股骨转子间骨折围手术期隐性失血的比较研究

 目的 探讨围手术期不同内固定方式、不同时段隐性失血量的差异。方法 回顾性分析2008 年1 月至2012 年1 月应用动力髋螺钉(DHS)、股骨近端短重建钉(IMHS)和经皮加压钢板(PCCP)治疗AO/OTA 31-A1、31-A2 型股骨转子间骨折患者的围手术期临床资料, 其中DHS 组35 例, IMHS 组55 例, PCCP组38 例。比较不同内固定方式及不同时间段(术后第1 天、第2~3 天、第4~5天)的隐性失血量。结果 三种手术方式治疗股骨转子间骨折术后平均总隐性失血量是平均显性失血量的7 倍以上。PCCP、IMHS、DHS 组组间总隐性失血量比较, 差异均有统计学意义;而IMHS 组与DHS 组比较, 差异无统计学意义。对于阶段性隐性失血量, 在DHS 组三个时间段比较, 差异无统计学意义;在IMHS 组及PCCP 组, 术后第4~5 天与第1 天、第2~3 天比较差异均有统计学意义;而术后第1 天与第2~3 天比较差异无统计学意义。对于各组三个时间段阶段性隐性失血量/总隐性失血量比例, 术后第4~5 天与术后第1天、第2~3天比较, 差异均有统计学意义, 而术后第1 天与第2~3 天比较差异无统计学意义。结论 股骨转子间骨折围手术期隐性失血量远大于术中显性失血量。PCCP 组的总隐性失血量明显少于IMHS 组和DHS 组, 而IMHS 组与DHS 组的总隐性失血量相似。隐性失血主要发生在手术后的前3 d, 故术后前3 d应密切监测患者的血红蛋白变化, 及时评估患者的失血情况。

The perioperative hidden blood loss in intertrochanteric fractures: a comparative study

Objective To determine the perioperative hidden blood loss (HBL) associated with different fixation Methods for intertrochanteric fracture. Methods We retrospectively studied 128 patients with 31-A1 and 31-A2 intertrochanteric fractures which underwent internal fixation with dynamic hip screw (DHS, n=35), short reconstruction intramedullary hip screw (IMHS, n=55) or percutaneous compression plate (PCCP, n=38) from January 2008 to January 2012. The HBL were calculated and compared. Results The mean total hidden blood loss (THBL) was more than 7 times than the mean apparent blood loss (ABL) in all the three groups. For the THBL, there were significant statistical differences among three groups; no difference was found between IMHS and DHS group. For the phasic hidden blood loss (PHBL), there was no difference among the three phase of treatment in DHS group. But in IMHS and PCCP group, there were significant differences between the 4th-5th day and the 1st day, the 2nd-3rd day after operation; no difference was found between the 1st and the 2nd-3rd day. For the ratio of PHBL/THBL, there were significant differences between the 4th-5th day and the 1st day, the 2nd-3rd day after operation; but no statistical differences were found between the 1st day and the 2nd-3rd day after operation. Conclusion It can be concluded that HBL after surgery for intertrochanic fractures is much greater than that observed intra-operatively. The IMHS and DHS cause more HBL than PCCP. Frequent post-operative measurements of haemoglobin are necessary, especially the first three days after surgery.