髓内、外内固定方式治疗高龄股骨粗隆间骨折患者失血量及相关因素分析

Extramedullary and intramedullary fixation for femoral intertrochanteric fracture in old patients

目的分析高龄股骨粗隆间骨折运用髓内髓外固定方式治疗时的失血量差异并探讨相关因素的影响。方法回顾性分析自2011-01—2015-01诊治的157例高龄股骨粗隆间骨折,患者分别采用股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)内固定治疗,分析2组显性失血量、隐性失血量及总失血量的差异,以及年龄、性别和体重指数对2种术式中隐性失血量的影响。建立隐性失血量与术后第3天血红蛋白之间的线性方程式。结果 PFNA组显性出血量(140.3±31.6)ml,隐性出血量(409.7±191.3)ml,总出血量(550.0±192.5)ml,DHS组显性出血量(174.3±39.0)ml,隐性出血量(295.0±134.3)ml,总出血量(469.3±144.1)ml,2组显性失血量(t=6.01,P<0.001)、隐性失血量(t=-4.33,P<0.001)、总失血量(t=-2.96,P=0.036)比较差异有统计学意义。PFNA组中高龄组与超高龄组中隐性出血量比较差异有统计学意义(P<0.05);性别(F=0.97,P=0.326)与BMI(F=0.00,P=0.976)对2组的隐性出血量差异无统计学意义。手术方案、术后3 d Hb及隐性出血量三者之间呈线性关系。结论髓内固定方式治疗高龄股骨粗隆间骨折的隐性出血量显著大于髓外固定方式,但显性出血量相反;年龄是影响隐性出血量的因素;隐性失血量与术后血红蛋白水平呈负相关。

Objective To analyze the difference in the blood loss between the intramedullary and extramedullary internal fixation for femoral intertrochanteric fracture in old patients and investigate the influential factors. Methods A total of 157 old patients with femoral intertrochanteric fracture treated with intramedullary and extramedullary internal fixations from January 2011 to January 2015 were analyzed retrospectively and the difference of the obvious, hidden and total blood loss and the association with the age, gendre and BMI in the two internal fixation groups were compared. The linear equation of the hidden blood loss and hemoglobin on the third postoperative day was established. Results In PFNA group the mean obvious blood loss was （140.3±31.6）ml, hidden blood loss （409.7± 191.3）ml and total blood loss （550.0±192.5）ml, while in D HS group the mean obvious blood loss was （174.3±39.0）ml, hidden blood loss（295.0±134.3）ml and total blood loss （469.3±144.1）ml. The obvious blood loss （t =6.01, P 〈0.001 ）, hidden blood loss （t =-4.33, P =-2.96） and total blood loss （t =-2.96, P =0.036） between the two groups were different significantly. A significant difference（P 〈0.05） with age influenced the hidden blood loss in PFNA group; Gendre （F =0.97, P =0.326） and BMI （F =0.00, P =0.976） did not influence on hidden blood loss. A significant association existed among hidden hemorrhage, day 3 hemoglobin and internal fixation method. Conclusion The hidden blood loss of the intramedullary fixation for femoral intertrochanteric fracture in old patients is significantly more than extramedullary fixation, but obvious blood loss is contrary; age influences the hidden blood loss in old patients. There is negative correlation between hidden blood loss and post-operative hemoglobin.