标题：股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的隐性失血特点及影响因素

      作者：李锐军，林浙龙，周正茂，全守尧，陈淼俭    (中山市港口医院骨科，广东 中山 528447)

      卷次： 2018年29卷10期

      【摘要】 目的 观察股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折(IFF)隐性失血的特点，并分析出血的影响因素。方法 回顾性分析中山市港口医院骨科2015年1月至2017年12月收治的55例老年 IFF患者的临床资料，根据Gross方程计算PFNA治疗期间的隐性失血量，以隐性失血量为因变量，多元线性回归分析相关因素对隐性失血的影响。结果 PFNA手术显性、隐性及总失血量分别为(166.25±30.13) mL、(706.25±90.26) mL、(859.16±91.24) mL。隐性失血是导致PFNA围手术期失血的主要原因。单因素及多元线性分析结果显示，高血压病、伤后手术延迟、年龄、抗凝药物应用情况、骨折类型以及糖尿病是影响 PFNA隐性失血的独立危险因素(P<0.05)。结论 隐性失血是老年 IFF患者PFNA手术失血主要原因，内固定方式、骨折类型、合并基础疾病、抗凝药物运用以及伤后手术延迟是导致PFNA隐性失血的独立危险因素。
      【关键词】 隐性失血；危险因素；股骨粗隆间骨折；股骨；骨折
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2018）10—1366—03

Characteristics and influencing factors of hidden blood loss in senile patients with intertrochanteric femurfractures treated with proximal femoral nail antirotation.
LI Rui-jun, LIN Zhe-long, ZHOU Zheng-mao, QUANShou-yao, CHEN Miao-jian. Department of Orthopedics, Zhongshan Port Hospital, Zhongshan 528447, Guangdong, CHINA
【Abstract】 Objective To observe the characteristics of hidden blood loss of proximal femoral nail antirotation(PFNA) treatment of senile intertrochanteric femur fractures (IFF) and analyze its influence factors. Methods The clini-cal data of 55 elderly IFF patients, who admitted to Department of Orthopedics of Zhongshan Port Hospital from Jan.2015 to Dec. 2017, were retrospectively analyzed. The amount of hidden blood loss during PFNA treatment was calculat-ed according to the Gross equation, which was used as the dependent variable to analyze the effect of associated factorson hidden blood loss through multiple linear regression. Results The total amount of dominant, hidden and total bloodloss in PFNA treatment were (166.25±30.13) mL, (706.25±90.26) mL, (859.16±91.24) mL, respectively. The hiddenblood loss was a major cause of perioperative blood loss of PFNA. Univariate and multivariate linear analysis showedthat hypertension after injury, delayed operation, age, fracture type, application of anticoagulant drugs and diabetes wereindependent risk factors of hidden blood loss of PFNA (P<0.05). Conclusion The hidden blood loss was the maincause of blood loss in elderly IFF patients undergoing PFNA surgery. Internal fixation, fracture types, complicating un-derlying diseases, use of anticoagulant drugs and postoperative delay are independent risk factors for recessive bloodloss in PFNA.
      【Key words】 Hidden blood loss; Risk factors; Intertrochanteric femur fractures (IFF); Femur; Fracture·论 著·doi:10.3969/j.issn.1003-6350.2018.10.010基金项目：广东省中山市科技计划项目(编号：2017A020227)