摘要
[目的]分析股骨近端防旋髓内钉（proximol femorol nail anti-rotation,PFNA）治疗老年股骨转子间骨折的围手术期失血量,提高对其隐性失血的认识。[方法]回顾性分析本院在2009年1～7月,采取PFNA治疗的69例股骨转子间骨折患者。使用Gross方程,根据身高、体重和手术前后的红细胞压积（Hct）变化,计算围手术期失血量。[结果]69例患者中因手术期未输血的43例,男20例,女23例;平均年龄75.2岁,平均手术时间68.8 min,术中显性失血及术后引流量共169.0 ml。术前Hb平均113.2 g/L,术后85.3 g/L,降低了27.9 g/L;术前Hct平均34.27,术后26.13,降低了8.14。采取输血支持的26例,男4例,女22例;平均年龄83.7岁,平均手术时间64.2 min,术中显性失血及术后引流量共137.0 ml,平均输血量646 ml。术前Hb平均93.4 g/L,术后91.1 g/L,降低了2.3 g/L;术前Hct平均28.57,术后27.95,降低了0.62。按Gross方程计算,两组围手术期失血量分别为937 ml和706 ml,其中隐性失血分别占81.96%和80.69%,总失血量约是显性失血量的6倍。[结论]PFNA手术切口虽小,但围手术期隐性失血量却不少,临床上需引起足够重视。
[Objective]To analyze the perioperative blood loss in geriatric intertrochanteric fractures treated with proximal femoral nail anti-rotation（PFNA）,and to enhance the clinical realization of hidden blood loss. [Methods]A retrospective case series of 69（male 24,female 45） patients with an average of 78.4 year,operated between January and July 2009 was reviewed.The blood volume and its estimated loss were calculated by Gross formula,on according to the changes of pre-and post-operative haemocrit（Hct）.[Results]There were 43 cases（62.3%） in the non-blood transfusion group（M=20,F=23） with mean age of 75.2 years.The mean Haemoglobin（Hb） value pre-op was 113.2 g/L and post-op 85.3 g/L（decrease 27.9 g/L）,and the mean Hct value was 34.27 preopertively and 26.13 postoperatively（decrease 8.14）,respectively.The calculated mean total blood loss was 937 ml,with observed loss during operation and drainage 169 ml.There were 26 patients（37.7%） in the blood transfusion group（M=4,F=22） with mean age of 83.7 years.The mean blood transfusion volume was 646 ml.The mean Hb value was 98.4 g/L preoperatively and 96.1 g/L postoperatively（decrease 2.3 g/L）,the mean Hct value was 29.97 and 29.35（decrease 0.62）,respectively.The calculated mean total blood loss was 706 ml,with observed loss during operation and drainage 137 ml.The hidden blood loss was 768 ml in non-transfusion group and 569 ml in transfusion group,which was about 6 times greater than the observed blood loss,and occupied about 80% of the total blood loss volume.[Conclusion]Nailing of PFNA,although a small incision rapid procedure,can cause a considerable hidden blood loss,which may lead to severe postoperative anemia.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第17期1423-1426,共4页
Orthopedic Journal of China
关键词
股骨转子间骨折
隐性失血
骨折内固定术
PFNA
围手术期
老年
intertrochanteric fracture
hidden blood loss
fracture internal fixation
proximal femoral nail anti-rotation
perioperative period
geriatrics
