[1]杨鹏,刘冲.PFNA治疗老年股骨转子间骨折后隐匿性失血及其危险因素的横断面研究[J].中华老年骨科与康复电子杂志,2023,(05):301-306.[doi:10.3877/cma.j.issn.2096-0263.2023.05.008]
　Yang Peng,Liu Chong.A cross-sectional study on occult blood loss and its risk factors after PFNA treatment of intertrochanteric fractures in the elderly[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(05):301-306.[doi:10.3877/cma.j.issn.2096-0263.2023.05.008]
点击复制

PFNA治疗老年股骨转子间骨折后隐匿性失血及其危险因素的横断面研究()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2023年05期
页码:
301-306
栏目:
髋部骨折
出版日期:
2023-10-05

文章信息/Info

Title:
A cross-sectional study on occult blood loss and its risk factors after PFNA treatment of intertrochanteric fractures in the elderly
作者:
杨鹏; 刘冲
073000 定州市人民医院骨一科
Author(s):
Yang Peng;  Liu Chong
Department of Orthopaedics, Dingzhou People’s Hospital, Dingzhou 073000, China
关键词:
股骨转子间骨折;  老年人;  髓内钉;  失血;  危险因素
Keywords:
Intertrochanteric fractures;  Aged;  Intramedullary Nailing;  Blood loss;  Risk factors
DOI:
10.3877/cma.j.issn.2096-0263.2023.05.008
文献标志码:
A
摘要:
目的 分析股骨近端防旋髓内钉（PFNA）治疗老年股骨转子间骨折围手术期隐匿性失血的相关危险因素。方法 回顾性分析2018年1月至2019年12月于定州市人民医院行PFNA手术治疗的老年转子间骨折患者的临床资料。记录患者手术前一天和术后第三天血红蛋白和红细胞压积动态变化，并分别采用Nadler和Gross公式计算患者总血容量和隐匿性失血量。采用皮尔逊相关性单因素分析及多元线性回归分析围手术期发生隐匿性失血的危险因素。结果 共纳入老年转子间骨折患者156例，男性68例，女性88例，所有纳入患者均得到随访，平均随访时间为（40.2±3.4）个月。平均年龄为（78.8±5.2）岁（65～92岁），平均身高（1.65±0.07）m，平均体重（61.1±9.8）kg，平均身体质量指数（BMI）为（22.4±3.1）kg/m2。总失血量为（912.4±167.0）mL，术中可见显性失血量为（232.5±82.0）ml，隐匿性失血量为（649.3±130.9）ml，占总失血量的74.1%±21.9%。单因素分析结果显示，骨折类型、BMI、麻醉方式、性别以及合并高血压均与围手术期隐匿性失血增加有显著相关性。多元线性回归分析结果显示，不稳定性骨折、BMI＜25 kg/m2、全身麻醉以及高血压是PFNA治疗老年转子间骨折发生隐匿性失血的独立危险因素。结论 隐匿性失血是股骨转子间骨折围手术期失血的主要原因，其独立危险因素包括不稳定性骨折、BMI＜25 kg/m2、全身麻醉以及高血压。正确认识PFNA围手术期隐匿性失血的危险因素，有助于改善老年转子间骨折患者预后，减少并发症的发生。
Abstract:
Objective To analyze the risk factors related to perioperative hidden blood loss in elderly patients with intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). Methods The clinical data of elderly patients with intertrochanteric fractures who underwent PFNA in Dingzhou People’s hospital from January 2018 to December 2019 were retrospectively analyzed. The dynamic changes of hemoglobin and hematocrit on the day before and the third day after surgery were recorded, and the total blood volume and hidden blood loss were calculated using Nadler and Gross formulas, respectively. Pearson correlation single factor analysis and multiple linear regression were used to analyze the risk factors for hidden blood loss during perioperative period. Results A total of 156 elderly patients with intertrochanteric fractures were included, including 68 males and 88 females, and all included patients were followed up with a mean follow-up time of (40.2±3.41) months. The mean age was (78.8±5.2) years (65-92 years), the mean height was (1.65±0.07) m, the mean weight was (61.1±9.8) kg, and the Body Mass Index (BMI) was (22.4±3.1) kg/m2. The total blood loss was (912.4±167.0) mL, the apparent intraoperative blood loss was (232.5±82.0) mL, and the hidden blood loss was (649.3±130.9) mL, accounting for 74.1%±21.9% of the total blood loss. Univariate analysis showed that fracture type, BMI, anesthesia style, gender, and hypertension were significantly associated with an increase in hidden blood loss during perioperative period. Multiple linear regression analysis showed that unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension were independent risk factors for hidden blood loss in elderly patients with intertrochanteric fractures treated with PFNA. Conclusions Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures of the femur, and its independent risk factors include unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension. Correctly understanding the risk factors of hidden blood loss during perioperative period of PFNA can help improve the prognosis of elderly patients with intertrochanteric fractures and reduce the occurrence of complications.

