PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血分析

doi:10.3877/cma.j.issn.2095-5790.2020.02.009

目的

分析PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血的临床特点。

方法

回顾性分析2016年1月至2019年12月分别采用PHILOS钢板治疗（45例）和Multiloc髓内钉治疗（37例）的老年肱骨近端骨折患者的临床资料，比较手术时间、显性失血量和隐性失血量，对患者围手术期失血情况进行评估和分析。

结果

PHILOS钢板组平均手术时间（141.78±36.18）min，总失血量674.68（592.87,979.65）ml，显性失血量320.00（220.00,430.00）ml；Multiloc髓内钉组平均手术时间（102.70±22.10）min，总失血量589.23（430.80,714.82）ml，显性失血量100.00（100.00,125.00）ml，两组间差异具有统计学意义（P<0.05）。两组围手术期隐性失血量为383.55（253.17,575.48）ml和460.98（309.87,610.25）ml，差异无统计学意义（P>0.05），分别占总失血量56.85%和78.23%。

结论

与PHILOS钢板比较，Multiloc髓内钉内固定治疗此类骨折患者的平均手术时间短，总失血量和显性失血量少。两种内固定治疗方式的隐性失血量无明显差异，但隐性失血量在总失血量中所占比重较大，临床上应该时刻重视，积极干预，改善患者预后。

关键词: 肱骨近端骨折, PHILOS钢板, Multiloc髓内钉, 围手术期失血

Background

Proximal humeral fractures are common in upper limb fractures with the third highest incidence after hip fractures and distal radius fractures , accounting for 4% to 5% of total body fractures. The aging society has witnessed an increasing trend of the morbidity and mortality of proximal humeral fractures among the elderly group. The mortality is known to increase with perioperative anemia. Perioperative blood loss is a significant yet easily neglected factor for upper limb fracture patients. Cases of patients with proximal humeral fractures undergone procedures of PHILOS locking plate and Multiloc intramedullary nail were retrospectively analyzed. It is hoped that our study will demonstrate the importance of consideration of patients’ revealed and hidden blood loss as to improve the prognosis.

Objective

To analyze the revealed and hidden blood loss in elderly proximal humeral fractures treated with PHILOS locking plate and Multiloc intramedullary nail.

Methods

The clinical data of 45 elderly patients with proximal humeral fractures treated with PHILOS locking plate and 37 elderly patients treated with Multiloc intramedullary nail were retrospectively analyzed from January 2016 to December 2019, respectively. The operation time, perioperative revealed blood loss and perioperative hidden blood loss were compared, and the perioperative blood loss was evaluated and analyzed.

Results

The mean operation time of the PHILOS locking plate treatment group was (141.78±36.18) min, the total blood loss was 674.68 (592.87, 979.65) ml, and the perioperative revealed blood loss was 320.00 (220.00, 430.00) ml. The mean operation time of Multiloc intramedullary nail treatment was (102.70±22.10) min, the total blood loss was 589.23 (430.80, 714.82) ml, and the perioperative revealed blood loss was 100.00 (100.00, 125.00) ml. The difference between two groups was statistically significant (P<0.05) . The perioperative hidden blood loss in the two groups was 383.55 (253.17, 575.48) ml and 460.98 (309.87, 610.25) ml, which was not statistically significant (P>0.05) , accounting for 56.85% and 78.23% of the total blood loss, respectively.

Conclusions

Compared with PHILOS locking plate, the average operation time of Multiloc intramedullary nail group is short, and both the total blood loss and the revealed blood loss are less. There was no significant difference in the amount of hidden blood loss between the two methods of internal fixation. The proportion of hidden blood loss in total blood loss in both two procedures was large, which should be paid more attention to in clinical practice. Thus, clinical attention should be paid to the positive intervention to improve the prognosis of patients.

