摘要
目的观察比较防旋髓内钉和髋关节置换治疗高龄不稳定型股骨粗隆间骨折(intertrochanteric femoral fractures,IFF)围术期隐性失血情况。方法选取高龄(≥70岁)IFF 115例,根据手术方法不同将其分为防旋髓内钉组74例和髋关节置换组41例,观察比较两组手术时间、围术期失血情况及术后1、2、3、5 d隐性失血量。结果防旋髓内钉组平均手术时间63.3 min,其中16例术中或术后输血;髋关节置换组平均手术时间71.5 min,其中28例术中或术后输血。防旋髓内钉组术中显性失血量、围术期实际失血总量及围术期隐性失血量均少于髋关节置换组,差异有统计学意义(P<0.05)。术后1、2、3及5 d防旋髓内钉组隐性失血量均少于髋关节置换组,差异具有统计学意义(P<0.05)。结论防旋髓内钉内固定较髋关节置换治疗高龄不稳定型IFF围术期隐性失血少,且隐性失血多集中在术后2~3 d,临床应根据患者具体情况选择合适手术方式,并采取相应措施处理围术期隐性失血。
Objective To observe and compare condition of perioperatively recessive blood loss between spiraled intramedullary nail and hip replacement in treatment of elderly patients with unstable fracture of femurs haft. Methods A total of115 elderly patients with unstable fracture of femurs haft( ≥70 years old) were divided into spiraled intramedullary nail group( group A,n = 74) and hip replacement group( group B,n = 41) according to operative method. Operative time,perioperative condition of blood loss and hidden blood loss volumes at postoperative 1^(st),2^(nd),3^(rd) and 5^(th) d were observed and compared in two groups. Results In group A,the average operation time was 63. 3 min,and 16 patients had intraoperative or postoperative blood transfusion. In group B,the average operation time was 71. 5 min,and 28 patients had intraoperative or postoperative blood transfusion. Values of intraoperative dominant volume perioperatively of blood loss,volumes of perioperatively total blood loss and perioperatively latent blood loss during observation period in group A were significantly lower than those in group B( P < 0. 05). Hidden blood loss volumes at postoperative 1^(st),2^(nd),3^(rd) and 5^(th) d in group A were significantly less than those in group B( P < 0. 05). Conclusion Spiraled intramedullary nail in treatment of elderly patients with unstable fracture of femurs haft has less hidden blood loss volume than that by hip replacement,and the hidden blood loss are mostly found at postoperative 2^(nd) and 3^(rd) d. Clinicians should choose appropriate operation method on the basis of patients' condition and adopt corresponding measures to deal with perioperative hidden blood loss.
出处
《临床误诊误治》
2018年第2期87-91,共5页
Clinical Misdiagnosis & Mistherapy
基金
张家口市科技计划项目(1521033D)
关键词
股骨骨折
高龄
失血
手术
防旋髓内钉
关节成形术
置换
髋
Femoral fractures
Old age
Blood loss
surgical
Spiraled intramedullary nail
Arthroplasty
replacement
hip
