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中华老年骨科与康复电子杂志

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
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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]. 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]. 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。

关键词: 老年人, 股骨颈骨折, 股骨转子间骨折, 失血, 隐性失血量
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.

Key words: Aged, Femoral neck fractures, Femoral intertrochanteric fractures, Blood loss, Hidden blood loss
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
组别 例数 性别（例） 骨折部位（例） 年龄（岁，±s） BMI（kg/m2，±s）
男性 女性 左侧 右侧
股骨颈骨折组 45 10 35 24 21 78±8 22.90±1.46
股骨转子间骨折组 24 12 12 13 11 75±10 22.66±1.59
统计值   χ2=5.561 χ2=0.061 t=1.483 t=0.627
P值   0.118 0.804 0.143 0.533
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）
组别 例数 高血压 2-型糖尿病 冠心病 脑梗死后遗症
股骨颈骨折组 45 18 4 2 12
股骨转子间骨折组 24 7 6 1 4
χ2值   1.389 3.278 0.879 0.003
P值   0.239 0.070 0.349 0.957
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）
组别 例数 显性失血量 术前隐性失血量 围手术期隐性失血量 总失血量
股骨颈骨折组 45 77.78±27.29 238.33±97.82 314.46±130.30 392.24±133.62
股骨转子间骨折组 24 160.42±51.03 344.80±130.01 459.73±173.34 620.15±171.11
t值   -7.390 -3.831 -3.923 -6.110
P值   <0.01 <0.01 <0.01 <0.01
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）
手术方式 例数 显性失血量 术后隐性失血量 围手术期隐性失血量 总失血量
股骨颈骨折全髋关节置换术 6 81.67±20.41 117.04±22.15 248.06±89.77 400.32±131.13
股骨颈骨折半髋关节置换术 39 75.64±27.80 108.23±42.24 324.67±126.72 339.72±150.43
股骨转子间骨折半髋关节置换术 13 169.23±56.04 141.02±59.36 453.06±108.09 622.29±202.31
股骨转子间骨折PFNA术 11 150.00±44.72 131.02±54.26 467.61±130.46 617.61±134.94
F值   26.843 7.865 5.579 12.524
P值   <0.01 <0.01 <0.01 <0.01
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