FHR治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义

FHR治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义

杨中良,董鹤萍,黄伟杰,吴洪亮

上海国龙医院,上海浦东新区浦南医院,上海浦东新区浦南医院,上海浦东新区浦南医院

收稿日期:2018-09-13 修回日期:2018-11-28 出版日期:2019-04-25
基金资助:
浦东新区卫生和计划生育委员会卫生计生科研项目（项目编号：PW2017B-21；项目名称：PRF-BMP复合物联合空心加压螺钉治疗股骨胫骨折）

Clinical Significance of Perioperative Hidden Blood Loss in Very Elderly Patients with Unstable Femoral Intertrochanteric Fracture Treated by Femoral Head Replacement

YANG ZhongLiang,DONG HePing,HUANG WeiJie and WU HongLiang

Shanghai Guolong Hospital,Shanghai Punan Hospital of Pudong New District,Shanghai Punan Hospital of Pudong New District,Shanghai Punan Hospital of Pudong New District

Received:2018-09-13 Revised:2018-11-28 Online:2019-04-25

摘要/Abstract

摘要： 目的：分析生物型人工股骨头置换（FHR）治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义。方法：选取2013年 1月至2017年6月我院165例实施手术治疗的高龄不稳定型股骨粗隆间骨折患者作为研究对象，其中生物型FHR组患者68例，股骨近端防旋髓内钉手术（PFNA）组患者97例。FHR组患者根据术后1周复查血红蛋白（Hb）水平，分为高Hb亚组（≥9 g?dL-1）和低Hb亚组（＜9 g?dL-1）。比较FHR组和PFNA组患者围术期总失血量、隐性失血量、术中出血量、手术时间、手术切口长度、下床时间及髋关节功能优良率的差异。对高Hb亚组和低Hb亚组的Hb量、红细胞压积（Hct）、院内感染、术后1个月和12个月髋关节Harris评分及功能独立性评定（FIM）评分进行分析比较。结果：FHR组患者围术期总失血量、隐性失血量、术中出血量、手术时间及手术切口长度均大于/长于PFNA组，而下床时间短于PFNA组，P<0.01。FHR组与PFNA组患者的隐性失血量均占总失血量的60%以上。FHR组患者中低Hb亚组院内感染率高于高Hb亚组，低Hb亚组术后1周Hb和Hct水平、术后1个月和12个月的Harris评分及FIM评分均低于高Hb亚组，P<0.01。结论：FHR治疗高龄不稳定型股骨粗隆间骨折疗效快，但总失血量高于PFNA组患者，其中隐性失血量占总失血量的60%以上。术后中重度贫血（＜9 g?dL-1）患者院内感染率增高，影响了髋关节功能的恢复。围术期定期监测Hb有助于及时发现并纠正贫血，改善患者的预后。

Abstract: Objective：To analyze the perioperative hidden blood loss and associated clinical significance in very elderly patients with unstable femoral intertrochanteric fracture treated by femoral head replacement (FHR). Methods：165 elderly patients (≥80 years old) with unstable femoral intertrochanteric fracture were included in this study between January 1， 2013 and June 30， 2017. Of the patients，68 received FHR operations（FHR group）， and 97 patients received operations of proximal femoral nail anti-rotation（PFNA group）. The patients in FHR group were divided into high hemoglobin(Hb) subgroup and low Hb subgroup according to Hb level a week after surgery. Such indicators as total blood loss， hidden blood loss， visible blood loss， operation duration， incision length getting-out-of-bed time， and excellent rates of hip function recovery were measured and analyzed for the two groups. The Hb, Hct, nosocomial infection rate and hip function Harris scale and function independence measure (FIM) scores were compared between high Hb subgroup (Hb≥9 g?dL-1) and low Hb subgroup (Hb＜9 g?dL-1). Results：The perioperative total blood loss， hidden blood loss， visible blood loss， operation duration and incision length in FHR group were significantly more or longer than PFNA group， while getting-out-of-bed time was significantly shorter than PFNA group， P< 0.01. Hidden blood loss was above 60% of total blood loss in both groups. Nosocomial infection rate in low Hb subgroup was higher than high Hb subgroup， while Harris scores and FIM scores at postoperative 1 month and 12 months were lower than low Hb group， P< 0.01. Conclusion： FHR is effective in the treatment of elderly unstable intertrochanteric fractures.The perioperative hidden blood loss accounting for over 60% of total blood loss in very elderly patients with unstable femoral intertrochanteric fracture treated by FHR， and was more than in those patients treated by PFNA. Post-operative moderate-severe anemia (Hb＜9 g?dL-1) resulted in an increase in nosocomial infection rate and a decrease in hip function recuperation. Perioperative regular monitoring of Hb levels helps to identify and rectify anemia and improve prognosis.

杨中良,董鹤萍,黄伟杰,吴洪亮. FHR治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义[J]. .

YANG ZhongLiang,DONG HePing,HUANG WeiJie and WU HongLiang. Clinical Significance of Perioperative Hidden Blood Loss in Very Elderly Patients with Unstable Femoral Intertrochanteric Fracture Treated by Femoral Head Replacement[J]. .

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