股骨近端防旋髓内钉内固定治疗老年股骨粗隆间骨折患者围手术期隐性失血的相关影响因素

Related Influencing Factors of Perioperative Latent Blood Loss in Elderly Patients with Intertrochanteric Femoral Fracture Treated with Internal Fixation of Proximal Femoral Nail Antirotation

目的探讨股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨粗隆间骨折患者围手术期隐性失血的相关影响因素。方法回顾性分析2019年6月至2021年6月医院收治的82例老年股骨粗隆间骨折患者的临床资料,所有患者均接受PFNA治疗。根据围手术期是否发生隐性失血分为发生组(18例)与未发生组(64例),采用单因素及多因素Logistic回归分析法分析PFNA治疗老年股骨粗隆间骨折患者围手术期隐性失血的相关影响因素。结果82例接受PFNA治疗的患者中,围手术期隐性失血的发生率为21.95%(18/82)。单因素分析结果显示,年龄≥75岁、手术时间≥60 min、合并基础疾病、术前使用抗凝药物与PFNA治疗老年股骨粗隆间骨折患者围手术期隐性失血有关(P<0.05);性别、体质量、是否输血与围手术期隐性失血无关(P>0.05)。多因素Logistic回归分析结果显示,年龄≥75岁、手术时间≥60 min、合并基础疾病及术前使用抗凝药物均为PFNA治疗老年股骨粗隆间骨折患者围手术期隐性失血的独立危险因素(OR≥1,P<0.05)。结论年龄≥75岁、手术时间≥60 min、合并基础疾病、术前使用抗凝药物是导致围手术期隐性失血发生的独立危险因素,临床需予以高度重视。

Objective To explore the relevant influencing factors of perioperative latent blood loss in elderly patients with intertrochanteric femoral fracture treated with internal fixation of proximal femoral nail antirotation(PFNA).Methods With the retrospective analysis of clinical data of 82 elderly patients with intertrochanteric femoral fracture admitted to the hospital from June 2019 to June 2021,all patients received PFNA treatment.According to whether there was latent blood loss during the perioperative period,the patients were divided into the occurrence group(18 cases)and the non-occurrence group(64 cases).The univariate and multivariate Logistic regression analysis were used to analyze the related influencing factors of perioperative latent blood loss in elderly patients with intertrochanteric femoral fracture treated with PFNA.Results The incidence of latent blood loss during the perioperative period was 21.95%(18/82)among 82 patients receiving PFNA treatment.The results of univariate analysis showed that age≥75 years,surgery time≥60 minutes,comorbidities with underlying diseases,and preoperative use of anticoagulants were associated with perioperative latent blood loss in elderly patients with intertrochanteric femoral fractures treated with PFNA(P<0.05);Gender,body weight and blood transfusion were not associated with perioperative latent blood loss(P>0.05).The results of multivariate Logistic regression analysis showed that age≥75 years,surgery time≥60 minutes,comorbidities with underlying diseases,and preoperative use of anticoagulants were all independent risk factors for perioperative latent blood loss in elderly patients with intertrochanteric femoral fractures treated with PFNA(OR≥1,P<0.05).Conclusion Age≥75 years old,operation time≥60 min,combined with underlying diseases and preoperative use of anticoagulant drugs are independent risk factors leading to perioperative latent blood loss,which should be paid close attention in clinical practice.