老年股骨转子间骨折THA与PFNA治疗的围手术期失血情况分析

王波 范秋平 季卫平

[摘要] 目的 探讨老年股骨转子间骨折经人工全髋关节置换（THA）和股骨近端防旋髓内钉（PFNA）治疗的围手术期失血情况。 方法 选择我院2011年1月～2015年1月的老年股骨转子间骨折患者，其中关节置换组67例，PFNA组82例。将患者分为四组：有输血的PFNA组（A组），有输血的THA组（B组），无输血的PFNA组（C组），无输血的THA组（D组）；观察并比较术前及术后第1、4、7天的血红蛋白、白蛋白、输血量等指标。 结果 A、B组术前白蛋白与术后白蛋白下降值无统计学意义（P>0.05），C、D组术前白蛋白与术后白蛋白下降值有统计学意义（P<0.05）；A、B、C、D组术前与术后第1天血红蛋白差值有统计学意义（P<0.05）；A、B组术后第1天与术后第4天血红蛋白差值有统计学意义（P<0.05），C、D组术后第1天与术后第4天血红蛋白差值无统计学意义（P>0.05）；A、B、C、D组术后第4天与术后第7天血红蛋白差值无统计学意义。 结论 THA组输血量相对大。输血组白蛋白下降无统计学意义，未输血组THA白蛋白下降更加明显。术后两种手术方式均有白蛋白和血红蛋白下降，输血PFNA组下降时间略晚于THA组。两种手术方式，无论有没有输血，术后第4天后血红蛋白均有明显上升趋势。

[关键词] 股骨转子间骨折；全髋关节置换；股骨近端防旋髓内钉；围手术期失血

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2015）34-0074-03

Evaluation of perioperative blood loss following THA and PFNA for intertrochanteric fracture in aged patients

WANG Bo FAN Qiuping JI Weiping

Department of Orthopaedics， the Sixth Affiliated Hospital of Wenzhou Medical University， Lishui People's Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the perioperative blood loss following total hip arthroplasty （THA） and proximal femoral nail antirotation（PFNA） for intertrochanteric fracture in aged patients. Methods Elderly patients with intertrochanteric fracture who treated in our hospital from January 2011 to January 2015 were analyzed. Sixty-seven patients underwent THA， and the other 82 patients underwent PFNA. The patients were divided into four groups： PFNA with blood transfusion （group A）， THA with blood transfusion （group B）， PFNA without blood transfusion （group C）， and THA without blood transfusion （group D）. Hemoglobin， albumin， blood transfusion volume and other indicators were observed and compared preoperatively and at 1 day， 4 days and 7 days postoperatively. Results There was no significant decrease in pre- and postoperative albumin value was found in group A or B （P>0.05）， while the decrease was significant in group C and D （P<0.05）. The difference in hemoglobin between preoperative and 1 day postoperative values was statistically significant in group A， B， C and D （P<0.05）. The difference in hemoglobin between 1 day and 4 days after surgery was statistically significant in group A and B （P<0.05）， while it was not significant in group C and D （P>0.05）. No significant difference in hemoglobin was found between 4 days and 7 days after surgery in group A， B， C or D （P>0.05）. Conclusion The THA group required more blood transfusion relatively. The decline in albumin is not statistically significant in transfusion group while it is significant in THA without blood transfusion group. Both of the surgical methods caused decreases in albumin and hemoglobin after surgery. The decrease is slightly later in the PFNA with blood transfusion group than in the THA group. Hemoglobin is significantly increased in both surgical methods at 4 days after surgery， no matter blood transfusion is used or not.

[Key words] Intertrochanteric fracture； Total hip arthroplasty； Proximal femoral nail antirotation； Perioperative blood loss

股骨转子间骨折是老年人常见的骨折。引起老年人股骨转子间骨折的因素主要有骨质疏松、老年人活动不便、其他内科疾病[1]，且随着老年人年龄增长，越来越容易发生股骨转子间骨折[2]。目前治疗老年股骨转子间骨折的方式主要有非手术治疗、外固定支架固定、髓外系统固定、髓内系统固定、人工关节置换等。由于手术的方式相对较多，且尚无定论，目前对于老年股骨转子间骨折患者的手术方式选择还存在较大争议，不同专业方向的医生持有不同的见解，创伤骨科的医生倾向于选择髓内系统固定，关节外科的医生则罗列很多关节置换的优点[3-6]。既往对……