目的：探讨经皮加压钢板( PCCP)内固定治疗老年股骨粗隆间骨折围手术期隐性失血的影响因素。方法回顾性分析2009年3月至2012年3月采用PCCP手术治疗的股骨粗隆间骨折136例患者临床资料,分析年龄、骨折类型、术前阿司匹林应用、合并内科疾病等对围手术期隐性失血的影响及不同血红蛋白( HGB)水平的患者分布情况。结果平均隐性失血量499 mL,占总失血量92.54%,HGB平均下降11 g/L,A2.3型与A3型骨折患者HGB<80 g/L入院时发生率6.62%,术后14.70%,A2.3型(862 mL)、A3型(698 mL)平均隐性失血分别高于A1型(430 mL)、A2.1型(450 mL)和A2.2型(415 mL),P<0.05为差异有统计学意义。多元线性回归分析表明,A2.3型与A3型骨折、术前阿司匹林应用是围手术期隐性失血量增加的独立危险因素。结论微创PCCP手术显性失血少,股骨粗隆间骨折是围手术期大量隐性失血的主要影响因素, A2.3型与 A3型骨折是围手术期HGB<80 g/L老年患者的早期预测因素。%Objective To explore the influence factors of hidden blood loss during the treatment of femoral intertrochanteric fractures with percutaneous compression plate( PCCP) in elder patient. Methods The data of 136 patients with intertrochanteric fracture in our hos-pital from March 2009 to March 2012 treated with percutaneous compression plate were retrospectively analyzed,the effect of age,fracture type,preoperative aspirin,internal diseases on perioperative hidden blood loss, and different haemoglobin ( HGB) levels in patients with dif-ferent distribution were analyzed. Results The mean hidden blood loss volume was 499 mL,which accounted for 92. 54% of the total blood loss. The mean HGB decline was 11 g/L. The rate of on admisson haemoglobin level lower than 80 g/L was 6. 62% in AO type A2. 3 and A3 groups,and the rate of postoperative haemoglobin level lower than 80 g/L was 14. 70%. The average hidden blood loss for AO type A2. 3 (862 mL) and A3 (698 mL) were higher than those for AO types A1 (430 mL),A2. 1 (450 mL) and A2. 2 (415 mL) (P<0. 05). Multi-variate linear regression analysis showed that comminuted fracture and preoperative aspirin treatment were independently associated with in-creased perioperative hidden blood loss. Conclusion It indicated that the overt blood loss was fewer for PCCP operation. Intertrochanteric fracture was the main reason for substantial perioperative hidden blood loss. Types A2. 3 and A3 intertrochanteric fracture were early predic-tive factors of postoperative haemoglobin level lower than 80 g/L in elderly patients.
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