PFNA手术时机对老年股骨粗隆间骨折术后失血的影响分析

Effect of PFNA Operation Timing on Postoperative Blood Loss with Intertrochanteric Fracture of Femur in Elderly Patients

目的:探讨股骨近端防旋髓内钉(PFNA)手术时机对老年股骨粗隆间骨折(IFF)患者术后失血的影响。方法:回顾性分析佛山市第一人民医院2018年1月至2021年1月收治的54例老年IFF患者,按手术时机分为早期组(伤后1~2 d内手术)11例与延期组(伤后3~7 d手术)43例。记录两组患者入院时身高、体质量和年龄、入院至行手术治疗的间隔时间,手术用时;术前、术后1 d、术后3 d的红细胞比容(Hct)、血红蛋白(Hb)、红细胞计数(RBC)水平以及术后并发症发生情况。计算总红细胞丢失量、失血总量、术后Hct差,评估患者围手术期失血情况。结果:早期组患者的总红细胞丢失量、失血总量、术后Hct差均少于延期组,延期组手术时间长于早期组,差异具有统计学意义(P<0.05);延期组与早期组的并发症发生率比较,差异无统计学意义(P>0.05);按照患者受伤至手术的天数将其分为7组(1~7 d),经过Kruskal–Wallis检验,不同组别(1~7 d)失血总量之间的差异具有统计学意义(χ^(2)=13.512,P=0.036)。结论:老年IFF患者尽早手术治疗能减少术后失血量和术后并发症的发生率,并能更有效的促进髋关节功能的恢复。

Objective To investigate the effect of the timing of proximal femoral nail antirotation(PFNA)on postoperative blood loss in elderly patients with intertrochanteric fracture of femur(IFF).Methods A retrospective analysis was made of 54 elderly patients with intertrochanteric fracture of the femur admitted to Foshan First People's Hospital from January 2018 to January 2021.According to the time of operation,they were divided into 11 cases in the early group(operation within 1~2 days after injury)and 43 cases in the delayed group(operation within 3~7 days after injury).Record the height,weight and age of the two groups of patients at the time of admission,the time between injury and surgical treatment,and the operation time;The levels of hematocrit(Hct),hemoglobin(Hb)and erythrocyte count(RBC)before and 1 and 3 days after operation,as well as the occurrence of postoperative complications.The total red blood cell loss,total blood loss and postoperative Hct difference were calculated to evaluate the blood loss of patients during the perioperative period.Results The total red blood loss,total blood loss and postoperative Hct difference in the early group were lower than those in the delayed group,and the operation time in the delayed group was longer than that in the early group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the delayed group and the early group(P>0.05).According to the days from injury to operation,the patients were divided into 7 groups(1~7 days).Kruskal-Wallis test showed that the difference of total blood loss among different groups(1~7 days)was statistically significant(χ^(2)=13.512,P=0.036).Conclusion Early surgical treatment in elderly IFF patients can reduce postoperative blood loss and the incidence of postoperative complications,and promote the recovery of hip function more effectively.