微创手术治疗老年股骨粗隆间骨折的隐性失血研究黄强沈杰王序全.DOCVIP

PAGE PAGE 1 微创手术治疗老年股骨粗隆间骨折的隐性失血研究 黄强，沈杰，王序全，许建中，谢肇 （400038重庆，第三军医大学西南医院骨科，全军矫形外科中心） [摘要] 目的 探讨经皮加压钢板（PCCP）内固定治疗老年股骨粗隆间骨折围手术期隐性失血的影响因素。 方法 回顾性分析2009年3月～2012年3月采用PCCP手术治疗的股骨粗隆间骨折136例，平均年龄为80.9岁（60～101岁），分析年龄、骨折类型、术前阿司匹林应用、合并内科疾病等对围手术期隐性失血的影响及不同HGB水平的患者分布情况。 结果 平均隐性失血量499 ml，占总失血量92.5%。血红蛋白（HGB）平均下降11g/L。A2.3型与A3型骨折患者入院时HGB80g\L发生率6.61%，术后HGB80g\L发生率14.70%。A2.3型（862ml）、A3型（698ml）平均隐性失血分别高于A1型（430ml），A2.1型（450ml）和A2.2型（415ml）（P0.05）。多元线性回归分析表明，A2.3型与A3型骨折、术前阿司匹林应用是围手术期隐性失血量增加的独立危险因素。 结论 微创PCCP手术显性失血少，股骨粗隆间骨折是围手术期大量隐性失血的主要影响因素，A2.3型与A3型骨折是围手术期HGB80g\L老年患者的早期预测因素。 [关键词] 经皮加压钢板；股骨粗隆间骨折；隐性失血；因素分析。 [通信作者] 谢肇，电话：023E-mail：HYPERLINK mailto:xiezhao54981@xiezhao54981@163.com hidden blood loss after minimally invasive operation for intertrochanteric fracture in the elder patient Huang Qiang, Shen Jie, Wang XuQuan, Xu JianZhong, Xie Zhao (Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China) Corresponding author: Xie Zhao, Tel: (023, E-mail:xiezhao54981@163.com [Abstract] Objective To explore influence factors of hidden blood loss during treatment of intertroehanter fractures with percutaneous compression plate in the elder patient. Methods We retrospectively analysed 136 patients with intertrochanteric fracture treated with percutaneous compression plate between March 2009 and March 2012, with a mean age of 80.9 years (60 to 101 years), the affect of age, fracture type, preoperative aspirin, internal diseases on perioperative hidden blood loss were analyzed, and different HGB level in patients with different distribution. Results The mean hidden blood loss volume was 499 ml, which accounted for 92.5% of the mean total blood loss. The mean haemoglobin (HGB) decline was 11 g/L. The rate of on admisson haemoglobin level 80 g/L was 6.61%（9/136）in AO type 31A2.3 and 31A3 groups，and the rate of postoperative haemoglobin level 80 g/L was 14.70%（20/136）.The average hidden blood loss for AO type 31-A2