股骨粗隆间骨折围手术期隐性失血影响因素分析

doi:10.3969/j.issn.2095-378X.2025.03.006

Abstract

Abstract: Objective To study the influencing factors of perioperative hidden blood loss of femoral intertrochanteric fractures and explore the risk factors for clinical intervention （in-hospital blood transfusion） using retrospective analysis. Methods Data of patients with intertrochanteric fracture admitted to our hospital from 2020 to 2022 were retrospectively analyzed. Their gender, age, height, weight, comorbidities, preoperative and postoperative blood routine test results, postoperative complications, surgical methods, operation time, intraoperative blood loss, and blood transfusion were retrieved, and grouped accordingly. A t-test was used to analyze the amount of blood loss between different groups, and a binary logistic regression was used to evaluate the risk factors for in-hospital blood transfusion secondary to perioperative hidden blood loss in patients. Results A total of 274 patients were retrospectively analyzed, including 125 males and 149 females, 151 cases with left fracture and 123 cases with right fractue. All of the patients were treated by surgery without serious complications. The average operation time was （65.16±23.61） min, the total blood transfusion volume was （386±293） mL, the total blood loss volume was （862±477） mL, of which the average hidden blood loss volume was （753±444） mL, and the average hospitalization was （12.77±4.69） d. Unstable fracture （Evans Ⅲ-Ⅳ） was an influencing factor for increased hidden blood loss （P<0.05）. Age, body mass index, and comorbidities had no significant effect on total blood loss or hidden blood loss volume. Long operative time and low preoperative hemoglobin level were main risk factors for blood transfusion secondary to perioperative hidden blood loss （P<0.05）. Conclusion Unstable fracture is an influencing factor for hidden blood loss during perioperative femoral intertrochanteric fractures, and long operation time and low preoperative hemoglobin level are risk factors for in-hospital blood transfusion secondary to perioperative hidden blood loss.

Key words: Intertrochanteric fracture of the femur, Perioperative period, Hidden blood loss, Risk factor

CLC Number:

R683.42

DAI Yahui, QIN Tao, SUN Yan. Influencing factors for perioperative hidden blood loss of femoral intertrochanteric fractures[J]. Surgical Research and New Technique, 2025, 14(3): 226-229.

References

[1] Cooper C, Campion G, Melton LR.Hip fractures in the elderly: a world-wide projection[J]. Osteoporos Int,1992,2(6):285-289.
[2] Elliott J, Beringer T, Kee F, et al.Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery[J]. J Clin Epidemiol,2003,56(8):788-795.
[3] Fansa A, Huff S, Ebraheim N.Prediction of mortality in nonagenarians following the surgical repair of hip fractures[J].Clin Orthop Surg,2016,8(2):140-145.
[4] Roberts KC, Brox WT, Jevsevar DS, et al.Management of hip fractures in the elderly[J]. J Am Acad Orthop Surg,2015,23(2):131-137.
[5] Sehat KR, Evans R, Newman JH.How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account[J]. Knee,2000,7(3):151-155.
[6] Gross JB.Estimating allowable blood loss:corrected for dilution[J]. Anesthesiology,1983,58(3):277-280.
[7] Ekstrom W, Al-Ani AN, Saaf M, et al.Health related quality of life,reoperation rate and function in patients with diabetes mellitus and hip fracture—a 2 year follow-up study[J]. Injury,2013,44(6):769-775.
[8] Borges A, Torres J, Sao SR, et al.Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures[J]. Acta Med Port,2014,27(2):218-222.
[9] 祝晓忠,张世民,王欣,等. 老年股骨转子间骨折PFNA内固定的隐性失血[J]. 中国矫形外科杂志,2010,18(17):1423-1426.
[10] Zhang S, Xiao C, Yu W, et al.Tranexamic acid safely reduces hidden blood loss in patients undergoing intertrochanteric fracture surgery:a randomized controlled trial[J]. Eur J Trauma Emerg Surg,2022,48(2):731-741.
[11] Lin P, Chien J, Hung J, et al.Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period:a retrospective case control study[J].BMC Musculoskelet Disord,2020,21(1).
[12] Ohmori T, Toda K, Kanazawa T, et al.Retrospective high volume comparative study suggests that patients on aspirin could have immediate surgery for hip fractures without significant blood loss[J]. Int Orthop,2021,45(3):543-549.
[13] Tian S, Shen Z, Liu Y, et al.The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA[J]. Injury,2018,49(3):680-684.
[14] Lei J, Zhang B, Cong Y, et al.Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA:a single-center randomized controlled trial[J]. J Orthop Surg Res,2017,12(1):124.
[15] Wei H, Xiao Q, He J, et al.Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA[J]. Medicine,2021,100(34):e27123.
[16] Li B, Li J, Wang S, et al.Clinical analysis of peri-operative hidden blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation[J]. Sci Rep,2018,8(1):3225.
[17] 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.