相似文献/References:

[1]沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林.锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析[J].中华老年骨科与康复电子杂志,2015,(02):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
　Shen Pengcheng,Zhu Lifan,Jiang Fugui,et al.Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
[2]刘文宣　张宇宸　刘文聪　高霞　李涛　张晓琳.CTR 基因多态性与老年男性骨质疏松的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
　Liu Wenxuan,Zhang Yuchen,Liu Wencong,et al.Association between calcitonin receptor gene polymorphism and osteoporosis in elderly men[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
[3]董仁卫　郭琪　王家仲　王连成.老年人群肌力水平与心血管疾病 三大危险因素的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
　Dong Renwei,Guo Qi,Wang Jiazhong,et al.The association between muscle strength level and three major risk factors of cardiovascular disease in elderly population[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
[4]李森磊,孙立,杨先腾,等.老年髋关节置换术后认知功能障碍的危险因素分析[J].中华老年骨科与康复电子杂志,2016,(02):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
　Li Senlei,Sun Li,Yang Xianteng,et al.Risk factors analysis for postoperative cognitive dysfunction in 　elderly patients undergoing hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
[5]钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J].中华老年骨科与康复电子杂志,2016,(02):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
　Zhong Junqing,Wang Liancheng..Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
[6]赵德伟,马志杰,杨磊,等.多孔钽金属涂层髋关节假体置换治疗老年股骨颈骨折的临床疗效观察[J].中华老年骨科与康复电子杂志,2016,(02):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
　Zhao Dewei,Ma Zhijie,Yang Lei,et al.Clinical investigation of hip implants by using porous tantalum coating in the treatment of elderly femoral neck fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
[7]吴啸波,裴宝瑞.老年髋部骨折围手术期相关问题的研究进展[J].中华老年骨科与康复电子杂志,2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
　Wu Xiaobo,Pei Baorui..Perioperative related problems of surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
[8]宋会平,张柳.阿仑膦酸钠治疗老年女性严重骨质疏松症患者的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
　Song Huiping,Zhang Liu.Effcacy analysis of alendronate in the treatment of severe osteoporosis in senile women[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
[9]柴仪,田伟明,温志刚.经皮椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
　Chai Yi,Tian Weiming,Wen Zhigang.Curative effective analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fracture in senile patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
[10]陈旭光,张天燕,单新１,等.围术期抑郁对老年骨科手术患者单核细胞组织因子表达及血小板功能的影响[J].中华老年骨科与康复电子杂志,2016,(03):155.[doi:10.3877//cma.j.issn2096-2063.2016.03.006]
　Chen Xuguang,Zhang Tianyan,Shan Xin,et al.Effect of depressive disorder on tissue factor expression of monocytes and platelet function in elderly patients undergoing orthopaedic surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):155.[doi:10.3877//cma.j.issn2096-2063.2016.03.006]
[11]曹发奇,谢旭东,胡益强,等.双反牵引器微创复位在老年不稳定型股骨转子间骨折的应用研究[J].中华老年骨科与康复电子杂志,2022,(06):325.[doi:10.3877/cma.j.issn.2096-0263.2022.06.002]
　Cao Faqi,Xie Xudong,Hu Yiqiang,et al.Application of minimally invasive reduction with double-reverse traction repositor in elderly unstable femoral intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2022,(05):325.[doi:10.3877/cma.j.issn.2096-0263.2022.06.002]

更新日期/Last Update: 2023-10-25