| At present the anti-rotating proximal femoral intramedullary nail(PFNA)is the most common surgical fixation method for the treatment of elderly intertrochanteric fracture.Its advantages include short operation time,less surgical trauma and less intraoperative blood loss.However,the neglect of the patients’ hidden blood loss during the perioperative period may lead to serious complications,ranging from anemia and obstruction to fracture healing and postoperative rehabilitation to life-threatening.The purpose of this study was to analyze the differences in the treatment of perioperative hidden blood loss by PFNA in different types of intertrochanteric fractures.Objective:To explore the comparison and analysis of PFNA in the treatment of perioperative hidden blood loss in elderly patients with different fracture types of intertrochanteric fracture.Methods:Retrospective analysis was performed on elderly patients(aged≥65 years old)who suffered from intertrochanteric fracture and underwent PFNA surgery successfully by the same group of physicians.According to Evans-Jensen classification,divided the patients into type Ⅰ B,type Ⅱ A,type ⅡB,type Ⅲ(type ⅠA for fracture undisplaced with no surgery,not considered)and grouping.Data of age,gender,height,weight,injured side,body mass index,operation time,Slash length,blood transfusion,hematocrit(HCT),retrospective blood loss,hospital stays were recorded to evaluate the difference of period perative latent blood loss in elderly patients with different fracture types.Results:A total of 76 patients with intertrochanteric fracture were included in this study,among whom 37 patients met the inclusion criteria,including 13 males and 24 females,aged from 65 to 94 years old,with an average age of 78.35±7.07 years old.According to Evans-jensen classification,there were 19 cases of type IB,4 cases of type ⅡA,11 cases of type ⅡB and 3 cases of type Ⅲ.All the surgeries were performed by the same group of surgeons using internal fixation with PFNA.There were no significant differences in operation time and incision length among the patients.In terms of blood loss,the total blood loss of patients with type ⅠB was 730.12±71.63ml,the dominant blood loss was 153.16±46.91ml,and the hidden blood loss was 576.96±64.63ml;The total blood loss of patients with type ⅡA was 702.19±109.93ml,the dominant blood loss was 192.50±45.00ml,and the hidden blood loss was 509.69±65.01 ml;The total blood loss of patients with type ⅡB was 970.95±204.81ml,the dominant blood loss was 163.64±45.01ml,and the hidden blood loss was 807.32±169.43ml;The total blood loss of type Ⅲ patients was 1166.54±96.87ml,the dominant blood loss was 186.67±35.12ml,the implicit blood loss was 730.12±71.63ml,the dominant blood loss was 153.16±46.91ml,and the implicit blood loss was 576.96±64.63ml.Patients with type Ⅲ hidden blood loss and type ⅡA,type ⅠB there were significant difference(P<0.05);Compared with type Ⅱ B patients,type Ⅱ A and type ⅠB hidden blood loss were significant differences(P<0.05);Type Ⅲ compared with type ⅡB,compared type ⅡA and type ⅠB,hidden blood loss in patients with no significant difference(P>0.05).In hospital time and transfusion volume type Ⅲ patients hospitalized time and amount of blood transfusion and type Ⅱ A,type ⅠB there were significant difference(P<0.05);Compared with type ⅡB patients,type ⅡA and type ⅠB hospitalization time and transfusion volume are significant difference(P<0.05);type Ⅲ compared with typeⅡ B,type Ⅱ A and type ⅠB,compared to patients in hospital time and transfusion volume there is no significant difference(P>0.05).Conclusion:The perioperative blood loss of elderly patients with intertrochanteric fracture was mainly caused by hidden blood loss by femoral anti-rotation intramedullary nail(PFNA)technique.There are significant differences in perioperative hidden blood loss in elderly patients with different fracture types of intertrochanteric fracture treated with PFNA,and the amount of hidden blood loss is large.Therefore,vital signs of the patients should be strictly monitored during and after the operation,and blood routine should be reviewed in time to avoid complications caused by severe anemia. |
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