股骨近端防旋髓内钉治疗股骨转子间骨折中显性和隐性失血量分析

目的 对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation，PFNA)内固定方法治疗的老年股骨转子间骨折的术前和术中显性、隐性出血量进行临床分析，为临床围术期处理提供必要的数据支撑。 方法 回顾性分析2005年12月-2010年9月采用PFNA内固定治疗的216例股骨转子间骨折患者的临床资料，对患者术前、术后血常规以及术中、术后出血、输血情况等进行分析，对患者围术期的显性和隐性出血情况进行评估。 结果216例患者术中平均失血48.9ml，无一例进行术中输血。42例术后第2～4天血色素下降明显(＜9 g/L)患者进行输血，平均输血300 ml;216例患者术后的平均显性失血量为62.3ml，平均隐性失血量为385ml，男女之间差异无统计学意义。 结论 股骨转子间骨折老年患者比较多见，与术中微创操作所见的出血量极少(＜70 ml)不同，PFNA内固定治疗转子间骨折术后的隐性失血量较多，提示应严格注意术后患者的生命体征监测以减少并发症的产生。

Clinical analysis of obvious and hidden blood loss during treatment of intertrochanter fracture with proximal femoral nail anti-rotation

Objective To analyze the obvious and hidden preoperative and intraoperative blood loss during treatment of the intertrochanter fracture with proximal femoral nail anti-rotation (PFNA) so as to provide necessary data support for clinical perioperative treatment. Methods The clinical data of 216 patients with intertrochanteric fractured treated with PFNA between December 2005 and September 2010 were analyzed retrospectively.An analysis was done on preoperative and postoperative blood routine, perioperative and postoperative blood loss and transfusion, perioperative obvious and hidden blood loss and perioperative and postoperative blood transfusion.Results The average blood loss was 48.9ml during operation, with no blood transfusion.Obvious hemochrome decrease (＜9 g/L) was found in 42 patients at 2-4 days after operation and the patients received blood transfusion for mean 300 ml.The mean obvious blood loss was 62.3 ml, while the mean hidden blood loss was 385 ml in all the patients.There was no obvious difference between males and females. Conclusion The intertrochanter fracture is mostly seen in the elder patients.Compared with the minimal invasive operation, PFNA has more hidden blood loss, as indicates that much attention should be paid to the vital signs of the patients after surgery for prevention of the complications.