摘要
目的探讨不同类型中青年髋部骨折及不同手术方式的围手术期失血情况,为优化血液管理提供依据。方法分析攀枝花市中心医院骨科收治的130例中青年髋部骨折患者,依骨折类型分为股骨颈骨折组(n=66)和股骨转子间骨折组(n=64)。股骨颈骨折组行空心钉和股骨颈动力交叉钉系统内固定,股骨转子间骨折组中行重建钉、联合拉力交锁髓内钉系统和股骨近端防旋髓内钉内固定。比较两组间及组内不同固定方式间围手术期显性失血量、隐性失血量和总失血量。结果股骨颈骨折组围手术期显性失血量、术前隐性失血量、围手术期隐性失血量和总失血量均低于股骨转子间骨折组(P<0.05)。股骨颈骨折组中行股骨颈动力交叉钉系统内固定的围手术期显性失血量、隐性失血量和总失血量明显高于空心钉内固定(P<0.05)。股骨转子间骨折组患者三种不同手术方式间围手术期显性失血量、隐性失血量和总失血量比较差异无统计学意义(P>0.05)。结论中青年股骨转子间骨折患者围手术期失血量多于股骨颈骨折患者,其中隐性失血量,尤其是术前隐性失血量不容忽视,手术中选择组织剥离少,髓腔破坏小的内固定方式更有利于减少失血。
Objective To discuss perioperative blood loss in different types of hip fractures and different surgical methods in young and middle⁃aged patients,and to provide evidence for optimizing blood management.Methods 130 young and middle⁃aged patients with hip fracture in Panzhihua Central Hospital were analyzed and divided into femoral neck fracture group(n=66)and intertrochanteric fracture group(n=64)according to fracture type.The femoral neck fracture group received cannulated compression screwsand FNS internal fixation,and the intertrochanteric fracture group received reconstruction nail,InterTAN and PFNA internal fixation.The dominant,hidden and total perioperative blood loss were compared between the two groups and among different fixation methods within the group.Results The perioperative dominant blood loss,preoperative hidden blood loss,periop⁃erative hidden blood loss and total blood loss in femoral neck fracture group were all lower than those in intertro⁃chanteric fracture group(P<0.05).In the femoral neck fracture group,the perioperative dominant,hidden and total blood loss ofFNSinternal fixation were significantly higher than those of cannulated compression screws internal fixation(P<0.05).There was no significant difference in perioperative dominant blood loss,hidden blood loss and total blood loss among patients with intertrochanteric fracture group(P>0.05).Conclusion The periop⁃erative blood loss of young and middle⁃aged patients with intertrochanteric fracture is more than that of patients with femoral neck fracture.The hidden blood loss,especially the preoperative hidden blood loss,can not be ignored.The internal fixation with less tissue dissection and less destruction of pulp cavity is more conducive to reducing blood loss.
作者
唐茁栋
王明友
李亭燕
李林涛
刘绍江
Tang Zhuodong;Wang Mingyou;Li Tingyan;Li Lintao;Liu Shaojiang(Department of Orthopedics,Panzhihua Central Hospital,Panzhihua 617000,China)
出处
《血栓与止血学》
CAS
2024年第5期227-232,共6页
Chinese Journal of Thrombosis and Hemostasis
基金
攀枝花市指导性科技计划项目(2022ZD⁃S⁃16)
攀枝花市中心医院2021年度院内科研项目(202118)。
关键词
隐性失血量
髋部骨折
中青年
围手术期
Blood loss
Hip fracture
Comparative study
Young and middle⁃aged
Perioperative period
