两种手术方式治疗老年股骨转子间骨折的围手术期失血量比较

目的：比较股骨近端防旋髓内钉和动力髋螺钉内固定治疗老年股骨转子间骨折的围手术期失血量。方法：回顾性分析接受手术治疗的316例老年股骨转子间骨折患者的临床资料，采用股骨近端防旋髓内钉固定者189例，采用动力髋螺钉内固定者127例，比较2组患者的围手术期失血量，并分别比较2组中不同年龄范围患者的围手术期失血量。结果：①2组患者围手术期失血量比较结果。2组患者术前隐性失血量比较，差异无统计学意义（138．29±40．46）mL，（141．76±42．57）mL；t=0．931，P=0．189]；动力髋螺钉组的术后隐性失血量小于股骨近端防旋髓内钉组（301．75±110．13）mL，（210．36±42．59）mL；t=8．129，P=0．000]；2组患者术后显性失血量比较，差异无统计学意义（101．68±22．40）mL，（97．13±20．38）mL；t=1．453，P=0．098]。②股骨近端防旋髓内钉组中不同年龄范围患者围手术期失血量比较结果。股骨近端防旋髓内钉组中年龄≥80岁患者的术前隐性失血量和术后隐性失血量均大于年龄〈80岁的患者（158．29±48．26）mL，（87．27±32．13）mL；t=14．178，P=0．000；（326．84±100．63）mL，（215．26±32．27）mL；t=9．406，P=0．000]；但两者术后显性失血量比较，差异无统计学意义（104．47±17．50）mL，（99．44±21．11）mL；t=1．603，P=0．082]。③动力髋螺钉组中不同年龄范围患者围手术期失血量比较结果。动力髋螺钉组中年龄≥80岁患者的术前隐性失血量和术后隐性失血量均大于年龄〈80岁的患者（149．76±50．16）mL，（94．67±28．93）mL；t=11．296，P=0．000；（246．67±38．69）mL，（190．00±21．52）mL；t=15．082，P=0．000]；但两者术后显性失血量比较，差异无统计学意义（96．29±16．96）mL，（97．25±19．93）mL；t=0．128，P=0．293]。结论：动力髋螺钉内固定治疗老年股骨

Comparison of perioperative blood loss of two kinds of surgery for treatment of intertrochanteric fractures in aged patients

Objective：To compare the perioperative blood loss between proximal femoral nail antirotation（PFNA） fixation and dynamic hip screw（DHS） fixation in treatment of intertroehanterie fractures in aged patients. Methods：The clinical records of 316 patients with in- tertrochanteric fractures were analyzed retrospectively. One hundred and eighty-nine patients were treated with PFNA fixation （PFNA group） ,while 127 patients were treated with DHS fixation（ DHS group）. The perioperative blood loss were compared between the 2 groups and between different ages in each group. Results ： There was no statistical difference in preoperative hidden blood loss between the 2 groups （ 138.29 ＋/-40.46 vs 141.76 ＋/-42.57 ml,t =0. 931 ,P =0. 189） ,while the postoperative hidden blood loss of DHS group was less than that of PFNA group（ 301.75 ＋/-110.13 vs 210.36 ＋/-42.59 ml, t = 8. 129, P = 0. 000）. There was no statistical difference in postopera- tive dominant blood loss between the 2 groups （ 101.68 ＋/- 22.40 vs 97.13 ＋/- 20.38 ml, t = 1. 453, P = 0. 098 ）. The preoperative and postoperative hidden blood loss was greater in patients ≥ 80years compared to patients 〈 80years in PFNA group （ 158.29 ＋/- 48.26 vs 87.27 ＋/- 32.13 ml,t = 14. 178 ,P =0. 000 ;326.84 ＋/- 100.63 vs 215.26 ＋/-32.27 ml,t = 9. 406,P =0.000） ,while there was no statistical difference in postoperative dominant blood loss between them（ 104.47 ＋/- 17.50 vs 99.44 ＋/- 21.11 ml, t = 1. 603, P = 0. 082）. The preoperative and postoperative hidden blood loss was greater in patients ≥ 80years compared to patients 〈 80years in DHS group （ 149.76 ＋/- 50.16 vs 94.67 ＋/- 28.93 ml, t = 11. 296,P = 0. 000 ;246.67 ＋/- 38.69 vs 190.00 ＋/- 21.52 ml, t = 15. 082, P = 0. 000 ）, while there was no statistical difference in postoperative dominant blood loss between them（96.29 ＋/- 16.96 vs 97.25 ＋/- 19.93 ml,t = 0. 128 ,P = 0. 293 ）. Conclusion ：The postoperative hidden blood loss is less in DHS