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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 ›› 2023, Vol. 09 ›› Issue (05) : 301 -306. doi: 10.3877/cma.j.issn.2096-0263.2023.05.008

髋部骨折

PFNA治疗老年股骨转子间骨折后隐匿性失血及其危险因素的横断面研究
杨鹏†(), 刘冲   
  1. 073000　定州市人民医院骨一科
  • 收稿日期:2023-05-24 出版日期:2023-10-05
  • 通信作者: 杨鹏

A cross-sectional study on occult blood loss and its risk factors after PFNA treatment of intertrochanteric fractures in the elderly

Peng Yang†(), Chong Liu   

  1. Department of Orthopaedics, Dingzhou People's Hospital, Dingzhou 073000, China
  • Received:2023-05-24 Published:2023-10-05
  • Corresponding author: Peng Yang
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杨鹏, 刘冲. PFNA治疗老年股骨转子间骨折后隐匿性失血及其危险因素的横断面研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 301-306.

Peng Yang, Chong Liu. A cross-sectional study on occult blood loss and its risk factors after PFNA treatment of intertrochanteric fractures in the elderly[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 301-306.

目的

分析股骨近端防旋髓内钉（PFNA）治疗老年股骨转子间骨折围手术期隐匿性失血的相关危险因素。

方法

回顾性分析2018年1月至2019年12月于定州市人民医院行PFNA手术治疗的老年转子间骨折患者的临床资料。记录患者手术前一天和术后第三天血红蛋白和红细胞压积动态变化，并分别采用Nadler和Gross公式计算患者总血容量和隐匿性失血量。采用皮尔逊相关性单因素分析及多元线性回归分析围手术期发生隐匿性失血的危险因素。

结果

共纳入老年转子间骨折患者156例，男性68例，女性88例，所有纳入患者均得到随访，平均随访时间为（40.2±3.4）个月。平均年龄为（78.8±5.2）岁（65~92岁），平均身高（1.65±0.07）m，平均体重（61.1±9.8）kg，平均身体质量指数（BMI）为（22.4±3.1）kg/m2。总失血量为（912.4±167.0）mL，术中可见显性失血量为（232.5±82.0）ml，隐匿性失血量为（649.3±130.9）ml，占总失血量的74.1%±21.9%。单因素分析结果显示，骨折类型、BMI、麻醉方式、性别以及合并高血压均与围手术期隐匿性失血增加有显著相关性。多元线性回归分析结果显示，不稳定性骨折、BMI<25 kg/m2、全身麻醉以及高血压是PFNA治疗老年转子间骨折发生隐匿性失血的独立危险因素。

结论

隐匿性失血是股骨转子间骨折围手术期失血的主要原因，其独立危险因素包括不稳定性骨折、BMI<25 kg/m2、全身麻醉以及高血压。正确认识PFNA围手术期隐匿性失血的危险因素，有助于改善老年转子间骨折患者预后，减少并发症的发生。

关键词: 股骨转子间骨折, 老年人, 髓内钉, 失血, 危险因素
Objective

To analyze the risk factors related to perioperative hidden blood loss in elderly patients with intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA).

Methods

The clinical data of elderly patients with intertrochanteric fractures who underwent PFNA in Dingzhou People's hospital from January 2018 to December 2019 were retrospectively analyzed. The dynamic changes of hemoglobin and hematocrit on the day before and the third day after surgery were recorded, and the total blood volume and hidden blood loss were calculated using Nadler and Gross formulas, respectively. Pearson correlation single factor analysis and multiple linear regression were used to analyze the risk factors for hidden blood loss during perioperative period.

Results

A total of 156 elderly patients with intertrochanteric fractures were included, including 68 males and 88 females, and all included patients were followed up with a mean follow-up time of (40.2±3.41) months. The mean age was (78.8±5.2) years (65-92 years), the mean height was (1.65±0.07) m, the mean weight was (61.1±9.8) kg, and the Body Mass Index (BMI) was (22.4±3.1) kg/m2. The total blood loss was (912.4±167.0) mL, the apparent intraoperative blood loss was (232.5±82.0) mL, and the hidden blood loss was (649.3±130.9) mL, accounting for 74.1%±21.9% of the total blood loss. Univariate analysis showed that fracture type, BMI, anesthesia style, gender, and hypertension were significantly associated with an increase in hidden blood loss during perioperative period. Multiple linear regression analysis showed that unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension were independent risk factors for hidden blood loss in elderly patients with intertrochanteric fractures treated with PFNA.

Conclusions

Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures of the femur, and its independent risk factors include unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension. Correctly understanding the risk factors of hidden blood loss during perioperative period of PFNA can help improve the prognosis of elderly patients with intertrochanteric fractures and reduce the occurrence of complications.

Key words: Intertrochanteric fractures, Aged, Intramedullary Nailing, Blood loss, Risk factors
表1 股骨转子间骨折患者围手术期失血参数
项目 ±s/[例（%）]
术前Hb<100 g/L患者数 28（17.9）
术后Hb<100 g/L患者数 121（77.6）
TBL（mL） 912.4±167.0
VBL（mL） 232.5±82.0
HBL（mL） 649.3±130.9
HBL/TBL（%） 74.1±21.9
表2 股骨转子间骨折患者围手术期参数与HBL单因素相关分析
项目 例数 隐性失血量 P值
性别      
男 68 607.9±129.5 <0.001
女 88 681.3±122.7  
年龄      
65~74 24 655.3±132.7 0.784
≥75岁 132 648.2±130.5  
侧别      
左 95 657.4±132.8 0.340
右 61 636.7±126.8  
BMI      
<25 109 691.5±120.2 <0.001
≥25 47 551.4±98.3  
骨折类型      
稳定 77 593.9±121.3 <0.001
不稳定 79 703.3±116.6  
受伤机制      
摔倒 105 654.8±130.4 0.451
车祸伤 51 637.9±131.1  
手术时间      
≤1 h 59 632.0±132.6 0.101
>1 h 97 659.8±128.7  
受伤至手术时间      
≤2 d 41 659.8±121.4 0.307
>2 d 115 645.5±133.9  
ASA评分      
1 9 686.7±93.1 0.307
2 58 655.2±133.7
3 89 641.7±131.5  
合并高血压      
是 99 686.3±117.3 <0.001
否 57 585.0±128.4  
合并糖尿病      
是 78 645.1±137.8 0.692
否 78 653.5±123.4  
麻醉方式      
全麻 77 695.6±95.3 <0.001
腰麻 79 604.1±144.4  
表3 PFNA术后HBL危险因素的多元线性回归分析
项目 B SE B的95%置信区间 P值
常量 929.746 90.941 750.055，1109.437 0.000
性别 27.264 16.991 -6.308，60.835 0.111
BMI -15.754 3.089 -21.859，9.650 0.000
骨折类型 44.435 17.747 9.369，79.501 0.013
合并高血压 49.867 18.027 14.247，85.487 0.006
麻醉方式 -45.805 16.971 -79.339，12.271 0.008
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