髋关节置换术治疗老年股骨颈骨折围手术期隐性失血的研究

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摘要目的探讨全髋关节置换术治疗老年股骨颈骨折围手术期隐性失血的情况，分析不同分型的骨折及假体类型之间隐性失血的差异。方法回顾性分析了自2012年1月至2015年12月，采用全髋关节置换术治疗61例老年股骨颈骨折的患者，男31例，女30例；年龄65～81岁，平均71岁。按照Garden分型，Ⅱ型11例，Ⅲ型22例，Ⅳ型28例。采用Gross方程计算围手术期失血量和隐性失血量。结果术中平均出血约(440±63)mL，围手术期总失血量平均为(956±51)mL，其中平均隐性失血为(556±45)mL，占总失血量58.2％。未输血患者34例，围手术期平均总失血量为(910±61)mL，其中隐性失血量为(549±52)mL，占总失血量的60.3％。围手术期输血者27例，平均总失血量为(1 014±54)mL，其中隐性失血量为(565±49)mL，占总失血量的55.7％。按照假体类型分组：金属-聚乙烯假体组平均隐性失血为(551±67)mL，陶瓷-聚乙烯假体组为(549±55)mL，陶瓷-陶瓷假体组为(584±62)mL，三组间差异无统计学意义(P＞0.05)。按照骨折类型分组：Garden Ⅱ型组为(562±68)mL，Garden Ⅲ型组为(546±59) mL，Garden Ⅳ型组为(561±61)mL，三组间差异无统计学意义(P＞0.05)。结论老年患者全髋关节置换术围手术期的隐性失血量较多，应该引起临床医生足够的重视，及早预防低血容量性休克。隐性失血量与骨折的类型及摩擦界面的选择没有相关性。

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关键词 ：股骨颈骨折, 全髋关节置换术, 老年患者, 隐性失血

Abstract：Objective To investigate the hidden blood loss during perioperative period in total hip arthroplasty in treating elderly patients with femoral neck fracture.Methods 61 elderly patients with femoral neck fracture were treated by total hip arthroplasty.There were 31 males and 30 females.Te average age was 71 years old.According to Gareden classification，there were 11 cases of type Ⅱ，22 case of type Ⅲ，28 case of type Ⅳ.The hidden blood loss and total blood loss were calculated by Gross formula during perioperative period.Results The average total blood loss was 956 mL and hidden blood loss was 556 mL，accounting for 58.2％ of the total blood loss.In 34 cases without blood transfusion，the average total perioperative blood loss was 910 mL and the hidden blood loss was 549 mL，accounting for 60.3％ of the total blood loss.In 27 cases with blood transfusion，the average total perioperative blood loss was 1014 mL and the hidden blood loss was 565 mL，accounting for 55.7％ of the total blood loss.There was no significant difference in different Prosthesis interface groups and different type of fractures. Conclusion The hidden blood loss in elderly patients with total hip arthroplasty was more than expected，and should be paid enough attention by clinical doctors.it is important to early prevention of severe blood loss.There is no significant difference in different Prosthesis interface groups and different type of fractures.

Key words： femoral neck fracture total hip arthroplasty elderly patients hidden blood loss

作者简介: 陈兵乾(1979－ )，男，副主任医师，苏州大学附属常熟市第一人民医院骨科，215500。

引用本文:

陈兵乾，薛峰，盛晓文，彭育沁，房小文. 髋关节置换术治疗老年股骨颈骨折围手术期隐性失血的研究[J]. 实用骨科杂志, 2017, 23(9): 786-789.
Chen Binqian，Xue Feng，Shen Xiaowen，et al. To Investigate the Hidden Blood Loss During Perioperative Period in Total Hip Arthroplasty in Treating Elderly Patients with Femoral Neck Fracture. sygkzz, 2017, 23(9): 786-789.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I9/786

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