Harper Katharine D, Navo Paul, Ramsey Frederick, Jallow Sainabou, Rehman Saqib
Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia PA, USA.
Lewis Katz School of Medicine at Temple University, Temple University School of Medicine, Philadelphia PA, USA.
Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):202-207. doi: 10.1177/2151458517729615. Epub 2017 Nov 22.
Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures.
472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location.
304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( = 0.07; = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; = 0.027).
Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.
研究表明，髋部骨折治疗过程中失血过多会导致并发症发生率增加。我们的目标是比较囊内和囊外（包括转子间骨折和转子下骨折）髋部骨折患者的失血量和输血率。
在五年期间对472例患者进行了评估。那些因股骨近端骨折（股骨颈、转子间或转子下骨折）入院的患者被纳入研究。排除标准包括多发伤、枪伤、假体周围骨折和非手术治疗。主要终点是从入院到手术日（DOS）血红蛋白（Hgb）的下降；次要终点是术前输血需求和出院地点。
对304例股骨近端骨折患者进行了分析。从入院到手术日，囊内骨折患者Hgb的中位数下降为0.6g/dL；囊外骨折患者为1.1g/dL（P = 0.0272）。囊外骨折患者术前输血率（36/194 = 18.6%）高于囊内骨折患者（5/105 = 4.5%）（P = 0.0006），并且在整个住院期间总体输血率仍然较高（囊外骨折为55.7%，囊内骨折为32.7%；P = 0.0001）。转子间骨折和转子下骨折之间的出血率和输血率差异无统计学意义（P = 0.07；P = 0.4483）。囊外髋部骨折患者更有可能被转至专业护理机构（SNF）（囊外骨折为84.4%，囊内骨折为73.8%；P = 0.