Influencing factors for perioperative hidden blood loss of femoral intertrochanteric fractures

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	WANG Jue, WEI Jianbo. Risk factors for recurrence of intracranial aneurysms after interventional treatment [J]. Surgical Research and New Technique, 2025, 14(2): 153-156.
[2]	GUAN Lina, ZHANG Yayun, ZHANG Di, GUO Ya, JIN Jie. Development and application of nursing training program for malignant hyperthermia in perioperative patients [J]. Surgical Research and New Technique, 2024, 13(2): 166-170.
[3]	LI Meijiao, GU Xiulan, HU Chuxia. Influencing factors for first cesarean section and impact of risk correction on reducing first cesarean section rate [J]. Surgical Research and New Technique, 2023, 12(4): 269-272.
[4]	ZHU Ning. Risk factors associated with difficult laryngeal exposure and application of adjustable support laryngoscope in laryngeal surgery [J]. Surgical Research and New Technique, 2023, 12(1): 40-44.
[5]	LI Zhengdao, DAI Xingming, LIU Dacheng, ZHANG Xiuwei. Factors related to hidden hemorrhage after proximal femoral nail antirotation fixation in elderly patients with femoral intertrochanteric fracture [J]. Surgical Research and New Technique, 2022, 11(3): 152-155.
[6]	DU Haiping, GAO Feng. Risk factors for secondary surgery at distant sites after craniotomy in patients with severe traumatic brain injury [J]. Surgical Research and New Technique, 2022, 11(1): 14-18.
[7]	HE Li, XU Wenye. Hemostatic effect of medical collagen sponge combined with batroxobin on wound after mixed hemorrhoids operation [J]. Surgical Research and New Technique, 2021, 10(1): 30-32.
[8]	YAN Hailan. Effect of NOSES on left colon cancer and risk factors affecting prognosis [J]. Surgical Research and New Technique, 2020, 9(4): 228-230.
[9]	WANG Fang. Discussion on value of dietary management in perioperative period of pediatric gastrointestinal surgery based on accelerated rehabilitation concept [J]. Surgical Research and New Technique, 2020, 9(2): 139-141.
[10]	HAN Jinyan, DING Rongxia, DAI Linfeng. Progress on effects of enhanced recovery after surgery on 3D laparoscopic perioperative period [J]. Surgical Research and New Technique, 2019, 8(3): 216-219.
[11]	WANG Xiaoyan. Evaluation of clinical nursing pathway in pulmonary tuberculosis patients undergoing lobectomy [J]. Surgical Research and New Technique, 2019, 8(1): 60-64.
[12]	LI Shi, GUO Songming. Application of painless treatment in perioperative period of anorectal surgery [J]. Surgical Research and New Technique, 2017, 6(3): 169-171.
[13]	. Features and risk factors analysis of Postoperative Pulmonary Complications of Esophageal Carcinoma [J]. Surgical Research and New Technique, 2016, 5(3): 150-152.
[14]	. Clinical analysis of 27 death cases undergoing isolated coronary artery bypass grafting [J]. Surgical Research and New Technique, 2014, 3(2): 104-107.
[15]	XU Feng, MEI Yun-qing. Research progress in risk factors of complications after coronary artery bypass grafting [J]. Surgical Research and New Technique, 2013, 2(4): 267-271.