老年人股骨粗隆间骨折Inter Tan术后隐性失血影响因素分析及其与预后的相关性

Risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and its correlation with the prognosis of patients

目的探讨老年股骨粗隆间骨折患者Inter Tan术后隐性失血的危险因素,以及隐性失血与患者预后的相关性。方法回顾性病例对照研究。纳入2018年12月—2022年1月中国中医科学院西苑医院创伤骨科股骨粗隆间骨折患者65例,其中男34例、女31例,年龄60~87(69±5)岁,均采用Inter Tan手术治疗。采集患者临床病理资料,计算患者术后隐性、显性及实际失血量,并采用单因素分析和多元线性回归分析隐性失血的危险因素。以全组患者隐性失血量的均值为界,将患者分为2组,≥均值28例入高隐组,<均值37例入低隐组。比较两组患者骨折愈合时间和术后Harris髋关节功能评分。采用Pearson相关分析隐性失血量与骨折愈合时间和术后Harris髋关节功能评分的相关性。结果65例老年股骨粗隆间骨折患者Inter Tan术后实际失血量为(803.5±126.9)mL,其中显性失血量为(104.8±23.8)mL、占13%,隐性失血量为(698.3±113.6)mL、占87%。多元线性回归分析显示,年龄≥75岁、饮酒史、骨折至手术时间≥3 d和手术时间≥60 min为老年股骨粗隆间骨折患者Inter Tan术后隐性失血独立影响因素(标准化回归系数分别为0.128、0.167、0.113和0.109,P值均<0.05)。28例高隐组骨折愈合时间为(12.5±2.3)周,长于37例低隐组的(10.3±2.7)周,差异有统计学意义(t=3.16,P=0.003)。高隐组和低隐组患者术后3、6、12个月Harris评分均较术前升高,差异均有统计学意义(F=112.35、160.72,P值均<0.001);患者术前Harris评分2组间比较差异无统计学意义(t=0.68,P=0.502),高隐组术后3、6和12个月Harris评分均低于低隐组、差异均有统计学意义(t=2.13、2.16、2.31,P值均<0.05)。Pearson相关分析结果显示,隐性失血量与骨折愈合时间呈正相关性,与术后12个月髋关节功能Harris评分呈负相关性,差异均有统计学意义(r=0.412、-0.301,P值均<0.05)。结论隐性失血是老年股骨粗隆间骨折患者Inter Tan围术期失血的主要原因,其影响因素包括患者年龄、饮酒史、骨折至手术时间和手术时间,且与术后骨折愈合时间和Harris髋关节功能评分相关。

Objective This study aims to explore the risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and influence of hidden blood loss on the prognosis of patients.Methods In this retrospective case-control study,65 patients with femoral intertrochanteric fractures were enrolled from the Department of Orthopedic Trauma of Xiyuan Hospital,China Academy of Chinese Medical Sciences from December 2018 to January 2022.The study participants consisted of 34 males and 31 females,with age of 60-87(69±5)years old.All patients were treated with Inter Tan surgery.The clinicopathological data were collected,and the hidden,dominant,and actual blood loss volumes after surgery were calculated.The risk factors of the hidden blood loss were analyzed by univariate analysis and multivariate linear regression analysis.The patients were grouped according to the hidden blood loss volume.The cases with hidden blood loss volume greater than or equal to the mean value were included in the high-hidden group(28 cases).Meanwhile,the cases with less than the mean value were enrolled as the low-hidden group(37 cases).The fracture healing time and postoperative Harris hip function score were compared between the two groups.The correlation of hidden blood loss volume with fracture healing time and postoperative Harris hip function score was analyzed by Pearson product-moment coefficient.Results The actual blood loss volume of 65 elderly patients with femoral intertrochanteric fractures after Inter Tan surgery was(803.5±126.9)mL,the dominant blood loss volume was(104.8±23.8)mL(13%),and the hidden blood loss volume was(698.3±113.6)mL(87%).Multivariate linear regression analysis revealed that age≥75 years old,drinking history,time from fracture to surgery≥3 d,and surgical time≥60 min were the independent influencing factors of the hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery(standardized regression coefficientβ=0.128,0.167,0.113,and 0.109,all P values<0.05).The fracture healing time in the high-hidden group(n=28)was(12.5±2.3)weeks,which was longer than(10.3±2.7)weeks of the low-hidden group(n=37),and the difference was statistically significant(t=3.16,P=0.003).The Harris scores in the high-hidden and low-hidden groups after surgery were significantly enhanced compared with that before surgery,and the differences were statistically significant(F=112.35 and 160.72,all P values<0.001).No statistically significant difference in the preoperative Harris score was observed between the two groups(t=0.68,P=0.502).The Harris scores in the high-hidden group at 3,6,and 12 months after surgery were lower than those in the low-hidden group(t=2.13,2.16,and 2.31,all P values=0.502).The hidden blood loss volume was positively correlated with fracture healing time and negatively correlated with Harris hip function score at 12 months after surgery(t=0.412 and-0.301,all P values<0.05).Conclusion Hidden blood loss is the main cause of perioperative blood loss in elderly patients with femoral intertrochanteric fractures undergoing Inter Tan surgery.The influencing factors of this condition include age,drinking history,time from fracture to surgery,and surgical time.Hidden blood loss is also associated with postoperative fracture healing time and Harris hip function score.