Ronga Mario, Bonzini Daniele, Valoroso Marco, La Barbera Giuseppe, Tamini Jacopo, Cherubino Mario, Cherubino Paolo
Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, Campobasso - Italy; Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
Injury. 2017 Oct;48 Suppl 3:S44-S47. doi: 10.1016/S0020-1383(17)30657-5.
Anaemia in patients with trochanteric fracture is associated with increased morbidity and mortality and it is an independent risk factor for functional mobility of patients. Several authors have reported the blood loss following operative treatment comparing different fixation systems but few authors have evaluated many associated variables that could influence the perioperative blood loss.
To evaluate the blood loss in patients that had their trochanteric fracture stabilized with dynamic hip screw (DHS) or Gamma nail. Multivariate analysis of different variables that can influence blood loss was carried out (type of fracture, antiaggregant or anticoagulant therapy, time to surgery). The hypothesis was that there is no difference in terms of blood loss in patients with trochanteric fracture treated with DHS or Gamma nail considering all these variables.
MATERIALS & METHODS: Perioperative blood loss was evaluated in 417 consecutive patients treated for trochanteric fracture with DHS or Gamma nail between January 2010 and March 2013. The perioperative blood loss was calculated using the Lisander formula modified by Foss-Kehlet based on pre- and post-operative haemoglobin values and transfusion rates. Univariate and multivariate analysis were performed integrating the following variables: type of fracture (A1 vs A2), antiaggregant/anticoagulant therapy vs no therapy, time to surgery (<24 vs >24 hours from trauma), type of implant (DHS vs Gamma nail).
A significant blood loss (p <0.05) was observed between A1 and A2 fracture types (1247ml vs 1796.7ml), antiaggregant/anticoagulant therapy and no therapy (1592.7ml vs 1470.2ml), time-to-surgery <24 and >24 hours from trauma (1584.4ml vs 1323.9ml), DHS and Gamma nail (894.7ml vs 1720.6ml). At multivariate analysis, in the A1 fracture groups the DHS showed a significant lower blood loss compared to Gamma nail (p < 0.05).
According to the perioperative blood loss, DHS should be used in A1 fractures while Gamma nail can be taking in account for the unstable A2 fractures.
转子间骨折患者的贫血与发病率和死亡率增加相关，并且是患者功能活动的独立危险因素。几位作者报告了手术治疗后不同固定系统的失血量，但很少有作者评估许多可能影响围手术期失血量的相关变量。
评估采用动力髋螺钉（DHS）或伽马钉固定转子间骨折患者的失血量。对可能影响失血量的不同变量进行多因素分析（骨折类型、抗血小板或抗凝治疗、手术时间）。假设是考虑所有这些变量，采用DHS或伽马钉治疗的转子间骨折患者在失血量方面没有差异。
对2010年1月至2013年3月期间连续417例采用DHS或伽马钉治疗转子间骨折的患者的围手术期失血量进行评估。围手术期失血量采用Foss-Kehlet修改的Lisander公式，根据术前和术后血红蛋白值及输血率计算。进行单因素和多因素分析，纳入以下变量：骨折类型（A1型与A2型）、抗血小板/抗凝治疗与未治疗、手术时间（创伤后<24小时与>24小时）、植入物类型（DHS与伽马钉）。
在A1型和A2型骨折类型（1247ml对1796.7ml）、抗血小板/抗凝治疗与未治疗（1592.7ml对1470.2ml）、手术时间创伤后<24小时与>24小时（1584.4ml对1323.9ml）、DHS与伽马钉（894.7ml对1720.6ml）之间观察到显著的失血量差异（p<0.05）。多因素分析显示，在A1型骨折组中，DHS的失血量显著低于伽马钉（p<0.05）。
根据围手术期失血量，A1型骨折应使用DHS，而不稳定的A2型骨折可考虑使用伽马钉。
