CAJ | 학술논문

　　背景：隐性失血是股骨转子间骨折患者，特别是高龄患者存在的一个重要隐患，可导致患者内固定治疗后处于贫血状态，影响切口愈合及患者恢复。目的：比较分析亚洲型股骨近端防旋髓内钉与动力髋螺钉治疗股骨转子间骨折的围术期失血量及其影响因素。方法：回顾性分析采取亚洲型股骨近端防旋髓内钉与动力髋螺钉两种方法治疗的股骨转子间骨折患者70例，其中年龄≥80岁的患者21例，年龄<80岁的患者49例；体质量指数>30 kg/m2的患者28例，体质量指数≤30 kg/m242例；使用防旋髓内钉固定30例，动力髋螺钉固定40例。根据身高、体质量和内固定治疗前后红细胞压积变化，使用Gross方程计算围术期失血量。结果与结论：患者平均失血量为936 mL，其中显性失血量为237 mL，隐性失血量为699 mL。隐性失血占失血总量达74.7%。动力髋螺钉组显性失血量高于防旋髓内钉组，隐性失血量低于防旋髓内钉组，高龄患者总失血量及隐性失血量均高于非高龄患者，男性与女性患者之间及肥胖与非肥胖患者之间比较差异无显著性意义。结果提示隐性出血是股骨转子间骨折内固定治疗后失血的主要原因；防旋髓内钉术式隐性失血量较动力髋螺钉大；高龄是隐性失血的危险因素。
　　배경：은성실혈시고골전자간골절환자，특별시고령환자존재적일개중요은환，가도치환자내고정치료후처우빈혈상태，영향절구유합급환자회복。목적：비교분석아주형고골근단방선수내정여동력관라정치료고골전자간골절적위술기실혈량급기영향인소。방법：회고성분석채취아주형고골근단방선수내정여동력관라정량충방법치료적고골전자간골절환자70례，기중년령≥80세적환자21례，년령<80세적환자49례；체질량지수>30 kg/m2적환자28례，체질량지수≤30 kg/m242례；사용방선수내정고정30례，동력관라정고정40례。근거신고、체질량화내고정치료전후홍세포압적변화，사용Gross방정계산위술기실혈량。결과여결론：환자평균실혈량위936 mL，기중현성실혈량위237 mL，은성실혈량위699 mL。은성실혈점실혈총량체74.7%。동력관라정조현성실혈량고우방선수내정조，은성실혈량저우방선수내정조，고령환자총실혈량급은성실혈량균고우비고령환자，남성여녀성환자지간급비반여비비반환자지간비교차이무현저성의의。결과제시은성출혈시고골전자간골절내고정치료후실혈적주요원인；방선수내정술식은성실혈량교동력관라정대；고령시은성실혈적위험인소。
BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age<80 years;28 patients with the body mass index>30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.