PFNA Ⅱ在不同平面的匹配度对于围手术期失血量的影响

Effects of PFNA Ⅱ on blood loss during perioperative period regarding different matching levels

目的探讨股骨粗隆间骨折使用亚洲型股骨近端防旋髓内钉(PFNA Ⅱ),不同平面的髓腔与髓内钉直径的比值(匹配度)对于围手术期的隐性失血,显性失血以及总失血量的影响。方法回顾性分析我院2015年1月到2016年11月收治的因股骨粗隆间骨折行闭合复位PFNA Ⅱ内固定的70位患者,统计其年龄,性别,身高,骨折类型,术前及术后的红细胞比积,术中显性失血量,根据CROSS方程计算出的总失血量和隐性失血量。根据术后X线片,分别测量正侧位的髓内钉漏斗起始部,漏斗终止部以及股骨干峡部三个平面的髓腔与髓内钉直径的比值,每个平面正侧位片比值的均值记为R。对每个平面,按R值大小分为高匹配组(R小于中位数)和低匹配度组(R大于等于中位数),两组间分别比较总失血量,隐性失血量和显性失血量。将隐性失血作为因变量,将年龄,性别,骨折类型,R值作为自变量进行多元线性回归分析。结果在三个平 面中,高匹配度组的隐性失血量及总失血量均较低匹配度组少,差异有统计学意义(P<0.05),而显性失血均无显著差异。多元线性回归分析表明,所有自变量中仅髓内钉漏斗起始部和漏斗终止部平面的R值与隐性失血量呈相关性(P<0.05)。结论亚洲型股骨近端防旋髓内钉的漏斗部的匹配度越高,隐性失血量及总失血量越少。

Objective To investigate the effect of the ratios of marrow cavity diameter and intramedullary nail diameter from different layers on hidden blood loss,overt blood loss and total blood loss in the perioperative period during using PFNAⅡfor femoral intertrochanteric fracture.Methods We retrospectively studied70patients treated in our hospital from Jan2015to Nov2016.Their age,gender,height,fracture type,preoperative and postoperative HTC,and overt blood loss during operation were analyzed.Total blood loss and hidden blood loss were calculated using CROSS equation.According to post-operative X-ray results,the ratios of marrow cavity diameter and intramedullary nail diameter from different layers,start of funnel,end of funnel and femoral isthmus,were measured,the mean of the ratio from frontal and lateral X-ray were designated as R.We classified the data into a high matching group(R is less than the median)and a low matching group(R is greater than or equal to the median)within each layer,and compared total blood loss,hidden blood loss and overt blood loss between the two groups.Hidden blood loss,as dependent variable,and age,fracture type and R,as independent variables were analyzed by using multiple linear regression.Results The hidden blood loss and total blood loss in the high matching group were significantly less than that in the low matching group on three layers(P<0.05),however,there was no significant difference of overt blood loss.Only R values from start of funnel and end of funnel were correlated to hidden blood loss(P<0.05).Conclusion The higher matching rate of PFNAⅡat the funnel is,the less hidden blood loss and total blood loss will be.