FHR治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义
|
摘要
目的:分析生物型人工股骨头置换(FHR)治疗高龄不稳定型股骨粗隆间骨折患者围术期隐性失血量及其临床意义。方法:选取2013年1月至2017年6月我院165例实施手术治疗的高龄不稳定型股骨粗隆间骨折患者作为研究对象,其中生物型FHR组患者68例,股骨近端防旋髓内钉手术(PFNA)组患者97例。FHR组患者根据术后1周复查血红蛋白(Hb)水平,分为高Hb亚组(≥9 g·dL~(-1))和低Hb亚组(<9 g·dL~(-1))。比较FHR组和PFNA组患者围术期总失血量、隐性失血量、术中出血量、手术时间、手术切口长度、下床时间及髋关节功能优良率的差异。对高Hb亚组和低Hb亚组的Hb量、红细胞压积(Hct)、院内感染、术后1个月和12个月髋关节Harris评分及功能独立性评定(FIM)评分进行分析比较。结果:FHR组患者围术期总失血量、隐性失血量、术中出血量、手术时间及手术切口长度均大于/长于PFNA组,而下床时间短于PFNA组,P<0.01。FHR组与PFNA组患者的隐性失血量均占总失血量的60%以上。FHR组患者中低Hb亚组院内感染率高于高Hb亚组,低Hb亚组术后1周Hb和Hct水平、术后1个月和12个月的Harris评分及FIM评分均低于高Hb亚组,P<0.01。结论:FHR治疗高龄不稳定型股骨粗隆间骨折疗效快,但总失血量高于PFNA组患者,其中隐性失血量占总失血量的60%以上。术后中重度贫血(<9 g·dL~(-1))患者院内感染率增高,影响了髋关节功能的恢复。围术期定期监测Hb有助于及时发现并纠正贫血,改善患者的预后。
Objective:To analyze the perioperative hidden blood loss and associated clinical significance in very elderly patients with unstable femoral intertrochanteric fracture treated by femoral head replacement(FHR). Methods:165 elderly patients(≥80 years old) with unstable femoral intertrochanteric fracture were included in this study between January 1, 2013 and June 30, 2017. Of the patients,68 received FHR operations(FHR group), and 97 patients received operations of proximal femoral nail anti-rotation(PFNA group). The patients in FHR group were divided into high hemoglobin(Hb) subgroup and low Hb subgroup according to Hb level a week after surgery. Such indicators as total blood loss, hidden blood loss, visible blood loss, operation duration, incision length getting-out-of-bed time, and excellent rates of hip function recovery were measured and analyzed for the two groups. The Hb, Hct, nosocomial infection rate and hip function Harris scale and function independence measure(FIM) scores were compared between high Hb subgroup(Hb≥9 g·dL~(-1)) and low Hb subgroup(Hb<9 g·dL~(-1)). Results:The perioperative total blood loss, hidden blood loss, visible blood loss, operation duration and incision length in FHR group were significantly more or longer than PFNA group, while getting-out-of-bed time was significantly shorter than PFNA group, P< 0.01. Hidden blood loss was above 60% of total blood loss in both groups. Nosocomial infection rate in low Hb subgroup was higher than high Hb subgroup, while Harris scores and FIM scores at postoperative 1 month and 12 months were lower than low Hb group, P< 0.01. Conclusion: FHR is effective in the treatment of elderly unstable intertrochanteric fractures.The perioperative hidden blood loss accounting for over 60% of total blood loss in very elderly patients with unstable femoral intertrochanteric fracture treated by FHR, and was more than in those patients treated by PFNA. Post-operative moderate-severe anemia(Hb<9 g·dL~(-1)) resulted in an increase in nosocomial infection rate and a decrease in hip function recuperation. Perioperative regular monitoring of Hb levels helps to identify and rectify anemia and improve prognosis.
