股骨近端防旋髓内钉治疗股骨转子间骨折围术期输血的危险因素分析

目的 :探讨应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折及患者围手术期输血的危险因素。方法:对2018年7月至2020年1月接受PFNA治疗的109例老年股骨转子间骨折患者的临床资料进行回顾性分析,术前均行骨盆双髋X线及CT平扫检查明确诊断,通过对患者术前术中基本资料的统计学分析,探究围术期输血的危险因素。结果:对109例患者进行Logistic回归分析,发现年龄(P=0.013),骨折类型(P0.01),糖尿病病史(P=0.031)以及术前血红蛋白(P0.01)是PFNA治疗老年股骨转子间骨折围术期需要输血的独立危险因素,经Spearman相关分析发现输血与患者年龄(P=0.017),骨折类型(P0.01),糖尿病病史(P=0.023)呈现正相关关系,而与术前血红蛋白(P0.01)呈现负相关关系。而性别(P=0.297),高血压病史(P=0.318),手术时间(P=0.325)等因素与围术期输血无显著关系。结论:年龄,骨折类型,糖尿病病史以及术前血红蛋白是PFNA治疗老年股骨转子间骨折围术期需要输血的独立危险因素,患者年龄越大,有糖尿病病史,骨折越不稳定,术前血红蛋白越低,越有可能需要输血,这可能为临床围术期输血决策提供参考。

Analysis of risk factors of perioperative blood transfusion in the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation

Objective: To explore the influencing factors of perioperative blood transfusion in the treatment of elderly femoral intertrochanteric fractures with proximal femoral nail antirotation(PFNA).Methods: The clinical data of 109 elderly patients with intertrochanteric fractures who received PFNA treatment from July 2018 to January 2020 were retrospectively analyzed. Both pelvic hip X-rays and CT plain scans were performed before surgery. All patients were diagnosed by X-ray and CT plain scan of pelvis and hip before operation. Through the statistical analysis of the basic data of patients before and during operation,the risk factors of perioperative blood transfusion were explored.Results: Logistic regression analysis showed that age (P=0.013),fracture type (P<0.01),diabetes history (P=0.031) and preoperative hemoglobin (P<0.01) were independent risk factors for perioperative blood transfusion in the treatment of intertrochanteric fractures in elderly patients with 109 patients. Spearman correlation analysis showed that there was a positive correlation between blood transfusion and age of patients (P=0.017),fracture type (P<0.01),diabetes history (P=0.023),and negatively correlated with preoperative hemoglobin (P<0.01). However,gender (P=0.297),history of hypertension (P=0.318) and operation time(P=0.325) had no significant relationship with perioperative blood transfusion.Conclusion: Age,fracture type,diabetes history,and preoperative hemoglobin are independent risk factors for perioperative blood transfusion in the treatment of elderly intertrochanteric fractures with PFNA. The older the patient,the history of diabetes,the more unstable the fracture,and the lower preoperative hemoglobin,the more likely it is to require a blood transfusion,which may provide a reference for clinical perioperative blood transfusion decisions.