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中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (04) : 204 -210. doi: 10.3877/cma.j.issn.2096-0263.2020.04.004

所属专题: 文献

骨与创伤

老年股骨颈骨折与股骨转子间骨折围手术期失血量的临床对比研究
胡祖圣1,(), 刘仙玲2, 王磊1, 段文1, 方策1, 张继学1   
  1. 1. 230031 合肥,中国科学技术大学附属第一医院西区骨科 安徽省肿瘤医院骨及软组织肿瘤科
    2. 230031 合肥,中国科学技术大学附属第一医院感染管理科
  • 收稿日期:2020-05-15 出版日期:2020-08-05
  • 通信作者: 胡祖圣
  • 基金资助:
    安徽省自然科学基金(1908085QH359)

Clinical comparison of blood loss of peri-operation between femoral neck fracture and intertrochanteric fracture in elderly patients

Zusheng Hu1,(), Xianling Liu2, Lei Wang1, Wen Duan1, Ce Fang1, Jixue Zhang1   

  1. 1. Department of Bone and Soft Tissue Oncology, the First Affiliated Hospital of University of Science and Technology of China, Anhui provincial Tumor hospital, Hefei 230031, China
    2. Department of Infection Management, the First Affiliated Hospital of University of Science and Technology of China, Anhui provincial Tumor hospital, Hefei 230031, China
  • Received:2020-05-15 Published:2020-08-05
  • Corresponding author: Zusheng Hu
引用本文:

胡祖圣, 刘仙玲, 王磊, 段文, 方策, 张继学. 老年股骨颈骨折与股骨转子间骨折围手术期失血量的临床对比研究[J/OL]. 中华老年骨科与康复电子杂志, 2020, 06(04): 204-210.

Zusheng Hu, Xianling Liu, Lei Wang, Wen Duan, Ce Fang, Jixue Zhang. Clinical comparison of blood loss of peri-operation between femoral neck fracture and intertrochanteric fracture in elderly patients[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(04): 204-210.

目的

通过老年股骨颈骨折与股骨转子间骨折患者围手术期失血量的比较,为临床老年髋部骨折围手术期血液管理提供科学依据。

方法

回顾性收集2018年7月至2020年4月间中国科学技术大学附属第一医院骨科收治的因低能量损伤导致的老年髋部骨折患者,共纳入69例。按照骨折类型分为股骨颈骨折组和股骨转子间骨折组,比较两组患者年龄、性别、骨折解剖部位以及术前合并症等基本信息,比较两组患者围手术期隐性失血量、显性失血量和总失血量。

结果

股骨颈骨折组患者的平均年龄为(78±8)岁(男性10例,女性35例),股骨转子间骨折患者的平均年龄为(75±10)岁(男性12例,女性12例)。两组患者术前隐性失血量[股骨颈骨折组:(238.33±97.82)ml ;股骨转子间骨折组:(344.80±130.01)ml,P<0.05]、围手术期隐性失血量[股骨颈骨折组:(314.46±130.30)ml;股骨转子间骨折组:(459.73±173.34)ml,P<0.05]、显性失血量[股骨颈骨折组:(77.78±27.29)ml;股骨转子间骨折组:(160.42±51.03)ml,P<0.05]和总失血量[股骨颈骨折组:(392.24±133.62)ml;股骨转子间骨折组:(620.15±171.11)ml,P<0.05]差异均具有统计学意义,股骨转子间骨折组均高于股骨颈骨折患者组。股骨转子间骨折组(半髋关节置换和PFNA内固定术)较股骨颈骨折组(全髋关节置换和半髋关节置换术)均有较多的显性失血量、术后隐性失血量、围手术期隐性失血量和总失血量(均P<0.05)。但两组内不同手术方式比较,差异无统计学意义。

结论

老年股骨转子间骨折患者较股骨颈骨折患者有更多的围手术期隐性失血量、显性失血量和总失血量,在临床诊治中,尤其需要更加重视老年股骨转子间骨折患者的围手术期血液管理。

Objective

To provide scientific basis for perioperative blood management of elderly patients with femoral neck fracture and intertrochanteric fracture by comparing their perioperative blood loss.

Methods

All of 69 elderly patients with hip fracture caused by low energy injury admitted to Orthopaedic Department of the first Affiliated Hospital of University of Science and Technology of China from July 2018 to April 2020 were included in this study. According to the type of fracture, patients divided into femoral neck fracture group and femoral intertrochanteric fracture group. Age, sex, anatomical site of fracture and comorbidity were compared between the two groups. The hidden blood loss, dominant blood loss and total blood loss were calculated and compared between the two groups.

Results

The mean age of patients in the femoral neck fracture group was (78±8) years old (10 Male, 35 Female), and that of patients with intertrochanteric fracture was (75±10) years old (12 Male, 12 Female). There were statistically significant differences in the pre-operative hidden blood loss [(238.33±97.82) vs (344.80±130.01)ml, P<0.05)], peri-operative Hidden blood loss [(314.46±130.30) vs (459.73±173.34)ml, P<0.05)], dominant blood loss [(77.78±27.29)ml vs (160.42±51.03)ml, P<0.05)] and total blood loss [(392.24±133.62)ml vs (620.15±171.11)ml, P<0.05)] between the two groups. The intertrochanteric fracture group were significantly higher than that of the femoral neck fracture group. The intertrochanteric fracture group (hemi-hip replacement and PFNA internal fixation) had more dominant blood loss, post-operative hidden blood loss, peri-operative hidden blood loss and total blood loss than the femoral neck fracture group (total hip replacement and hemi-hip replacement) (all P<0.05). However, there was no significant statistical difference between the two groups in different surgical procedures (all P>0.05).

