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[1]朱云森,江敞,李俊.兩種手術(shù)方式治療老年股骨轉(zhuǎn)子間骨折的圍手術(shù)期失血量比較[J].中醫(yī)正骨,2014,26(09):29-32.
　Zhu Yunsen*,Jiang Chang,Li Jun..Comparison of perioperative blood loss of two kinds of surgery for treatment of intertrochanteric fractures in aged patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(09):29-32.
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兩種手術(shù)方式治療老年股骨轉(zhuǎn)子間骨折的圍手術(shù)期失血量比較()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期數(shù):
2014年09期
頁碼:
29-32
欄目:
臨床研究
出版日期:
2014-09-30

文章信息/Info

Title:
Comparison of perioperative blood loss of two kinds of surgery for treatment of intertrochanteric fractures in aged patients
作者:
朱云森; 江敞; 李俊
浙江省溫嶺市第一人民醫(yī)院,浙江 溫嶺 317500
Author(s):
Zhu Yunsen*; Jiang Chang; Li Jun.
*The first people's hospital of Wenling,Wenling 317500,Zhejiang,China
關(guān)鍵詞:
髖骨折 轉(zhuǎn)子間骨折 骨折固定術(shù); 內(nèi) 失血
Keywords:
Hip fractures;  Intertrochanteric fractures;  Fracture fixation; internal;  Blood loss
摘要:
目的:比較股骨近端防旋髓內(nèi)釘和動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的圍手術(shù)期失血量。方法:回顧性分析接受手術(shù)治療的316例老年股骨轉(zhuǎn)子間骨折患者的臨床資料,采用股骨近端防旋髓內(nèi)釘固定者189例,采用動(dòng)力髖螺釘內(nèi)固定者127例,比較2組患者的圍手術(shù)期失血量,并分別比較2組中不同年齡范圍患者的圍手術(shù)期失血量。結(jié)果:①2組患者圍手術(shù)期失血量比較結(jié)果。2組患者術(shù)前隱性失血量比較,差異無統(tǒng)計(jì)學(xué)意義[(138.29±40.46)mL,(141.76±42.57)mL; t=0.931,P=0.189]; 動(dòng)力髖螺釘組的術(shù)后隱性失血量小于股骨近端防旋髓內(nèi)釘組[(301.75±110.13)mL,(210.36±42.59)mL; t=8.129,P=0.000]; 2組患者術(shù)后顯性失血量比較,差異無統(tǒng)計(jì)學(xué)意義[(101.68±22.40)mL,(97.13±20.38)mL; t=1.453,P=0.098]。②股骨近端防旋髓內(nèi)釘組中不同年齡范圍患者圍手術(shù)期失血量比較結(jié)果。股骨近端防旋髓內(nèi)釘組中年齡≥80歲患者的術(shù)前隱性失血量和術(shù)后隱性失血量均大于年齡<80歲的患者[(158.29±48.26)mL,(87.27±32.13)mL; t=14.178,P=0.000;(326.84±100.63)mL,(215.26±32.27)mL; t=9.406,P=0.000]; 但兩者術(shù)后顯性失血量比較,差異無統(tǒng)計(jì)學(xué)意義[(104.47±17.50)mL,(99.44±21.11)mL; t=1.603,P=0.082]。③動(dòng)力髖螺釘組中不同年齡范圍患者圍手術(shù)期失血量比較結(jié)果。動(dòng)力髖螺釘組中年齡≥80歲患者的術(shù)前隱性失血量和術(shù)后隱性失血量均大于年齡<80歲的患者[(149.76±50.16)mL,(94.67±28.93)mL; t=11.296,P=0.000;(246.67±38.69)mL,(190.00±21.52)mL; t=15.082,P=0.000]; 但兩者術(shù)后顯性失血量比較,差異無統(tǒng)計(jì)學(xué)意義[(96.29±16.96)mL,(97.25±19.93)mL; t=0.128,P=0.293]。結(jié)論:動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的術(shù)后隱性失血量小于股骨近端防旋髓內(nèi)釘內(nèi)固定,因此應(yīng)根據(jù)患者的病情選擇合適的內(nèi)固定方式,避免隱性失血帶來的不利影響; 對(duì)于年齡≥80歲的患者更應(yīng)重視其術(shù)前和術(shù)后隱性失血情況,必要時(shí)應(yīng)采取輸血等措施,提高其生存率。
Abstract:
Objective:To compare the perioperative blood loss between proximal femoral nail antirotation(PFNA)fixation and dynamic hip screw(DHS)fixation in treatment of intertrochanteric fractures in aged patients.Methods:The clinical records of 316 patients with intertrochanteric fractures were analyzed retrospectively.One hundred and eighty-nine patients were treated with PFNA fixation(PFNA group),while 127 patients were treated with DHS fixation(DHS group).The perioperative blood loss were compared between the 2 groups and between different ages in each group.Results:There was no statistical difference in preoperative hidden blood loss between the 2 groups(138.29+/-40.46 vs 141.76+/-42.57 ml,t=0.931,P=0.189),while the postoperative hidden blood loss of DHS group was less than that of PFNA group(301.75+/-110.13 vs 210.36+/-42.59 ml,t=8.129,P=0.000).There was no statistical difference in postoperative dominant blood loss between the 2 groups(101.68+/-22.40 vs 97.13+/-20.38 ml,t=1.453,P=0.098).The preoperative and postoperative hidden blood loss was greater in patients ≥80years compared to patients <80years in PFNA group(158.29+/-48.26 vs 87.27+/-32.13 ml,t=14.178,P=0.000; 326.84+/-100.63 vs 215.26+/-32.27 ml,t=9.406,P=0.000),while there was no statistical difference in postoperative dominant blood loss between them(104.47+/-17.50 vs 99.44+/-21.11 ml,t=1.603,P=0.082).The preoperative and postoperative hidden blood loss was greater in patients ≥80years compared to patients <80years in DHS group(149.76+/-50.16 vs 94.67+/-28.93 ml,t=11.296,P=0.000; 246.67+/-38.69 vs 190.00+/-21.52 ml,t=15.082,P=0.000),while there was no statistical difference in postoperative dominant blood loss between them(96.29+/-16.96 vs 97.25+/-19.93 ml,t=0.128,P=0.293).Conclusion:The postoperative hidden blood loss is less in DHS fixation compared to PFNA fixation in treatment of intertrochanteric fractures in aged patients,so the adverse effect of hidden blood loss could be prevented by chosing suitable internal fixation based on patient's condition.Blood transfusion should be performed in case of necessity to improve survival rate in patients ≥80years,whose preoperative and postoperative hidden blood loss should be attached more attention.

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更新日期/Last Update: 2014-09-30