Nagra Navraj S, van Popta Dmitri, Whiteside Sigrid, Holt Edward M
University of Oxford, Oxford, UK.
University Hospital of South Manchester, NHS Foundation Trust, Wythenshawe M23 9LT, UK.
Acta Orthop Traumatol Turc. 2016 Oct;50(5):507-513. doi: 10.1016/j.aott.2015.11.001. Epub 2016 Oct 15.
The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture.
Patients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively.
Analysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046).
The decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
Level IV Prognostic study.
本研究旨在分析血红蛋白水平的变化，并确定股骨颈骨折固定患者术后血红蛋白监测的合适时间线。
纳入因股骨颈骨折接受动力髋螺钉（DHS）固定（n = 74，平均年龄：80岁）或半髋关节置换术（n = 104，平均年龄：84岁）的患者。对患者的血红蛋白水平进行围手术期监测。
分析发现，从术前（D0）到术后第5天，血红蛋白平均下降31.1 g/L，具有统计学和临床意义（p < 0.001），从D0到第1天以及从第1天到第2天有显著下降（p < 0.001）。在每个术后时间点，DHS患者的血红蛋白值低于半髋关节置换术患者（p = 0.046）。
术后24小时内（D0到第1天）血红蛋白的下降低估了第2天发现的血红蛋白最低值。仅依据第1天的血红蛋白水平可能对患者护理不利。我们提出一种预测可能需要输血患者的方法，并推荐一种针对股骨颈骨折手术患者的方案，以规范术后血红蛋白监测。
IV级预后研究。