Conclusions

The elderly patients with intertrochanteric fracture have more perioperative hidden blood loss and dominant blood loss than those with femoral neck fracture. In clinical diagnosis and treatment. We should pay more attention to perioperative blood management of elderly patients with intertrochanteric fracture.

图3~4 女性,77岁,右侧股骨转子间骨折。图3 术前X线片;图4 行半髋关节置换术后X线片
表1 股骨颈骨折组与股骨转子间骨折组患者一般临床资料比较
表2 股骨颈骨折组与股骨转子间骨折组患者术前合并症(例)
表3 股骨颈骨折组与股骨转子间骨折组围手术期失血量比较(±s
表4 股骨颈骨折组与股骨转子间骨折组不同手术方式围手术期失血量比较(±s
1
张英泽. 成人髋部骨折指南解读 [J]. 中华外科杂志, 2015, 53(1): 57-62.
2
Parker M, Johansen A. Hip fracture [J]. BMJ, 2006, 333(7557): 27-30.
3
张瑞鹏,尹英超,李石伦, 等. 髋部骨折指南解读与诊疗现状分析 [J]. 河北医科大学学报, 2018, 39(6): 621-622, 627.
4
张立海,谭晶,龙安华, 等. 老年髋部骨折围术期输血与临床预后的关系 [J]. 中华老年多器官疾病杂志, 2014 (7): 485-488.
5
危杰,王军,高明, 等. 老年髋部骨折围手术期失血量的分析 [J]. 中华创伤骨科杂志, 2015, 17(2): 104-107.
6
姚东晨,杨明辉,朱仕文, 等. 老年髋部骨折患者术前隐形失血量分析 [J]. 中华骨与关节外科杂志, 2019, 12(12): 955-960.
7
Meunier A, Petersson A, Good L, et al. Validation of a haemo-globin dilution method for estimation of blood loss [J]. Vox Sang, 2008, 95(2): 120-124.
8
Cooper C, Cole ZA, Holroyd CR, et al. Secular trends in the incidence of hip and other osteoporotic fractures [J]. Osteoporosis International, 2011, 22(5): 1277.
9
Tian FM, Zhang L, Zhao HY, et al. An increase in the incidence of hip fractures in Tangshan,China [J]. Osteoporos Int, 2014, 25(4): 1321-1325.
10
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures [J]. Lancet, 2002, 359(9319): 1761.
11
Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States [J]. JAMA, 2009, 302(14): 1573.
12
Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglob in after knee joint surgery [J]. Ann Rheum Dis, 1973, 32(6): 582-584.
13
Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?Correct blood loss management should take hidden loss into account [J]. Knee, 2000, 7(3): 151-155.
14
Gross JB. Estimating allowable blood loss:corrected for dilution [J]. Anaesthesiology, 1983, 58(3): 277-280.
15
Fross NB, Kehlet H. Hidden blood loss after surgery forhip fracture [J]. J Bone Joint Surg Br, 2006, 88(8): 1053-1059.
16
Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture [J]. Injury, 42(2): 133-135.
17
张英泽. 临床创伤骨科流行病学第2版 [M] . 北京: 人民卫生出版社, 2014 .
18
Maeda Y, Sugano N, Saito M, et al. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures [J]. Clinical Orthopaedics&Related Research, 2011, 469(3): 884.
19
王亦璁,姜保国. 骨与关节损伤第五版 [M] . 北京: 人民卫生出版社, 2012 .
20
Ferris BD, Kennedy C, Bhamra M, et al. Morphology of the femur in proximal femoral fractures [J]. Journal of Bone&Joint Surgery British Volume,1989,71 (3): 475-477.
21
Leslie WD, Lix LM, Morin SN, et al. Hip axis length is a FRAX-and bone density-independent risk factor for hip fracture in women [J]. Journal of Clinical Endocrinology & Metabolism, 2015, 100(5): 2063-2070.
22
Partanen J, Jämsä T, Jalovaara P. Influence of the upper femur and pelvic geometry on the risk and type of hip fractures [J]. Journal of Bone&Mineral Research the Official Journal of the American Society for Bone&Mineral Research, 2010, 16(8): 1540-1546.
23
Mautalen CA, Vega EM, Einhorn TA. Are the etiologies of cervical and trochanteric hip fractures different? [J]. Bone, 1996, 18(3 Suppl): 133S.
24
Pulkkinen P, Glüer CC, Jämsä T. Investigation of differences between hip fracture types:A worthy strategy for improved risk assessment and fracture prevention [J]. Bone, 2011, 49(4): 600-604.
25
Yamauchi K, Naofumi M, Sumida H, et al. Comparison of morphological features in the femur between femoral neck fractures and femoral intertrochanteric fractures [J]. Surgical&Radiologic Anatomy, 2016, 38(7): 1-6.
26
Hu ZS, Xianling L, Zhang YZ. Comparison of proximal femoral geometry and risk factors between femoral neck fractures and femoral intertrochanteric fractures in an elderly Chinese population [J]. Chin Med J, 2018, 131(21): 2524-2530.
27
卢国平,戴杰,洪晓亮, 等. 老年高龄髋部骨折患者围手术期隐性失血的相关性研究 [J]. 中华骨科杂志, 2017, 37(12): 728-734.
28
Zhu XZ, Tao YL, Ma Z. Routine blood tests as predictors of mortality in hip fracture patients [J]. Injury, 2013, 44(11): 1659.
29
Molyneux S, Rehman H, Brown G, et al. Admission blood tests signifieantly underestimate anaemia in hip fracture patients-A prospective cohort study [J]. Int J Surg, 2013, 11(8): 660.
30
刘国印,贾小宝,张勇, 等. 老年人营养状况与髋部骨折术前隐性失血的相关性研究 [J]. 中华骨与关节外科杂志, 2018, 11(1): 15-19.
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