中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
7期
648-653
,共6页
髋骨折%手术期间%失血,手术
髖骨摺%手術期間%失血,手術
관골절%수술기간%실혈,수술
Hip fractures%Intraoperative period%Blood loss,surgical
目的 探讨围手术期不同内固定方式、不同时段隐性失血量的差异.方法 回顾性分析2008年1月至2012年1月应用动力髋螺钉(DHS)、股骨近端短重建钉(IMHS)和经皮加压钢板(PCCP)治疗AO/OTA 31-A1、31-A2型股骨转子间骨折患者的围手术期临床资料,其中DHS组35例,IMHS组55例,PCCP组38例.比较不同内固定方式及不同时间段(术后第1天、第2～3天、第4～5天)的隐性失血量.结果 三种手术方式治疗股骨转子间骨折术后平均总隐性失血量是平均显性失血量的7倍以上.PCCP、IMHS、DHS组组间总隐性失血量比较,差异均有统计学意义;而IMHS组与DHS组比较,差异无统计学意义.对于阶段性隐性失血量,在DHS组三个时间段比较,差异无统计学意义;在IMHS组及PCCP组,术后第4～5天与第1天、第2～3天比较差异均有统计学意义;而术后第1天与第2～3天比较差异无统计学意义.对于各组三个时间段阶段性隐性失血量/总隐性失血量比例,术后第4～5天与术后第1天、第2～3天比较,差异均有统计学意义,而术后第1天与第2～3天比较差异无统计学意义.结论 股骨转子间骨折围手术期隐性失血量远大于术中显性失血量.PCCP组的总隐性失血量明显少于IMHS组和DHS组,而IMHS组与DHS组的总隐性失血量相似.隐性失血主要发生在手术后的前3d,故术后前3d应密切监测患者的血红蛋白变化,及时评估患者的失血情况.
目的 探討圍手術期不同內固定方式、不同時段隱性失血量的差異.方法 迴顧性分析2008年1月至2012年1月應用動力髖螺釘(DHS)、股骨近耑短重建釘(IMHS)和經皮加壓鋼闆(PCCP)治療AO/OTA 31-A1、31-A2型股骨轉子間骨摺患者的圍手術期臨床資料,其中DHS組35例,IMHS組55例,PCCP組38例.比較不同內固定方式及不同時間段(術後第1天、第2～3天、第4～5天)的隱性失血量.結果 三種手術方式治療股骨轉子間骨摺術後平均總隱性失血量是平均顯性失血量的7倍以上.PCCP、IMHS、DHS組組間總隱性失血量比較,差異均有統計學意義;而IMHS組與DHS組比較,差異無統計學意義.對于階段性隱性失血量,在DHS組三箇時間段比較,差異無統計學意義;在IMHS組及PCCP組,術後第4～5天與第1天、第2～3天比較差異均有統計學意義;而術後第1天與第2～3天比較差異無統計學意義.對于各組三箇時間段階段性隱性失血量/總隱性失血量比例,術後第4～5天與術後第1天、第2～3天比較,差異均有統計學意義,而術後第1天與第2～3天比較差異無統計學意義.結論 股骨轉子間骨摺圍手術期隱性失血量遠大于術中顯性失血量.PCCP組的總隱性失血量明顯少于IMHS組和DHS組,而IMHS組與DHS組的總隱性失血量相似.隱性失血主要髮生在手術後的前3d,故術後前3d應密切鑑測患者的血紅蛋白變化,及時評估患者的失血情況.
목적 탐토위수술기불동내고정방식、불동시단은성실혈량적차이.방법 회고성분석2008년1월지2012년1월응용동력관라정(DHS)、고골근단단중건정(IMHS)화경피가압강판(PCCP)치료AO/OTA 31-A1、31-A2형고골전자간골절환자적위수술기림상자료,기중DHS조35례,IMHS조55례,PCCP조38례.비교불동내고정방식급불동시간단(술후제1천、제2～3천、제4～5천)적은성실혈량.결과 삼충수술방식치료고골전자간골절술후평균총은성실혈량시평균현성실혈량적7배이상.PCCP、IMHS、DHS조조간총은성실혈량비교,차이균유통계학의의;이IMHS조여DHS조비교,차이무통계학의의.대우계단성은성실혈량,재DHS조삼개시간단비교,차이무통계학의의;재IMHS조급PCCP조,술후제4～5천여제1천、제2～3천비교차이균유통계학의의;이술후제1천여제2～3천비교차이무통계학의의.대우각조삼개시간단계단성은성실혈량/총은성실혈량비례,술후제4～5천여술후제1천、제2～3천비교,차이균유통계학의의,이술후제1천여제2～3천비교차이무통계학의의.결론 고골전자간골절위수술기은성실혈량원대우술중현성실혈량.PCCP조적총은성실혈량명현소우IMHS조화DHS조,이IMHS조여DHS조적총은성실혈량상사.은성실혈주요발생재수술후적전3d,고술후전3d응밀절감측환자적혈홍단백변화,급시평고환자적실혈정황.
Objective To determine the perioperative hidden blood loss (HBL) associated with different fixation methods for intertrochanteric fracture.Methods We retrospectively studied 128 patients with 31-A1 and 31-A2 intertrochanteric fractures which underwent internal fixation with dynamic hip screw (DHS,n=35),short reconstruction intramedullary hip screw (IMHS,n=55) or percutaneous compression plate (PCCP,n=38) from January 2008 to January 2012.The HBL were calculated and compared.Results The mean total hidden blood loss (THBL) was more than 7 times than the mean apparent blood loss (ABL) in all the three groups.For the THBL,there were significant statistical differences among three groups; no difference was found between IMHS and DHS group.For the phasic hidden blood loss (PHBL),there was no difference among the three phase of treatment in DHS group.But in IMHS and PCCP group,there were significant differences between the 4th-5th day and the 1st day,the 2nd-3rd day after operation; no difference was found between the Ist and the 2nd-3rd day.For the ratio of PHBL/THBL there were significant differences between the 4th-5th day and the 1st day,the 2nd-3rd day after operation; but no statistical differences were found between the 1st day and the 2nd-3rd day after operation.Conclusion It can be concluded that HBL after surgery for intertrochanic fractures is much greater than that observed intra-operatively.The IMHS and DHS cause more HBL than PCCP.Frequent post-operative measurements of haemoglobin are necessary,especially the first three days after surgery.
