高龄患者PFNA治疗股骨转子间骨折显性和隐性失血量临床研究.docVIP

高龄患者PFNA治疗股骨转子间骨折显性和隐性失血量临床研究 　　【摘要】 目的：探讨应用PFNA治疗高龄患者股骨转子间骨折的显性与隐性出失血情况。方法：回顾性分析本院2011年4月-2015年4月应用PFNA治疗的80例高龄股骨转子间骨折患者的临床资料，记录患者术前、术后第1、2、3天HCT和Hb的变化，依据患者不同年龄、性别及骨折分型进行对比及统计学分析。结果：所有患者PFNA治疗术中显性失血（106.23±18.76）mL，隐性失血（596.36±138.63）mL，总失血量（702.59±155.39）mL，不同年龄、性别患者失血量比较差异均无统计学意义（P0.05）；A3型骨折患者隐性失血明显高于A1、A2型，比较差异均有统计学意义（P0.05）。结论：PFNA内固定虽是微创治疗，术中显性失血较少，但术后的隐性失血量可为显性失血的4～5倍，应特别重视术后的患者的失血情况观察，指导临床输血治疗，减少围手术期并发症并节约用血。 　　【关键词】 ???龄； 股骨近端防旋髓内钉； 股骨转子间骨折； 显性失血； 隐性失血； 临床用血 　　【Abstract】 Objective：To investigate the dominant and hidden blood loss of the femoral intertrochanteric fractures in elder patients treated with PFNA.Method：Eighty cases of elder femoral intertrochanteric fractures patients treated with PFNA in our hospital from April 2011 to April 2015 were retrospective analyzed.The changes of their Hb and HCT were recorded before and first，second and third days after the operation，then which were compared between the different ages，genders and fracture types.Result：The dominant blood loss during the PFNA treatment was about （106.23±18.76）mL，the hidden blood loss was about （596.36±138.63）mL，the total blood loss was about （702.59±155.39）mL，the difference had no significant between different ages or genders（P0.05）.The hidden blood loss of A3 type fractures were significantly higher than that of the A1 and A2 type，the differences were statistically significant（P0.05）.Conclusion：PFNA internal fixation is a minimally invasive treatment with less dominant blood loss，but the hidden blood loss after operation can be 4-5 times of the dominant blood loss，we should pay special attention to the blood loss in postoperative patients，guiding clinical transfusion treatment，reduce the perioperative complications and save the usage of blood. 　　【Key words】 Elder； Proximal femoral nail anti-rotation； Femoral intertrochanteric fracture； Dominant blood loss； Hidden blood loss； Clinical usage of blood 　　First-author’s address：Huizhou Huakang Orthopaedic Hospital，Huizhou 516007，Chin