股骨近端防旋髓内钉治疗股骨粗隆间骨折的隐性失血分析

张忠平1，赵剑2，刘俊1，张浩1

1.江苏省如皋市中医院骨伤科，江苏如皋226500；2.南通大学附属医院骨科，江苏南通226001

[摘要]目的探讨PFNA治疗股骨粗隆间骨折隐性失血的特点及影响因素。方法回顾性研究2011年6月—2014年2月采用PFNA治疗的股骨粗隆间骨折的患者69例进行统计围手术期的隐性失血，对年龄、性别、肥胖及骨折类型进行分析，并分析隐性失血对术后康复的影响。结果男性组与女性组、肥胖组与非肥胖组间隐性失血均差异无统计学意义（P>0.05），高龄组的隐性失血量高于非高龄组(P<0.05)。在隐性失血量方面，不同骨折类型之间比较，差异均有统计学意义(P<0.05)。隐性失血量<650 mL与隐性失血量>650 mL组间术后弃拐时间差异有统计学意义(P<0.05)；两组骨折愈合时间、患髋Harris评分均差异无统计学意义（P>0.05）。结论PFNA治疗股骨粗隆间骨折存在较多的隐性失血，性别、肥胖不是隐性失血的危险因素，高龄、骨折类型是隐性失血的危险因素，隐性失血对术后康复有重要影响。

[关键词]股骨粗隆间骨折；股骨近端防旋髓内钉；隐性失血；危险因素

[中图分类号]R687.3

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0006-03

[作者简介]张忠平(1971.8-)，男，江苏如皋人，硕士，主治医师，主要从事创伤、脊柱疾病的基础与临床研究工作。

Abstract[]Objective To explore the characteristics and influencing factors of the hidden blood loss during treatment of the intertrochanteric fracture with proximal femoral nail antirotation (PFNA).Methods A retrospectively analysis was performed on 69 patients with intertrochanteric fracture treated by PFNA from June 2011 to February 2014 for making clear the hidden blood loss in the perioperative period.The age, gender, obesity and type of fracture were analyzed.The impact of hidden blood loss on postoperative rehabilitation was also analyzed.Results There were no difference in hidden blood loss between male group and female group, obesity group and normal group(P>0.05).There were more hidden blood loss in advanced age group than non-advanced age group (P<0.05).There was significantly different difference in the hidden blood loss between different type of fracture group(P<0.05).There was significantly different difference in the discarding crutches time between the group whose hidden blood loss were less than 650mL and the group whose hidden blood loss were more than 650 mL (P<0.05), however, there was no significantly different difference in the fracture healing time and Harris score between the two groups (P>0.05).Conclusion There is much hidden blood loss during treatment of the intertrochanteric fracture with PFNA.Gender and obesity are not the risk factors of the hidden blood loss, but advanced age and fracture type are.The hidden blood loss has an important impact on the postoperative rehabilitation of the patients.

收稿日期：（2015-07-05）

Clinical Analysis of Hidden Blood Loss During Treatment of Intertrochanteric Fracture with Proximal Femoral Nail Antirotation

ZHANG Zhong-ping1, ZHAO Jian2, LIU Jun1, ZHANG Hao1

1.Department of Orthopedics and Traumatology, Rugao Hospital of Traditional Chinese Medicine, Rugao, Jiangsu Province, 226500 China;2.Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, 226001 China

[Key words]Intertrochanteric fracture; Proximal femoral nail antirotation; Hidden blood loss; Risk factor

股骨粗隆间骨折，多见于老年人，随着社会人口老龄化，其发病率逐渐上升。由于老年患者长期卧床后，可引起下肢静脉血栓、坠积性肺炎、髋内翻畸形愈合等并发症，近年来，对于股骨粗隆间骨折，手术内固定已成为其治疗的首选方法[1]。闭合复位股骨近端防旋髓内钉（PFNA）内固定术，是近年来发展起来的骨科微创技术，其创伤小、固定牢固、操作简单、能获得良好的术后髋关节功能[2]。该研……