[1]朱云森,江敞,李俊.两种手术方式治疗老年股骨转子间骨折的围手术期失血量比较[J].中医正骨,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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两种手术方式治疗老年股骨转子间骨折的围手术期失血量比较()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年09期
页码:
29-32
栏目:
临床研究
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
浙江省温岭市第一人民医院,浙江 温岭 317500
Author(s):
Zhu Yunsen*; Jiang Chang; Li Jun.
*The first people's hospital of Wenling,Wenling 317500,Zhejiang,China
关键词:
髋骨折 转子间骨折 骨折固定术; 内 失血
Keywords:
Hip fractures;  Intertrochanteric fractures;  Fracture fixation; internal;  Blood loss
摘要:
目的:比较股骨近端防旋髓内钉和动力髋螺钉内固定治疗老年股骨转子间骨折的围手术期失血量。方法:回顾性分析接受手术治疗的316例老年股骨转子间骨折患者的临床资料,采用股骨近端防旋髓内钉固定者189例,采用动力髋螺钉内固定者127例,比较2组患者的围手术期失血量,并分别比较2组中不同年龄范围患者的围手术期失血量。结果:①2组患者围手术期失血量比较结果。2组患者术前隐性失血量比较,差异无统计学意义[(138.29±40.46)mL,(141.76±42.57)mL; t=0.931,P=0.189]; 动力髋螺钉组的术后隐性失血量小于股骨近端防旋髓内钉组[(301.75±110.13)mL,(210.36±42.59)mL; t=8.129,P=0.000]; 2组患者术后显性失血量比较,差异无统计学意义[(101.68±22.40)mL,(97.13±20.38)mL; t=1.453,P=0.098]。②股骨近端防旋髓内钉组中不同年龄范围患者围手术期失血量比较结果。股骨近端防旋髓内钉组中年龄≥80岁患者的术前隐性失血量和术后隐性失血量均大于年龄<80岁的患者[(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]; 但两者术后显性失血量比较,差异无统计学意义[(104.47±17.50)mL,(99.44±21.11)mL; t=1.603,P=0.082]。③动力髋螺钉组中不同年龄范围患者围手术期失血量比较结果。动力髋螺钉组中年龄≥80岁患者的术前隐性失血量和术后隐性失血量均大于年龄<80岁的患者[(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]; 但两者术后显性失血量比较,差异无统计学意义[(96.29±16.96)mL,(97.25±19.93)mL; t=0.128,P=0.293]。结论:动力髋螺钉内固定治疗老年股骨转子间骨折的术后隐性失血量小于股骨近端防旋髓内钉内固定,因此应根据患者的病情选择合适的内固定方式,避免隐性失血带来的不利影响; 对于年龄≥80岁的患者更应重视其术前和术后隐性失血情况,必要时应采取输血等措施,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