老年股骨转子间骨折围修复期隐性失血量与内固定植入物及性别的关系

Relationship of hidden blood loss,implants and sex during the perioperative treatment of elderly intertrochanteric fracture

背景:随着修复技术的不断更新和发展,股骨转子间骨折修复术中的失血量已经显著减少,但无论是哪种修复方式围修复期仍存在着较大量的隐性失血,而对于该方面的原因及相关因素临床上鲜有报道。目的:探讨老年股骨转子间骨折围修复期隐性失血量与患者性别及内固定方式之间的相关性。方法:2010年3月至2013年6月南阳市中心医院骨科收治121例老年股骨转子间骨折患者,根据患者病情及治疗意愿分为两组,分别采用动力髋螺钉和股骨近端防旋髓内钉内固定治疗。比较两组患者的治疗前隐性失血量、治疗后隐性失血量、总隐性失血量、显性失血量及总失血量,并对围修复期隐性失血量与患者性别、内固定方式进行多元线性回归分析。结果与结论:两组患者的治疗前隐性失血量差异无显著性意义(P>0.05);股骨近端防旋髓内钉组患者的总失血量、治疗后隐性失血量及总隐性失血量均明显高于动力髋螺钉组(P<0.05),而显性失血量明显低于动力髋螺钉组(P<0.05)。治疗前、治疗后隐性失血量及总隐性失血量男性均显著低于女性,差异有显著性意义(P<0.05)。多元线性回归分析可知,性别、内固定方式与隐性失血呈相关性(P<0.05)。提示老年股骨转子间骨折围修复期隐性失血量与患者性别和内固定方式密切相关,男性患者围修复期隐性失血量明显少于女性患者,股骨近端防旋髓内钉固定患者围手术期隐性失血量高于动力髋螺钉固定。

BACKGROUND： With the continuous renewal and development of clinical repair techniques, the intraoperatie blood loss has been greatly reduced in the treatment of intertrochanteric fracture; however, no matter what kind of repair methods should be adopted, there are still a large amount of perioperative hidden blood loss, however, there are few clinical reports for the reasons and related factors. OBJECTIVE： To study the correlation of perioperative hidden blood loss with gender and internal fixation methods in the surgery of elderly femoral intertrochanteric fractures.METHODS： Totally 121 patients with elderly femoral intertrochanteric fractures who received the treatment at Department of Orthopedics, Nanyang City Center Hospital from March 2010 to June 2013 were divided into two groups according to the condition and treatment wishes of patients, and were respectively treated with dynamic hip screw and proximal femoral anti-rotation intramedullary nail internal fixation. The preoperative hidden blood loss, postoperative hidden blood loss, the total hidden blood loss, dominant blood loss and total blood loss of patients in these two groups were compared. The multiple linear regression analysis on the correlation of perioperative hidden blood loss with gender and internal fixation methods was conducted. RESULTS AND CONCLUSION： There was no significant difference in the preoperative hidden blood loss between these two groups（P〉0.05）. The total blood loss, postoperative hidden blood loss and total hidden blood loss in the proximal femoral anti-rotation intramedullary nail group were significantly higher than those in the dynamic hip screw group（P〈0.05）, and the dominant blood loss was significantly lower than that in the dynamic hip screw group（P〈0.05）. There were significant differences in the preoperative, postoperative hidden blood loss and total hidden blood loss between males and females（P〈0.05）, and above indexes in males were significantly lower than in females. The multiple linear regression analysis showed that gender and internal fixation methods were correlated with hidden blood loss（P〈0.05）. These results suggest that the perioperative hidden blood loss in surgery for elderly femoral intertrochanteric fractures is closely related to gender and above indexes in internal fixation methods. The perioperative hidden blood loss of male patients is less than that of female patients, and the patients treated with proximal femoral anti-rotation intramedullary nail fixation have more hidden blood loss than dynamic hip screw fixation.