CAJ | 학술논문

目的对采用防旋型股骨近端髓内钉(PFNA)治疗的老年股骨转子间骨折患者的围手术期失血量进行分析,探讨PFNA内固定围手术期失血的危险因素.方法回顾性分析行PFNA内固定治疗的62例股骨转子间骨折老年患者的临床资料,对围手术期的显性失血量及隐性失血量进行统计分析,并依据性别、年龄、骨折类型进行分组,分析围手术期失血的影响因素.结果 62例患者总失血量为(775.8±129.6) ml,显性失血量为(120.6±42.0) ml,占总失血量的15.5％,隐性失血量为(655.2±109.1) ml,占总失血量的84.5％,隐性失血量显著高于显性失血量,差异有统计学意义(P＜0.01).男性组(20例)总失血量、显性失血量、隐性失血量分别为(773.3±131.5)、(122.5±44.1)、(650.8±114.2) ml;女性组(42例)分别为(777.0±124.7)、(119.7±40.2)、(657.3±107.7) ml,两组比较差异无统计学意义(P＞0.05).高龄组(35例)总失血量、显性失血量分别为(813.1±107.5)、(117.7±49.7)ml;非高龄组(27例)分别为(727.4±114.3)、(124.4±36.6) ml,两组比较差异无统计学意义(P＞0.05);高龄组隐性失血量为(695.4±74.1) ml,高于非高龄组的(603.0±65.3) ml,差异有统计学意义(P＜0.05).稳定组(14例)总失血量、显性失血量、隐性失血量分别为(578.1±82.3)、(68.5±23.1)、(509.6±63.1) ml,低于不稳定组(48例)的(833.5±84.1)、(135.8±35.0)、(697.7±79.3) ml,差异有统计学意义(P＜0.05).结论老年股骨转子间骨折PFNA内固定围手术期失血主要来自于隐性失血,年龄及骨折稳定性是影响隐性失血的危险因素.
목적 대채용방선형고골근단수내정(PFNA)치료적노년고골전자간골절환자적위수술기실혈량진행분석,탐토PFNA내고정위수술기실혈적위험인소.방법 회고성분석행PFNA내고정치료적62례고골전자간골절노년환자적림상자료,대위수술기적현성실혈량급은성실혈량진행통계분석,병의거성별、년령、골절류형진행분조,분석위수술기실혈적영향인소.결과 62례환자총실혈량위(775.8±129.6) ml,현성실혈량위(120.6±42.0) ml,점총실혈량적15.5％,은성실혈량위(655.2±109.1) ml,점총실혈량적84.5％,은성실혈량현저고우현성실혈량,차이유통계학의의(P＜0.01).남성조(20례)총실혈량、현성실혈량、은성실혈량분별위(773.3±131.5)、(122.5±44.1)、(650.8±114.2) ml;녀성조(42례)분별위(777.0±124.7)、(119.7±40.2)、(657.3±107.7) ml,량조비교차이무통계학의의(P＞0.05).고령조(35례)총실혈량、현성실혈량분별위(813.1±107.5)、(117.7±49.7)ml;비고령조(27례)분별위(727.4±114.3)、(124.4±36.6) ml,량조비교차이무통계학의의(P＞0.05);고령조은성실혈량위(695.4±74.1) ml,고우비고령조적(603.0±65.3) ml,차이유통계학의의(P＜0.05).은정조(14례)총실혈량、현성실혈량、은성실혈량분별위(578.1±82.3)、(68.5±23.1)、(509.6±63.1) ml,저우불은정조(48례)적(833.5±84.1)、(135.8±35.0)、(697.7±79.3) ml,차이유통계학의의(P＜0.05).결론 노년고골전자간골절PFNA내고정위수술기실혈주요래자우은성실혈,년령급골절은정성시영향은성실혈적위험인소.
Objective To analyze the periopemtive blood loss of elderly patients with intertrochanter fracture that fixed with proximal femoral nail-antirotation (PFNA),and to explore the risk factor influencing the perioperative blood loss following PFNA fixation.Methods The clinical data of 62 elderly patients with intemochanter fracture treated with PFNA were analyzed retrospectively to determine the perioperative obvious blood loss and hidden blood loss.The impact of gender,age and fracture type on blood loss was also analyzed.Results The obvious blood loss of 62 patients was (120.6 ±42.0) ml,which accounted for 15.5％ in total blood loss [(775.8 ± 129.6) ml].The hidden blood loss was (655.2 ± 109.1) ml,which accounted for 84.5％ in total blood loss.The hidden blood loss was much more than obvious blood loss (P＜ 0.01).The total blood loss,obvious blood loss,hidden blood loss was (773.3 ± 131.5),(122.5 ± 44.1),(650.8± 114.2) mlinmahgroup (20cases),(777.0± 124.7),(119.7±40.2),(657.3 ± 107.7) ml in female group (42 cases),and there was no significant difference between two groups (P ＞ 0.05).The total blood loss,obvious blood loss was (813.1 ± 107.5),(117.7 ±49.7) ml in advanced age group (35 cases),(727.4 ± 114.3),(124.4 ± 36.6) ml in non-advanced age group (27 cases),and there was no significant difference between two groups (P ＞0.05).The hidden blood loss was (695.4 ±74.1) ml in advanced age group,(603.0 ± 65.3) ml in non-advanced age group,and there was significant difference between two groups (P＜0.05).The total blood loss,obvious blood loss,hidden blood loss was (578.1 ±82.3),(68.5 ±23.1),(509.6 ±63.1) ml in stable group (14 cases),(833.5 ±84.1),(135.8 ±35.0),(697.7 ±79.3) ml in unstable group (48 cases),and there was significant difference between two groups (P ＜ 0.05).Conclusions Hidden blood loss is the major part of perioperative blood loss of elderly patients with intertrochanter fractures that fixed with PFNA.Advanced age and unstable fracture type are risk factors of hidden blood loss.