两种手术方式治疗老年人不稳定型股骨粗隆间骨折失血量的比较

Comparison of blood loss between two operative methods for unstable femoral intertrochanteric fractures in the elderly

目的比较股骨近端防旋髓内钉（PFNA）内固定与人工股骨头置换治疗≥75岁的EvansⅢ、Ⅳ型股骨粗隆间骨折围术期显性及隐性失血量与总失血量，为手术方式的选择提供临床依据。方法回顾性分析我院自2009年1月至2014年9月收治的≥75岁老年人Ⅲ、Ⅳ型股骨粗隆间骨折61例，其中采用PFNA内固定33例，双极人工股骨头置换治疗28例，记录术中的显性失血量，通过Gross方程，根据身高、体重和手术前后的红细胞压积计算两组患者总的失血量和隐性失血量。结果术中平均显性失血量PFNA内固定组（106．2±53．8）ml明显少于人工关节置换组（274．6±80．3）ml（P〈0．05），围术期平均隐性失血量人工关节置换组（577．0±52．2）m1）少于PFNA内固定组（821．8±69．5）ml（P〈0．001），两组在围术期平均总失血量方面[（置换组（908．6±204）ml，PFNA组（896．0±227．5）ml]，两组比较差异无统计学意义（P〉0．05）。结论老年EvansⅢ、Ⅳ型股骨粗隆间骨折采用人工股骨头置换与PFNA术但围术期总失血量方面无明显差异，应根据老年患者的全身情况及骨折类型选择适宜的手术方式。

Objective To compare the recessive and dominant blood loss and total blood loss during the perioperative period between proximal femoral nail antirotation （PFNA） and artificial femoral head replacement in the treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures for providing clinical evidence on selection of operative methods. Methods A retrospective study was conducted to analyze 61 older hospitalized patients with EvansⅢ,Ⅳ type femoral intertrochanteric fractures in Jimo City Traditional Chinese Medical Hospital from January 2009 to September 2014. The PFNA was adopted in 33 cases and the artificial femoral head replacement in 28 cases. The dominant blood loss was recorded, and total blood loss and recessive blood loss in the two groups were calculated by Gross equation according to the dominant blood loss, body height, body weight and hematocrit of pre-and post-operation. Results The average dominant blood loss in the intraoperative period was much less in the PFNA fixation group （106.2 ± 53.8）ml than in the artificial femoral head replacement group （274.6±80.3）ml （P〈0.05）. The average recessive blood loss in the perioperative period was much less in artificial femoral head replacement group （577. 0± 52. 2）ml than in PFNA group （821.8±69. 5） ml （P〈0. 001）. The total blood loss during the perioperative period was not significantly different between proximal femoral nail antirotation （896.0±227. 5）ml and artificial femoral head replacement （908. 6±204）ml（P〈0. 05）. Conclusions There is obvious difference in the dominant blood loss between PFNA and artificial femoral head replacement for treatment of Evans Ⅲ,Ⅳ type femoral intertrochameric fractures in the elderly patients. The proper operative method should be chosen based on the general condition of the elderly and fracture types.