股骨近端防旋髓内钉术中扩髓对手术失血量的影响.docVIP

股骨近端防旋髓内钉术中扩髓对手术失血量的影响 　　[摘要] 目的 探讨老年股骨粗隆间骨折采用闭合复位股骨近端防旋髓内钉（PFNA）内固定手术置钉前扩髓对手术失血量的影响。 方法 选取2013年11月～2015年10月广西壮族自治区柳州市中医院收治的股骨粗隆间骨折并进行PFNA内固定手术的患者60例，随机分为观察组与对照组，每组30例。观察组在置入PFNA主钉前进行髓腔扩髓，对照组不进行扩髓，比较两组的总失血量、术中失血量、隐性失血量、手术时间及术后不良反应发生率。 结果 观察组术中失血量多于对照组，隐性失血量少于对照组，两组差异有统计学意义（P 0.05）。观察组手术时间长于对照组（P 0.05）。 结论 在老年股骨粗隆间骨折PFNA内固定手术中，扩髓会延长手术时间及增加术中失血量，但术后隐性失血反而减少，总失血量无差异，术后不良反应少，而从骨折固定的稳定性方面考虑，建议股骨粗隆间骨折在使用PFNA内固定时进行髓腔扩髓。 　　[关键词] 股骨粗隆间骨折；股骨近端防旋髓内钉；扩髓；手术失血量；隐性失血 　　[中图分类号] R683.42 [文献标识码] A [文章编号] 1673-7210（2016）04（c）-0081-05 　　[Abstract] Objective To study the effect of pulp cavity expanding before expanding medullary nailing in proximal femoral nail anti-rotation （PFNA） surgery on the surgical blood loss for intertrochanteric fracture. Methods 60 patients with intertrochanteric fracture and PFNA internal fixation admitted into Traditional Chinese Medicine Hospital of Liuzhou City in Guangxi Zhuang Autonomous Region from November 2013 to October 2015 were selected and randomly divided into observation group and control group， 30 cases in each group. Observation group was treated with pulp cavity expanding before the PFNA main nail， and control group was not enlarged. Total blood loss， intraoperative blood loss， hidden blood loss， operative time and incidence rate of postoperative adverse reaction between two groups were compared. Results The intraoperative blood loss in observation group was more than that in control group， hidden blood loss was less than that in control group， the differences between two groups were statistically significant （P 0.05）. The operation time in observation group was longer than that in control group （P 0.05）. Conclusion The pulp cavity expanding in the PFNA internal fixation of intertrochanteric fracture can increase the operation time and intraoperative blood loss， but the hidden blood loss after surgery reduce instead， and from the stability of the fracture fixation consideration， it is recommended that the femoral intertrochanteric