CAJ | 학술논문

目的：探讨Evans‐Jensen分型与老年股骨转子间骨折围术期隐性失血的相关性。方法回顾性分析2009年5月至2013年8月246例老年股骨转子间骨折采用闭合复位股骨近端抗旋髓内钉（PFN A ）内固定治疗患者的资料，骨折按Evans‐Jensen分型，其中Ⅱ型40例，Ⅲ型93例，Ⅳ型69例，Ⅴ型44例。根据Gross方程计算隐性失血量，对以上4组隐性失血量进行相关分析。结果4组隐性失血量分别为Ⅱ型（404±7．38）m L ，Ⅲ型（425±3．93）m L ，Ⅳ型（487±4．35）m L ，Ⅴ型（535±5．96）m L ；隐性失血量在总失血量中占的比例分别为Ⅱ型82．60％、Ⅲ型81．00％、Ⅳ型82．70％、Ⅳ型82．10％，Evans‐JensenⅣ、Ⅴ型与Evans‐JensenⅡ、Ⅲ型相比，隐性失血量差异有统计学意义（P＜0．05）。结论应用PFNA治疗老年股骨转子间骨折，Evans‐JensenⅣ、Ⅴ型相对于Ⅱ、Ⅲ型隐性失血量明显增加，应引起术者的重视。
목적：탐토Evans‐Jensen분형여노년고골전자간골절위술기은성실혈적상관성。방법회고성분석2009년5월지2013년8월246례노년고골전자간골절채용폐합복위고골근단항선수내정（PFN A ）내고정치료환자적자료，골절안Evans‐Jensen분형，기중Ⅱ형40례，Ⅲ형93례，Ⅳ형69례，Ⅴ형44례。근거Gross방정계산은성실혈량，대이상4조은성실혈량진행상관분석。결과4조은성실혈량분별위Ⅱ형（404±7．38）m L ，Ⅲ형（425±3．93）m L ，Ⅳ형（487±4．35）m L ，Ⅴ형（535±5．96）m L ；은성실혈량재총실혈량중점적비례분별위Ⅱ형82．60％、Ⅲ형81．00％、Ⅳ형82．70％、Ⅳ형82．10％，Evans‐JensenⅣ、Ⅴ형여Evans‐JensenⅡ、Ⅲ형상비，은성실혈량차이유통계학의의（P＜0．05）。결론응용PFNA치료노년고골전자간골절，Evans‐JensenⅣ、Ⅴ형상대우Ⅱ、Ⅲ형은성실혈량명현증가，응인기술자적중시。
Objective To investigate the correlation between the Evans‐Jensen type with the perioperative hid‐den blood loss in elderly intertrochanteric fractures .Methods The clinical data in 246 cases of elderly intertrochan‐teric fractures treated by the closed reduction and proximal femoral nail anti‐rotation(PFNA) internal fixation in our hospital from May 2009 to August 2013 were retrospectively analyzed ,including 40 cases of typeⅡ ,93 cases of typeⅢ ,93 cases of typeⅣ and 69 cases of type Ⅴ by the Evans‐Jensen typing .The hidden blood loss amount was calcu‐lated by the Gross equation .The hidden blood loss amount in 4 groups were performed the correlation analysis .Re‐sults The hidden blood loss amounts were (404 ± 7 .38)mL for the type Ⅱ ,(425 ± 3 .93)mL for the type Ⅲ ,(487 ± 4 .35)mL for the type Ⅳ and (535 ± 5 .96)mL for the type Ⅴ ;the proportions of hidden blood loss amount to total blood loss amount were 82 .60% for the type Ⅱ ,81 .00% for the type Ⅲ ,82 .70% for the type Ⅳ and 82 .10% for the type Ⅴ ;the hidden blood loss amount had statistical differences between the Evans‐Jensen type Ⅳ and Ⅴ with the Evans‐Jensen typeⅡ and Ⅲ (P< 0 .05) .Conclusion Applying the PFNA in the treatment of intertrochanteric fracture ,the hidden blood loss in Evans‐Jensen type Ⅳ and Ⅴ is significantly increased compared with the type Ⅱand Ⅲ ,which should cause the surgeon′s attention .