PFNA治疗股骨粗隆间骨折围手术期隐性失血的分析

Analysis of the perioperative occult blood loss of PFNA in the treatment of intertrochanteric fracture

目的探讨抗旋髓内钉(PFNA)治疗股骨粗隆间骨折围手术期的隐性失血现象。方法收集我院2014年1月至2017年6月收治的83例股骨粗隆间骨折患者,患者均在硬膜外麻醉后采用PFNA内固定术治疗,观察患者隐性失血情况。结果围手术期患者的平均总失血量为(885.28±62.09)mL;其中,隐性失血量为(702.67±51.38)mL,显性失血量为(180.48±17.94)mL;隐性失血量多于显性失血量,差异具有统计学意义(P<0.05);男女间隐性失血量间差异无统计学意义(P>0.05)。合并基础性疾病患者的围手术期隐性失血量多于未合并基础性疾病患者,高龄患者的围手术期隐性失血量多于非高龄疾病患者,骨折分型中31-A2型隐性失血量高于31-A1型,差异具有统计学意义(P<0.05)。结论股骨粗隆间骨折患者采用PFNA治疗的围手术期患者的失血主要表现为隐性失血,且患者的年龄越高、31-A2型骨折、合并基础性疾病则隐性失血量越大。

Objective To investigate the perioperative occult blood loss of proximal femoral nail anti-rotation （PFNA） in the treatment of intertrochanteric fracture. Methods A total of 83 patients with intertrochanteric fracture admitted in our hospital from January 2014 to June 2017 were collected. All patients were treated with PFNA internal fixation af- ter epidural anesthesia, and the occult blood loss was observed. Results The mean total blood loss during periopera- tive period was （885.28±62.09） mL. The occult blood loss was （702.67±51.38） mL, and the dominant blood loss was （180.48±17.94） mL. The occult blood loss was more than the dominant blood loss, and the difference was statistically significant （P〈0.05）. There was no significant difference in occult blood loss between men and women （P〉0.05）. The perioperative occult blood loss in patients with underlying diseases was more than that in patients without underlying diseases, the perioperative occult blood loss in aged patients was more than that in younger patients, the occult blood loss of 31-A2 in fracture fractal was more than that of 31-A1, and the difference was statistically significant （P〈 0.05）. Conclusion The perioperative blood loss of patients with intertrochanteric fracture treated with PFNA is mainly occult blood loss. The higher the patients＇ age, 31-A2 fracture, the more the underlying diseases, the greater the amount of occult blood loss.