Objective:To analyze the perioperative hidden blood loss and associated clinical significance in very elderly patients with unstable femoral intertrochanteric fracture treated by femoral head replacement(FHR). Methods:165 elderly patients(≥80 years old) with unstable femoral intertrochanteric fracture were included in this study between January 1, 2013 and June 30, 2017. Of the patients,68 received FHR operations(FHR group), and 97 patients received operations of proximal femoral nail anti-rotation(PFNA group). The patients in FHR group were divided into high hemoglobin(Hb) subgroup and low Hb subgroup according to Hb level a week after surgery. Such indicators as total blood loss, hidden blood loss, visible blood loss, operation duration, incision length getting-out-of-bed time, and excellent rates of hip function recovery were measured and analyzed for the two groups. The Hb, Hct, nosocomial infection rate and hip function Harris scale and function independence measure(FIM) scores were compared between high Hb subgroup(Hb≥9 g·dL~(-1)) and low Hb subgroup(Hb<9 g·dL~(-1)). Results:The perioperative total blood loss, hidden blood loss, visible blood loss, operation duration and incision length in FHR group were significantly more or longer than PFNA group, while getting-out-of-bed time was significantly shorter than PFNA group, P< 0.01. Hidden blood loss was above 60% of total blood loss in both groups. Nosocomial infection rate in low Hb subgroup was higher than high Hb subgroup, while Harris scores and FIM scores at postoperative 1 month and 12 months were lower than low Hb group, P< 0.01. Conclusion: FHR is effective in the treatment of elderly unstable intertrochanteric fractures.The perioperative hidden blood loss accounting for over 60% of total blood loss in very elderly patients with unstable femoral intertrochanteric fracture treated by FHR, and was more than in those patients treated by PFNA. Post-operative moderate-severe anemia(Hb<9 g·dL~(-1)) resulted in an increase in nosocomial infection rate and a decrease in hip function recuperation. Perioperative regular monitoring of Hb levels helps to identify and rectify anemia and improve prognosis.
引文
[1] Cai LY,Wang T,Lu D,et al.Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly:a prospective randomised controlled trial exploring hidden perioperative blood loss[J].BMC musculoskelet disord,2016,17(1):475.
[2] Borges A,Torres J,S?o Sim?o R,et al.Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures[J].Acta Med Port,2014,27(2):218-222.
[3] Li BH,Li J,Wang SX,et al.Clinical analysis of perioperative hidden blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation[J].Sci Rep,2018,8(1):3225.
[4] Liu Y,Sun Y,Fan L,et al.Perioperative factors associated with hidden blood loss in intertrochanteric fracture patients[J].Musculoskelet Surg,2017,101(2):139-144.
[5] Yang X,Wu Q,Wang X.Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations[J].Injury,2017,48(8):1848-1852.
[6] 马文彬,王东.股骨粗隆间骨折治疗进展[J].中国社区医生,2017,33(22):5-7.
[7] Gross JB.Estimating allowable blood loss corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
[8] Hao Z,Wang X,Zhang X.Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time:a network meta-analysis[J].J Orthop Surg Res,2018,13(1):157.
[9] 翁天才,曾文磊,熊昌盛,等.PFNA内固定对老年股骨粗隆间骨折功能恢复的意义[J].中国医药导刊,2015,17(3):258-259.
[10] Setiobudi T,Ng YH,Lim CT,et al.Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw[J].Ann Acad Med Singapore,2011,40(11):482-487.
[11] 卢冰,刘攀,王跃,等.老年股骨粗隆间骨折髓内钉固定围手术期中隐性失血现象的病例对照研究[J].中国骨伤,2015,28(11):1032-1036.
[12] 潘益山,李国庆.内固定与GTF假体置换在老年股骨转子间骨折中的比较研究[J].中国医药导刊,2017,19(4):370-371.
[13] 李长民,李爱民.人工双极股骨头置换治疗高龄股骨转子间骨折[J].临床骨科杂志,2009,12(1):53-55.
[14] Li H,Wang Q,Dai GG,et al.PFNA vs.DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures[J].Eur Rev Med Pharmacol Sci,2018,22(1 Suppl):1-7.
[15] Man CH,Bae MW.Method for removing broken proximal femoral nails using existing screw hole [J].Acta Ortop Bras,2018,26(1):72-74.
