老年股骨粗隆间骨折髓内和髓外固定治疗显性及隐性失血量的初步分析

摘要

目的：对采取髓内固定和髓外固定两种内固定方法治疗老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析，以探讨对术后隐性失血量的影响。方法回顾性分析2010年1月1日～2013年12月31日间采用髓内内固定手术治疗的64例及采用髓外内固定手术治疗的87例股骨粗隆间骨折患者的临床资料，对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析，同时评估围手术期的显性、隐性失血情况。结果采用髓内固定治疗的患者平均术中失血（65.7±3.4） ml；术后平均显性失血量为（70.4±4.6）ml，平均隐性失血量为（431.6±17.8）ml。采用髓外固定治疗的患者平均术中失血量为（94.5±7.4）ml；术后平均显性失血量为（80.4±4.7）ml，平均隐性失血量为（298.4±5.3）ml。骨折髓外固定出血量均多于髓内固定（P＜0.01），但髓内固定术后隐性出血量及总体出血量均多于髓外固定（P＜0.01）。结论髓内固定和髓外固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量，但髓内固定术后隐性出血量更多，需引起重视。%Objective To analyze the overt and occult blood loss before and after operations in the elderly intertrochanteric fracture treated with intramedullary fixation and extramedullary fixation to provide data support for perioperative period treatment .Methods The clinical data of 64 cases of intertrochanteric fracture treated with ex-tramedullary fixation and 87 cases treated with intramedullary fixation from Jan .2010 to Dec.2013 were retrospec-tively analyzed , and the overt ,occult blood loss and blood transfusion before and after opertations were analyzed ,u-sing SPSS 13.0 statistical package.Results In the intramedullary fixation group,the average blood loss was (65.7 ±3.4)ml during operation.The average overt blood loss was (70.4 ±4.6)ml after operation and the average oc-cult blood loss was (431.6 ±17.8) ml.In the extramedullary fixation group ,the average blood loss was (94.5 ± 7.4)ml during operation.The average overt blood loss was (80.4 ±4.7)ml and the occult blood loss was (298.4 ±5.3)ml after operation.The blood loss during operation and overt blood loss after operation in the extramedullary fixation group was larger than that of the intramedullary fixation group ,while the occult blood loss of the extramedul-lary fixation group was smaller than that of the intramedullary fixation .The total blood loss and the occult blood loss of the intramedullary fixation gronp was bigger than that of the extramedullary fixation group .Conclusion There is much occult blood loss in both two groups for the internal fixation of the intertrochanteric fracture after operation , but more occult blood loss in the intramedullary fixation group .This reminds surgeons to monitor the life vital signs after internal and external fixation in order to decrease the complication .