老年股骨转子间骨折髓内固定术中局部应用凝血酶对术后失血量的影响研究

Intraoperative local application of thrombin and postoperative blood loss in intramedullary fixation of femoral intertrochanteric fracture

目的:探讨股骨近端防旋髓内钉(PFNA)固定老年股骨转子间骨折术中局部应用凝血酶对术后失血量的影响。方法:回顾性分析2021年1月至2023年12月期间宁波一院龙山医院医疗健康集团骨科收治的50例股骨转子间骨折患者资料。根据内固定术中局部是否应用凝血酶分为两组:治疗组25例,男9例,女16例;年龄(76.5±10.1)岁;在完成PFNA置入后将6支凝血酶冻干粉溶于60 mL无菌生理盐水,于主钉切口内喷洒30 mL,螺旋刀片切口内喷洒20 mL,远端锁钉切口内喷洒10 mL。对照组25例,男11例,女14例;年龄(71.1±10.1)岁;在完成PFNA置入后用相同剂量的生理盐水冲洗伤口。比较两组患者术后第1、3、7天的血红蛋白(Hb)和红细胞比容(Hct),以及总失血量、隐性失血量、输血率、深静脉血栓形成(DVT)的发生情况等。结果:两组患者术前一般资料及手术时间比较差异均无统计学意义( P>0.05),具有可比性。治疗组患者术后第1、3、7天Hb分别为(101.48±12.15)、(102.96±12.76)、(107.24±13.47)g/L,Hct分别为(0.31±0.03)、(0.32±0.03)、(0.33±0.04),均显著高于对照组患者[(92.72±10.95)、(86.52±7.43)、(91.56±10.24)g/L,(0.28±0.03)、(0.26±0.03)、(0.27±0.03)],差异均有统计学意义( P<0.05)。治疗组患者术后总失血量为(364.60±134.27)mL,隐性失血量为(258.04±112.59)mL,均显著少于对照组患者[(481.72±218.69)、(355.84±176.97)mL],差异均有统计学意义( P<0.05)。治疗组和对照组术后分别有2、1例患者发生DVT,差异无统计学意义( P>0.05)。 结论:老年股骨转子间骨折PFNA固定术中局部应用凝血酶可明显减少患者术后失血量,且不会增加术后DVT等并发症的发生。

ObjectiveTo explore the effect of intraoperative local application of thrombin on postoperative blood loss in internal fixation of femoral intertrochanteric fracture with proximal femoral nail antirotation(PFNA).MethodsA retrospective study was conducted to analyze the 50 patients with intertrochanteric femur fracture who had been treated at Department of Orthopaedics,The First Ningbo Hospital&Longshan Hospital Medical Health Group between January 2021 and December 2023.The patients were divided into 2 groups according to whether local thrombin was applied intraoperatively or not.In the treatment group of 25 cases[9 males and 16 females aged(76.5±10.1)years],after PFNA implantation,6 pieces of thrombin freeze-dried powder were dissolved in 60 mL of sterile physiological saline,30 mL of which was sprayed inside the main nail incision,20 mL of which inside the spiral blade incision,and 10 mL of which inside the distal locking nail incision.In the control group of 25 cases[11 males and 14 females aged(71.1±10.1)years],after PFNA implantation,the incisions were rinsed only with the same doses of physiological saline.The hemoglobin(Hb)and hematocrit(Hct)on the 1st,3rd,and 7th days after surgery,total blood loss,occult blood loss,transfusion rate,and deep vein thrombosis(DVT)were compared between the 2 groups.ResultsThere were no significant differences in the preoperative general data or operation time between the 2 groups,indicating comparability(P>0.05).On the 1st,3rd,and 7th days after surgery,respectively,the Hb was(101.48±12.15)g/L,(102.96±12.76)g/L,and(107.24±13.47)g/L,and the Hct 0.31±0.03,0.32±0.03,and 0.33±0.04 in the treatment group,significantly higher than those in the control group[(92.72±10.95)g/L,(86.52±7.43)g/L,and(91.56±10.24)g/L;0.28±0.03,0.26±0.03,and 0.27±0.03](P<0.05).In the treatment group,the total postoperative blood loss was(364.60±134.27)mL,and the occult blood loss was(258.04±112.59)mL,both significantly lower than those in the control group[(481.72±218.69)mL and(355.84±176.97)mL](P<0.05).In the treatment group and the control group,respectively,2 patients and 1 patient developed DVT after surgery,showing no statistically significant difference in the incidence(P>0.05).ConclusionIntraoperative local application of thrombin can significantly reduce postoperative blood loss but may not increase postoperative thrombosis or other complications in PFNA internal fixation of femoral intertrochanteric fracture.