PFNA治疗老年股骨转子间骨折的隐性失血分析

The hidden blood loss in proximal femoral nail antirotation(PFNA) used for treatment of intertrochanteric fractures in the elderly

[目的]分析股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折围手术期隐性失血及相关影响因素。[方法]回顾性分析2014年3月~2017年2月,本院采用PFNA内固定治疗老年股骨转子间骨折患者115例。记录术前,术后1、3、5 d的血常规及术中、术后出血量,使用Gross方程计算隐性失血量,应用方差分析对不同阶段的隐性失血量进行比较(以P<0.05为标准)。对性别、年龄、BMI、骨折分型、骨质疏松、糖尿病、高血压、术前抗凝、伤后手术延迟时间、手术持续时间进行独立样本t检验的单因素分析。采用多元线性回归分析筛选相关危险因素。[结果]115例患者的平均总失血量为(922.51±202.47)ml,其中平均显性失血为(85.16±14.18)ml,占总失血量的9.21%,平均隐性失血为(847.45±151.32)ml,占总失血量的90.79%。术后1 d隐性失血量与第2~3 d隐性失血量差异无统计学意义,但二者与第4~5 d隐性失血量比较,差异有统计学意义。近端+远端扩髓较单纯近端扩髓,其显性失血量与隐性失血量均增加,差异具有统计学意义(P<0.05)。单因素及多元线性回归分析均显示,年龄、骨折分型、糖尿病、高血压、术前抗凝、伤后手术延迟时间是影响PFNA内固定术后隐性失血量的危险因素(P<0.05)。[结论]PFNA治疗老年股骨转子间骨折术后以隐性失血为主,主要发生在术后前3 d,与年龄、骨折分型、糖尿病、高血压、术前抗凝、伤后手术延迟时间及扩髓方式等因素密切相关。

[Objective] To analyze the perioperative hidden blood loss and related factors in proximal femoral nail antirota- tion （PFNA） used for treatment of intertrochanteric fractures in the elderly. [Methods] From March 2014 to February 2017, 115 patients with intertroehanteric fractures were surgically treated with PFNA in our hospital. Based on routine blood tests checked before surgery, 1 d, 3 d and 5 d after operation, as well as intraoperative and postoperative bleeding, the hidden blood loss was calculated by the Gross formulation, which was compared among different early days postoperatively by variance analysis. One way analysis was conducted by independent sample t test for gender, age, BMI, fracture classification, osteoporosis, diabetes mellitus, hypertension, preoperative anticoagulation, delayed operation after injury, and duration of surgery. Multiple linear re- gression analysis was used to screen the related risk factors. [Results] Of the 115 patients, the total blood loss was （922.51 ± 202.47） ml on average, including the observable blood loss of （85.16 ± 14.18） ml accounting for 9.21% of total blood loss and the hidden blood loss of （847.45± 151.32） ml accounting for 90.79% of total blood loss. The hidden blood loss not varied significant- ly from 1 to 3 days,but its accounting for the total blood loss were significant decreased from 4 to 5 days. Proximal combined with distal reaming increased both the observable blood loss and hidden blood loss compared with proximal reaming only, and the difference was statistically significant （P〈0.05）. One-way and multivariate linear regression analysis showed that age, diabe- tes, hypertension, type, preoperative anticoagulation and surgical delay time after injury were the risk factors of hidden blood loss in PFNA internal fixation （P〈0.05）. [Conclusion] The hidden blood loss is the major part of total blood loss in PFNA treat-ing intertrochanteric fractures in the elderly, especially in the first 3 days, which is closely related with age, fracture type, diabetes, hypertension, preoperative anticoagulation af- ter injury, surgery time delay and reaming method and other factors.