Key words: Proximal humeral fractures, PHILOS locking plate, Multiloc intramedullary nail, Perioperative blood loss

图1 PHILOS钢板治疗肱骨近端骨折　图A：术前肩关节正位片；图B：术后肩关节正位片；图C：术后肩关节穿胸位片；图D：术后冈上肌出口位片

图2 Multiloc髓内钉治疗肱骨近端骨折　图A：术前肩关节正位片；图B：术后肩关节正位片；图C：术后肩关节穿胸位片；图D：术后冈上肌出口位片

表1 82例老年肱骨近端骨折患者的基本信息

组别	例数	男性[例（%）]	年龄（岁，±s）	体重（kg，±s）	身高（m，±s）	BMI（kg/m²,±s）
PHILOS钢板组	45	11（24.44）	67.49±8.62	67.09±9.00	1.62±0.08	25.53±3.37
Multiloc髓内钉组	37	10（27.03）	70.19±8.21	61.92±9.31	1.61±0.07	23.70±2.80
t值	?	0.071	-1.443	2.549	0.488	2.634
P值	?	0.790	0.153	0.013	0.627	0.010

表1 82例老年肱骨近端骨折患者的基本信息

组别	例数	男性[例（%）]	年龄（岁，±s）	体重（kg，±s）	身高（m，±s）	BMI（kg/m²,±s）
PHILOS钢板组	45	11（24.44）	67.49±8.62	67.09±9.00	1.62±0.08	25.53±3.37
Multiloc髓内钉组	37	10（27.03）	70.19±8.21	61.92±9.31	1.61±0.07	23.70±2.80
t值	?	0.071	-1.443	2.549	0.488	2.634
P值	?	0.790	0.153	0.013	0.627	0.010

表2 两组患者PBV、平均手术时间和手术前后Hct、Hb值比较（±s）

组别	例数	Hct值（%）			Hb值（g/L）		PBV（ml）	手术时间（min）
组别	例数	术前	术后		术前	术后	PBV（ml）	手术时间（min）
PHILOS钢板组	45	36.13±3.33		29.37±3.07	122.16±11.41	99.16±11.83	4026.32±551.39	141.78±36.18
Multiloc髓内钉组	37	34.94±4.46		29.78±4.04	120.16±16.32	98.97±15.72	3842.07±608.85	102.70±22.10
t值	?	1.375		-0.522	0.649	0.060	1.437	5.743
P值	?	0.173		0.603	0.518	0.952	0.155	0.000

表2 两组患者PBV、平均手术时间和手术前后Hct、Hb值比较（±s）

组别	例数	Hct值（%）			Hb值（g/L）		PBV（ml）	手术时间（min）
组别	例数	术前	术后		术前	术后	PBV（ml）	手术时间（min）
PHILOS钢板组	45	36.13±3.33		29.37±3.07	122.16±11.41	99.16±11.83	4026.32±551.39	141.78±36.18
Multiloc髓内钉组	37	34.94±4.46		29.78±4.04	120.16±16.32	98.97±15.72	3842.07±608.85	102.70±22.10
t值	?	1.375		-0.522	0.649	0.060	1.437	5.743
P值	?	0.173		0.603	0.518	0.952	0.155	0.000

表3 两组患者总失血量、显性失血量和隐性失血量比较[ml, M（P25-P75）]

组别	例数	总失血量	显性失血量	隐性失血量
PHILOS钢板组	45	674.68（592.87,979.65）	320.00（220.00,430.00）	383.55（253.17,575.48）
Multiloc髓内钉组	37	589.23（430.80,714.82）	100.00（100.00,125.00）	460.98（309.87,610.25）
Z值	?	-3.052	-6.689	-0.983
P值	?	0.002	0.000	0.326

表3 两组患者总失血量、显性失血量和隐性失血量比较[ml, M（P25-P75）]

组别	例数	总失血量	显性失血量	隐性失血量
PHILOS钢板组	45	674.68（592.87,979.65）	320.00（220.00,430.00）	383.55（253.17,575.48）
Multiloc髓内钉组	37	589.23（430.80,714.82）	100.00（100.00,125.00）	460.98（309.87,610.25）
Z值	?	-3.052	-6.689	-0.983
P值	?	0.002	0.000	0.326

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Clinical analysis of revealed and hidden blood loss in elderly proximal humeral fractures treated with PHILOS locking plate and Multiloc intramedullary nail

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Clinical analysis of revealed and hidden blood loss in elderly proximal humeral fractures treated with PHILOS locking plate and Multiloc intramedullary nail