Hou Guo-Jin, Zhou Fang, Zhang Zhi-Shan, Ji Hong-Quan, Tian Yun
Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2013 Oct 18;45(5):738-41.
To analyze blood loss in perioperative period of femoral intertrochanteric fractures in old patients treated with Gamma interlocking intramedullary nail (Gamma3), proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS), and to comprehend the character of blood loss in perioperative period of femoral intertrochanteric fractures.
A retrospective analysis was made of the medical records of 408 old patients with femoral intertrochanteric fractures admitted to our hospital between January 1, 2007 and to December 31, 2012. The estimated blood loss was calculated by Gross equation, according to the height, weight and changes of blood test pre- and post-operation and the differences of blood loss among Gamma3 group, PFNA group and DHS group were compared. The statistical analysis was conducted using One-Way ANOVA analysis with SPSS 13.0. A P value less than 0.05 was considered statistically significant.
In the Gamma3 group (96 cases, 39 males, 57 females), the average operation time was (74.7 ± 25.0) min, the mean obvious blood loss was (103.5 ± 83.0) mL, the mean total blood loss was (831.9 ± 474.8) mL, and the mean hidden blood loss was (728.3 ± 455.5) mL. In the PFNA group (84 cases,31 males, 53 females), the average operation time was (69.0 ± 27.1) min, the mean obvious blood loss was (91.5 ± 111.4) mL, the mean total blood loss was (825.7 ± 478.0) mL, and the mean hidden blood loss was (734.2 ± 455.7) mL. In the DHS group (40 cases, 14 males, 26 females), the average operation time was (97.5 ± 25.0) min, the mean obvious blood loss was (283.6 ± 142.1) mL, the mean total blood loss was (695.7 ± 502.4) mL, and the mean hidden blood loss was (412.1 ± 457.6) mL.
By comparing the three kinds of internal fixation methods we find that the Gamma3 and PFNA groups have a smaller size of incision, shorter time of operation and less intraoperative bleeding than the DHS group, but there is a considerable perioperative hidden blood loss. We should give enough attention to reducing the incidence of postoperative complications.
分析采用Gamma交锁髓内钉（Gamma3）、股骨近端抗旋髓内钉（PFNA）及动力髋螺钉（DHS）治疗老年股骨转子间骨折围手术期的失血情况，了解股骨转子间骨折围手术期失血特点。
回顾性分析2007年1月1日至2012年12月31日我院收治的408例老年股骨转子间骨折患者的病历资料。采用Gross公式根据患者身高、体重及术前术后血常规变化计算估计失血量，比较Gamma3组、PFNA组和DHS组之间的失血量差异。采用SPSS 13.0软件进行单因素方差分析。P值<0.05为差异有统计学意义。
Gamma3组（96例，男39例，女57例），平均手术时间为（74.7±25.0）分钟，平均显性失血量为（103.5±83.0）毫升，平均总失血量为（831.9±474.8）毫升，平均隐性失血量为（728.3±455.5）毫升。PFNA组（84例，男31例，女53例），平均手术时间为（69.0±27.1）分钟，平均显性失血量为（91.5±111.4）毫升，平均总失血量为（825.7±478.0）毫升，平均隐性失血量为（734.2±455.7）毫升。DHS组（40例，男14例，女26例），平均手术时间为（97.5±25.0）分钟，平均显性失血量为（283.6±142.1）毫升，平均总失血量为（695.7±502.4）毫升，平均隐性失血量为（412.1±457.6）毫升。
通过比较三种内固定方法发现，Gamma3组和PFNA组切口小、手术时间短、术中出血少，但围手术期隐性失血较多。应充分重视减少术后并发症的发生。
