Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China.
Sci Rep. 2018 Feb 19;8(1):3225. doi: 10.1038/s41598-018-21703-4.
The purpose of this study was to quantify the peri-operative blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation (PFNA) and analyze whether the substantial hidden blood loss was induced by initial trauma or the operation. The clinical data of 123 patients with intertrochanteric fracture treated with unreamed PFNA from Jan 2013 to Apr 2017 were analyzed retrospectively. Blood routine on admission day (ADM), pre-operative day one (PRE), post-operative days one and three (POD1 and POD3) and the visible blood loss (VBL) were obtained. The total blood loss (TBL) from ADM to POD1 and POD3 were 693.5 ± 359.6 ml and 863.8 ± 429.9 ml, of which the corresponding hidden blood loss (HBL) was 86.8% and 89.4% respectively. The mean TBL and HBL from ADM to PRE (375.5 ± 242.0 ml, 375.5 ± 242.0 ml) were higher than that from PRE to POD1 (318.0 ± 183.4 ml, 226.5 ± 163.2 ml), p < 0.001 respectively. There was no significant difference between HBL from ADM to PRE and HBL from PRE to POD3 (375.5 ± 242.0 ml, 396.7 ± 254.0 ml, p = 0.361). The majority of peri-operative HBL occurred before surgery, it was mainly associated with the initial trauma rather than the operation.
本研究旨在量化老年股骨转子间骨折患者行股骨近端防旋髓内钉（PFNA）内固定术的围手术期失血量，并分析大量隐性失血是由初始创伤还是手术引起的。回顾性分析 2013 年 1 月至 2017 年 4 月采用非扩髓 PFNA 治疗的 123 例股骨转子间骨折患者的临床资料。记录患者入院日（ADM）、术前 1 天（PRE）、术后 1 天和 3 天（POD1 和 POD3）的血常规，以及显性失血量（VBL）。从 ADM 到 POD1 和 POD3 的总失血量（TBL）分别为 693.5±359.6ml 和 863.8±429.9ml，其中相应的隐性失血量（HBL）分别为 86.8%和 89.4%。从 ADM 到 PRE 的平均 TBL 和 HBL（375.5±242.0ml，375.5±242.0ml）高于从 PRE 到 POD1 的 TBL 和 HBL（318.0±183.4ml，226.5±163.2ml），p<0.001。从 ADM 到 PRE 的 HBL 与从 PRE 到 POD3 的 HBL 无显著差异（375.5±242.0ml，396.7±254.0ml，p=0.361）。围手术期大量隐性失血发生在术前，主要与初始创伤有关，而与手术本身关系不大。
