成年股骨干骨折患者术前贫血的临床特征及其危险因素分析

Clinical characteristics and risk factors for preoperative anemia in patients with adult femoral shaft fracture

目的探讨成年股骨干骨折患者术前贫血的临床特征及其危险因素。方法回顾性分析2018年6月至2022年6月于南京大学医学院附属鼓楼医院骨科收治的157例成年股骨干骨折患者的临床资料,男106例、女51例,年龄(45.06±14.32)岁(范围18~65岁)。根据入院后2 d内检测的血红蛋白(hemoglobin,Hb)水平,男性(成人)Hb<120 g/L,女性(成人)Hb<110 g/L为贫血,将患者分为贫血组与无贫血组。收集两组患者的一般情况、骨折AO分型和临床特征、实验室检查结果等,采用单因素分析及多因素logistic回归分析术前贫血及其程度的危险因素。结果157例成年股骨干骨折患者中118例(75.2%)存在术前贫血(贫血组),男75例、女43例,年龄(45.84±14.23)岁(范围18~65岁);骨折AO分型:32A型41例、32B型19例、32C型58例;骨折部位:股骨干上1/3骨折14例、中1/3骨折67例、下1/3骨折37例;致伤原因:交通伤63例、砸伤5例、摔伤40例、坠落伤10例,合并多发伤65例。39例(24.8%)术前无贫血(无贫血组),男31例、女8例,年龄(42.72±14.51)岁(范围19~65岁);骨折AO分型:32A型24例、32B型5例、32C型10例;骨折部位:股骨干上1/3骨折3例、中1/3骨折19例、下1/3骨折17例;致伤原因:交通伤13例、砸伤5例、摔伤20例、坠落伤1例,合并多发伤8例。单因素分析结果显示成年股骨干骨折患者术前贫血组与无贫血组患者的骨折AO分型、致伤机制、合并多发伤、受伤至入院时间<48 h、白蛋白水平及年龄的差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示骨折AO分型C型(OR=3.12,P=0.020)、砸伤(OR=0.13,P=0.021)、白蛋白水平降低(OR=9.90,P=0.037)和合并多发伤(OR=3.65,P=0.016)是术前贫血的危险因素;合并多发伤(OR=5.20,P=0.004)和白蛋白水平降低(OR=5.47,P=0.001)是术前贫血程度的危险因素。结论致伤机制为砸伤、白蛋白水平降低、骨折AO分型C型和合并多发伤对术前贫血产生影响,其中合并多发伤和白蛋白水平降低会加重贫血程度。对砸伤、合并多发伤、低白蛋白血症和骨折AO分型C型的成年股骨干骨折患者需要关注术前贫血的存在。

Objective To investigate the clinical characteristics and predisposing factors associated with preoperative anemia in adult femoral shaft fractures.Methods A retrospective analysis of clinical data from 157 patients presenting with femoral shaft fractures admitted to the department of orthopedics at Nanjing Drum Tower Hospital between June 2018 and June 2022 was conducted.The study cohort comprised 106 males and 51 females,with an average age of 45.06±14.32 years(range:18-65 years).Based on hemoglobin levels measured within 2 days of admission,patients were stratified into two groups:anemia group(Hb<120 g/L in adult males and Hb<110 g/L in adult females)and non-anemia group.General demographic information,AO fracture types,and clinical characteristics,as well as the results of laboratory examinations for both groups were collected.Subsequently,univariate and multivariate logistic regression analyses were conducted.Results Out of the 157 patients with femoral shaft fractures,118(75.2%)exhibited preoperative anemia(the anemia group).Among them,75 cases were male,and 43 cases were female,with an average age of 45.84±14.23 years(range:18-65 years).In terms of fracture AO type,41 cases were classified as 32A,19 as 32B,and 58 as 32C.Regarding fracture location,14 were situated in the upper 1/3 of the femoral shaft,67 in the middle 1/3,and 37 in the lower 1/3.The causes of injury included 63 cases of motor vehicle accidents,5 cases of blunt trauma,40 cases of falls,and 10 cases of other falls,with 65 cases involving multiple injuries.Conversely,39 patients(24.8%)did not exhibit preoperative anemia(the non-anemia group).Of these,31 were male,and 8 were female,with an average age of 42.72±14.51 years(range:19-65 years).In terms of fracture AO type,24 cases were classified as 32A,5 as 32B,and 10 as 32C.Regarding fracture location,3 were situated in the upper 1/3 of the femoral shaft,19 in the middle 1/3,and 17 in the lower 1/3.The causes of injury included 13 cases of motor vehicle accidents,5 cases of blunt trauma,20 cases of falls,and 1 other fall,with 8 cases involving multiple injuries.Univariate analysis revealed statistically significant differences between preoperative anemia and AO fracture type,mechanism of injury,multiple injuries,time from injury to hospital admission,albumin levels,and age(P<0.05).Multifactorial logistic regression analysis identified AO type 32C(OR=3.12,P=0.020),blunt trauma injuries(OR=0.13,P=0.021),reduced albumin levels(OR=9.90,P=0.037),and multiple injuries(OR=3.65,P=0.016)as risk factors for preoperative anemia.Multifactorial logistic regression further revealed that multiple injuries(OR=5.20,P=0.004)and reduced albumin levels(OR=5.47,P=0.001)were risk factors for the severity of anemia.Conclusion AO type 32C fractures,blunt trauma injuries,reduced albumin levels,and multiple injuries were identified as potential contributors to the development of preoperative anemia,with multiple injuries and reduced albumin levels exacerbating the severity of anemia.Clinicians should be vigilant for the occurrence of preoperative anemia in adult femoral shaft fracture patients,particularly those with blunt trauma injuries,multiple injuries,hypoalbuminemia,and AO type 32C fractures.