目的 探讨股骨近端防旋髓内钉（proximal femoral nail antirotation, PFNA）治疗老年股骨粗隆间骨折（femoral intertrochanteric fracture, FIF）患者术后发生隐性失血的相关因素。方法 选取2017年5月—2021年5月于徐州市第一人民医院骨科接受PFNA治疗的120例老年股骨粗隆间骨折患者为研究对象。计算PFNA术后显性失血量、隐性失血量及总失血量;统计分析所有患者临床资料,并将可能的影响因素纳入,经单因素与多因素分析找出老年FIF患者行PFNA内固定术后发生隐性失血的影响因素。结果 PFNA手术显性、隐性及总失血量分别为（235.87±70.65） mL、（712.58±134.25） mL、（947.77±208.91） mL。单因素及多因素logistic分析显示,年龄≥75岁、不稳定性骨折、合并高血压、糖尿病、手术时间>60 min、术前抗凝治疗均为影响老年FIF患者行PFNA内固定术后发生隐性失血的危险因素（P<0.05）。结论 隐性失血是导致老年FIF患者经PFNA内固定治疗后围术期失血的主要原因,其中年龄≥75岁、不稳定性骨折、合并高血压、糖尿病、手术时间>60 min、术前抗凝治疗均为重要的危险因素,因此,临床可采取相应措施防治行PFNA内固定术治疗的老年FIF患者,以改善预后,减少隐性失血发生。
Objective To investigate the related factors affecting postoperative hidden hemorrhage in elderly patients with femoral intertrochanteric fracture （FIF） treated with proximal femoral nail antirotation （PFNA）. Methods A total of 120 elderly FIF patients who received PFNA treatment in the Department of Orthopedics of The First People's Hospital of Xuzhou from May 2017 to May 2021 were selected as study subjects. Apparent, hidden, and total blood loss volumes after PFNA were calculated. The clinical data of all patients were statistically analyzed, and possible influencing factors were included. Univariate and multivariate analyses were used to find out the influencing factors of hidden hemorrhage after PFNA internal fixation in elderly FIF patients. Results The apparent, hidden, and total blood loss volumes after PFNA were （235.87±70.65） mL, （712.58±134.25） mL, and （947.77±208.91） mL, respectively. Univariate and multivariate logistic analysis results showed that age≥75 years old, unstable fractures, being complicated with hypertension or diabetes, operation time>60 min, and preoperative anticoagulation therapy were all risk factors for the occurrence of hidden hemorrhage after PFNA internal fixation in elderly FIF patients （P<0.05）. Conclusion Hidden hemorrhage is the main cause of perioperative blood loss in elderly FIF patients treated with PFNA internal fixation, and age≥75 years, unstable fractures, being complicated with hypertension or diabetes, operation time>60 min, and preoperative anticoagulation therapy are important risk factors for hidden hemorrhage. Therefore, relevant clinical measures are suggested for elderly patients with FIF undergoing PFNA internal fixation to improve prognosis and reduce the occurrence of hidden hemorrhage.
[1] 刘敏, 张文平, 罗鹏, 等. 股骨近端防旋髓内钉内固定治疗老年股骨粗隆间骨折术中注射氨甲环酸对围手术期隐性失血和血浆D-二聚体水平的影响[J]. 临床外科杂志, 2018, 26(8): 598-601.
[2] 徐驰, 周勇, 赵军, 等. PFNA治疗老年股骨转子间骨折的隐性失血分析[J]. 中国矫形外科杂志, 2018, 26(6): 510-515.
[3] 李锐军, 林浙龙, 周正茂, 等. 股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的隐性失血特点及影响因素[J]. 海南医学, 2018, 29(10): 1366-1368.
[4] 陈安民, 李锋. 骨科疾病诊疗指南.第3版[M]. 北京: 科学出版社, 2013: 56-58.
[5] 宋春健, 周荣, 黄永刚. 股骨近端防旋髓内钉治疗老年外侧壁薄弱型股骨粗隆间骨折隐性失血的相关因素分析[J]. 中国骨与关节杂志, 2020, 9(9): 708-711.
[6] 崔勇, 王鹏, 陈会超, 等. 股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的应用体会[J]. 中国矫形外科杂志, 2017, 25(10):946-949.
[7] 印杰, 顾小华, 陆海健. 股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的疗效观察[J]. 海军医学杂志, 2017, 38(2): 153-156.
[8] 戴海, 黄宗贵, 吴永祥. 股骨近端防旋髓内钉内固定微创治疗股骨粗隆间骨折临床研究[J]. 山西医药杂志, 2017, 46(23): 2890-2892.
[9] 陈灿, 马家富, 陈秋萍. 小切口股骨近端防旋髓内钉内固定术治疗股骨粗隆间骨折的临床效果[J]. 广西医学, 2019, 41(3): 388-390.
[10] 李祥义, 王汝武, 毕超, 等. 股骨近端防旋髓内钉内固定治疗老年不稳定性股骨粗隆间骨折53例临床观察[J]. 山东医药, 2020, 60(34): 85-87.
[11] 行斌斌, 程俊文, 周志康, 等. 股骨防旋髓内钉治疗老年股骨粗隆间骨折隐性失血的相关因素分析[J]. 中国药物与临床, 2020, 20(18): 3057-3059.
[12] 周建伟, 李绍平, 潘奕欣, 等. 股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的疗效及术后隐性失血的影响因素分析[J]. 现代生物医学进展, 2021, 21(6):1165-1168, 1159.
[13] 饶海军, 朱智奇, 林学扬. 股骨近端防旋髓内钉治疗老年股骨粗隆间骨折隐性失血的影响因素分析[J]. 中国医药导报, 2019, 16(9): 79-82.
[14] 朱江龙, 章晓云, 陈跃平, 等. PFNA治疗老年股骨粗隆间骨折隐性失血的相关因素分析[J]. 中国骨与关节损伤杂志, 2019, 34(4): 374-376.
[15] 宋倩, 杨英, 韩杨. 股骨粗隆间骨折PFNA内固定术后隐性失血的危险因素分析[J]. 中国骨与关节损伤杂志, 2020, 35(4):385-387.
