切换至 "中华医学电子期刊资源库"
高级检索
中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 146 -150. doi: 10.3877/cma.j.issn.2095-5790.2020.02.009

所属专题： 文献；

论著

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
冷昆鹏1, 孟钰童1, 周君琳1,†()   
  1. 1. 100020　首都医科大学附属北京朝阳医院骨科
  • 收稿日期:2020-02-04 出版日期:2020-05-05
  • 通信作者: 周君琳
  • 基金资助:
    北京市科委首都市民健康项目培育(Z161100000116080); 北京市自然科学基金(7202049)

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

Kunpeng Leng1, Yutong Meng1, Junlin Zhou1,†()   

  1. 1. Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2020-02-04 Published:2020-05-05
  • Corresponding author: Junlin Zhou
  • About author:
    Corresponding author: Zhou Junlin, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

冷昆鹏, 孟钰童, 周君琳. 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[J]. 中华肩肘外科电子杂志, 2020, 08(02): 146-150.

Kunpeng Leng, Yutong Meng, Junlin Zhou. Clinical analysis of revealed and hidden blood loss in elderly proximal humeral fractures treated with PHILOS locking plate and Multiloc intramedullary nail[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(02): 146-150.

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）
术前 术后 术前 术后
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
[1]
Bell JE, Leung BC, Spratt KF, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly [J]. J Bone Joint Surg Am, 2011, 93(2): 121-131.
[2]
Court-Brown CM, Garg A, Mcqueen MM. The epidemiology of proximal humeral fractures [J]. Acta Orthop Scand, 2001, 72(4): 365-371.
[3]
Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures [J]. Clin Orthop Relat Res, 2006, 442: 87-92.
[4]
Roux A, Decroocq L, Elbatti S, et al. Epidemiology of proximal humerus fractures managed in a trauma center [J]. Orthop Traumatol Surg Res, 2012, 98(6): 715-719.
[5]
Kannus P, Palvanen M, Niemi S, et al. Osteoporotic fractures of the proximal humerus in elderly finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium [J]. Acta Orthop Scand, 2000, 71(5): 465-470.
[6]
Carson JL, Poses RM, Spence RK, et al. Severity of anaemia and operative mortality and morbidity [J]. Lancet, 1988, 1(8588): 727-729.
[7]
Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account [J]. J Bone Joint Surg Br, 2004, 86(4): 561-565.
[8]
Gross JB. Estimating allowable blood loss: corrected for dilution [J]. Anesthesiology, 1983, 58(3): 277-280.
[9]
Gaebler C, Mcqueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases [J]. Acta Orthop Scand, 2003, 74(5): 580-585.
[10]
PinkasI D, Wanich TS, Depalma AA, et al. Management of malunion of the proximal humerus: current concepts [J]. J Am Acad Orthop Surg, 2014, 22(8): 491-502.
[11]
Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis [J]. J Orthop Trauma, 2009, 23(3): 163-172.
[12]
Brorson S, Rasmussen JV, Frich LH, et al. Benefits and harms of locking plate osteosynthesis in intraarticular （OTA Type C） fractures of the proximal humerus: a systematic review [J]. Injury, 2012, 43(7): 999-1005.
[13]
Dilisio MF, