Tüzün Harun Yasin, Bilekli Ahmet Burak, Erşen Ömer
Department of Orthopedics, Gülhane Education and Research Hospital, Etlik, Keçiören, Ankara, Turkey.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1879-1884. doi: 10.1007/s00068-021-01670-8. Epub 2021 Apr 16.
Intertrochanteric femur fractures (IFF) is one of the biggest health problems in elderly population and mostly treated by proximal femoral nails. Although it is done in less invasive technique this method can cause higher blood loss than expected and subsequent allogenic blood transfusions. In this study, we aimed to investigate the factors that were related to the blood loss in proximal femoral nail fixation of IFF including patients' ongoing anticoagulant treatments.
231 consecutive patients with IFF who treated with proximal femoral nail anti-rotation between January 2017 and December 2019 were included the study. The factors that can affect the blood loss determined as patients demographics, time from injury to operation, duration of operation, the American Society of Anesthesiologists (ASA) scores, preoperative anticoagulant medications. Hematocrit and hemoglobin were obtained on admission day, postoperative day one and postoperative day 3. Total blood loss and allogenic blood transfusions assessed.
Higher BMI is found related to higher blood loss. The patients who were operated in the first two days after admission had lower blood loss levels independent from anticoagulant use (p = 0.027). Preoperative Hct was higher in patients who did not need RBCs in the perioperative period (p = 0.039). According to the AO classification, A2.1 fractures had lower blood loss levels.
This study demonstrated that ongoing anticoagulant treatments of intertrochanteric fracture patients did not increase the perioperative blood loss. The factors affecting blood loss in the proximal femoral nail fixation were BMI, the time to surgery, and fracture type in the elderly.
股骨粗隆间骨折（IFF）是老年人群面临的重大健康问题之一，大多采用股骨近端髓内钉治疗。尽管该方法采用微创技术，但仍可能导致比预期更多的失血以及随后的异体输血。在本研究中，我们旨在调查与IFF股骨近端髓内钉固定术中失血相关的因素，包括患者正在进行的抗凝治疗。
纳入2017年1月至2019年12月期间连续231例接受股骨近端抗旋髓内钉治疗的IFF患者。确定可能影响失血的因素为患者人口统计学特征、受伤至手术的时间、手术持续时间、美国麻醉医师协会（ASA）评分、术前抗凝药物。在入院当天、术后第1天和术后第3天获取血细胞比容和血红蛋白。评估总失血量和异体输血情况。
发现较高的体重指数与较多的失血相关。入院后前两天接受手术的患者，无论是否使用抗凝剂，失血水平均较低（p = 0.027）。围手术期不需要红细胞的患者术前血细胞比容较高（p = 0.039）。根据AO分类，A2.1型骨折失血水平较低。
本研究表明，股骨粗隆间骨折患者正在进行的抗凝治疗不会增加围手术期失血量。股骨近端髓内钉固定术中影响失血的因素为体重指数、手术时间和老年人的骨折类型。
