨折围手术期隐性失血量对术后临床疗效的影响。[方法]回顾性分析2011年1月~2014年6月应用股骨近端锁定钢板内固定（PFLP）、动力髋螺钉（DHS）和股骨近端防旋髓内钉（PFNA）固定治疗的131例老年股骨转子间骨折患者资料,计算平均隐性失血量,依据内固定方式将患者分为三组：依据平均隐性失血量,将三组患者分别分为高隐性失血量组和低隐性失血量组,并分别比较患者下地负重时间、骨折愈合时间和髋关节功能评分。[方法]PFLP组内高隐性失血量组和低隐性失血量组的下床负重时间分别为（35.98±6.37）d、（35.58±4.46）d（P〉0.05）;骨折愈合时间分别为（18.32±3.36）周、（16.48±2.35）周,Harris髋关节功能评分分别为（83.88±4.35）分、（83.88±4.35）分（P〈0.05）;低隐性失血量组在患者术后骨折愈合时间及Harris评分方面均优于高隐性失血量组。DHS组内高隐性失血量组和低隐性失血量组下床负重时间分别为（35.41±5.21）d、（31.52±9.42）d,骨折愈合时间分别为（17.24±2.86）周、（15.30±1.45）周,Harris髋关节功能评分分别为（85.57±7.76）分、（92.82±6.82）分（P〈0.05）;低隐性失血量组在术后下床负重时间、骨折愈合时间及Harris评分方面均优于高隐性失血组。PFNA组内高隐性失血量组和低隐性失血量组下床负重时间分别为（34.11±8.01）d、（30.25±7.42）d,骨折愈合时间分别为（16.74±2.31）周、（13.62±1.96）周,Harris髋关节功能评分分别为（87.07±7.21）分、（93.02±7.14）分（P〈0.05）;低隐性失血量组在患者术后下床负重时间、骨折愈合时间及Harris评分方面均优于高隐性失血量组。[结论]隐性失血量影响老年股骨转子间骨折术后功能恢复;老年转子间骨折围手术期的低隐性失血量患者术后临床疗效优于高隐性失血量患者。

[Objective] To study the effect of hidden blood loss on the postoperative clinical effect of elderly femoral intertrochanteric fractures. [Method]A total of 131 patients with femoral intertrochanteric fractures undergoing internal fixation in our department from January 2011 to July 2013 were retrospectively analyzed. Patients were divided into PFLP group,DHS group and PFNA group according to the fixation methods. The average hidden blood loss were calculated. On the basis of the calculated results,all patients were divided into high hidden blood loss group and low hidden blood loss group,and the off- bed with load time,fracture healing time and hip function score were recorded and compared among groups. [Result]In PFLP group,the loaded time of the high hidden blood loss group and the low hidden blood loss group were（ 35. 98 ± 6. 37） and（ 35. 58 ± 4. 46）days respectively（ P〉0. 05）,with the fracture healing time（ 17. 24 ± 2. 86） and（ 15. 30 ± 1. 45） weeks（ P〈0. 05）,the Harris score（ 83. 88 ± 4. 35） and（ 83. 88 ± 4. 35）（ P〈0. 05）. In terms of the fracture healing time and Harris score,the low hidden blood loss group was superior to the high hidden group. In DHS group,the loaded time,fracture healing time and Harris score in the high hidden blood loss group and the low hidden blood loss group were（ 35. 41 ± 5. 21） days,（ 31. 52 ± 9. 42） days（ P〈0.05）,（ 17. 24 ± 2. 86） weeks,（ 15. 30 ± 1. 45） weeks（ P〈0. 05）,（ 85. 57 ± 7. 76）,（ 92. 82 ± 6. 82）（ P〈0. 05）,respectively. The indexes indicated that the low hidden blood loss group was superior to the high hidden group. In PFNA group,the loaded time,fracture healing time and the Harris score were of the high hidden blood loss group and the low hidden blood loss group were（ 34. 11 ± 8. 01） days,（ 30. 25 ± 7. 42） days（ P〈0. 05）（ 16. 74 ± 2. 31） weeks,（ 13. 62 ± 1. 96） weeks（ P〈0. 05）,（ 87. 07 ± 7. 21,（ 93. 02 ± 7. 14）（ P〈0. 05）. The low hidden blood loss group was superior to the high hidden group,too. All indicatiors showed that,when taking hidden blood loss into account,the high hidden blood loss group was inferior to the low hidden blood loss group. [Conclusion]In perioperative period,the hidden blood loss is the factor influencing clinical effect of elderly femoral intertrochanteric fractures,and the higher the amount of hidden blood loss is,the worse the clinical effect of the elderly patients will be.