Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Min-Sheng Road, Dalin Town, Chia-Yi, Taiwan.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
BMC Musculoskelet Disord. 2020 Apr 15;21(1):244. doi: 10.1186/s12891-020-03208-2.
With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop.
Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants.
Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05).
Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality.
随着老年人口的增加，髋部骨折、股骨颈骨折和股骨转子间骨折（ITF）的发生率也在增加。建立有效的围手术期方法对于降低 ITF 相关发病率和死亡率非常重要。本研究旨在确定按 AO 分类的 ITF 对围手术期血红蛋白下降的影响。
回顾性分析 2016 年 9 月至 2018 年 8 月接受髓内钉固定的 76 例 AO 31-A1 或 A2 型 ITF 患者的病历资料。选择围手术期血红蛋白下降作为主要观察指标，计算方法为术前和术后血红蛋白水平的差值。进行多变量线性回归分析，包括以下变量：AO 分类（A1.1-A2.1[稳定]与 A2.2-A2.3[不稳定]）、损伤与手术的时间间隔、年龄、体重指数和抗凝药物的使用。
在符合纳入标准的 76 例患者中，AO 31 A2.2-A2.3（不稳定）组的血红蛋白下降明显高于 AO 31 A1.1-A2.1（稳定）组（p=0.04）。多变量分析也显示不稳定组的血红蛋白下降更大（p<0.05）。
不稳定 ITF 患者的血红蛋白下降更大，怀疑骨折部位周围有隐性失血。我们认为，对于不稳定 ITF 患者，在计划进行术前输血时应考虑到这一点，以减少相关的术后并发症，特别是在严重贫血或高死亡率风险的患者中。