[16] Fairag R,Abduljabbar FH,Page A,et al.Are cephalomedullary nail guides accurate?a case report of an unexpected complication after nailing an intertrochanteric femoral fracture[J].Geriatr Orthop Surg Rehabil,2018,9:2151458518757797.
[17] Konya MN,Korkusuz F,Maralcan G,et al.The use of a proximal femoral nail as a hip prosthesis:a biomechanical analysis of a newly designed implant[J].Proc Inst Mech Eng H,2018,232(2):200-206.
[18] Shen L,Zhang Y,Shen Y,et al.Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures:a meta-analysis of randomized controlled studies[J].Orthop Traumatol Surg Res,2013,99(4):377-383.
[19] 马勇.不同内固定方法结合康复训练治疗老年股骨粗隆间骨折患者的疗效观察[J].中国医药导刊,2014,16(5):815-816.
[20] Frisch NB,Wessell N,Charters M,et al.Hip fracture mortality:differences between intertrochanteric and femoral neck fractures[J].J Surg Orthop Adv,2018,27(1):64-71.
[2] Borges A,Torres J,S?o Sim?o R,et al.Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures[J].Acta Med Port,2014,27(2):218-222.
[3] Li BH,Li J,Wang SX,et al.Clinical analysis of perioperative hidden blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation[J].Sci Rep,2018,8(1):3225.
[4] Liu Y,Sun Y,Fan L,et al.Perioperative factors associated with hidden blood loss in intertrochanteric fracture patients[J].Musculoskelet Surg,2017,101(2):139-144.
[5] Yang X,Wu Q,Wang X.Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations[J].Injury,2017,48(8):1848-1852.
[6] 马文彬,王东.股骨粗隆间骨折治疗进展[J].中国社区医生,2017,33(22):5-7.
[7] Gross JB.Estimating allowable blood loss corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
[8] Hao Z,Wang X,Zhang X.Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time:a network meta-analysis[J].J Orthop Surg Res,2018,13(1):157.
[9] 翁天才,曾文磊,熊昌盛,等.PFNA内固定对老年股骨粗隆间骨折功能恢复的意义[J].中国医药导刊,2015,17(3):258-259.
[10] Setiobudi T,Ng YH,Lim CT,et al.Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw[J].Ann Acad Med Singapore,2011,40(11):482-487.
[11] 卢冰,刘攀,王跃,等.老年股骨粗隆间骨折髓内钉固定围手术期中隐性失血现象的病例对照研究[J].中国骨伤,2015,28(11):1032-1036.
[12] 潘益山,李国庆.内固定与GTF假体置换在老年股骨转子间骨折中的比较研究[J].中国医药导刊,2017,19(4):370-371.
[13] 李长民,李爱民.人工双极股骨头置换治疗高龄股骨转子间骨折[J].临床骨科杂志,2009,12(1):53-55.
[14] Li H,Wang Q,Dai GG,et al.PFNA vs.DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures[J].Eur Rev Med Pharmacol Sci,2018,22(1 Suppl):1-7.
[15] Man CH,Bae MW.Method for removing broken proximal femoral nails using existing screw hole [J].Acta Ortop Bras,2018,26(1):72-74.
[16] Fairag R,Abduljabbar FH,Page A,et al.Are cephalomedullary nail guides accurate?a case report of an unexpected complication after nailing an intertrochanteric femoral fracture[J].Geriatr Orthop Surg Rehabil,2018,9:2151458518757797.
[17] Konya MN,Korkusuz F,Maralcan G,et al.The use of a proximal femoral nail as a hip prosthesis:a biomechanical analysis of a newly designed implant[J].Proc Inst Mech Eng H,2018,232(2):200-206.
[18] Shen L,Zhang Y,Shen Y,et al.Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures:a meta-analysis of randomized controlled studies[J].Orthop Traumatol Surg Res,2013,99(4):377-383.
[19] 马勇.不同内固定方法结合康复训练治疗老年股骨粗隆间骨折患者的疗效观察[J].中国医药导刊,2014,16(5):815-816.
[20] Frisch NB,Wessell N,Charters M,et al.Hip fracture mortality:differences between intertrochanteric and femoral neck fractures[J].J Surg Orthop Adv,2018,27(1):64-71.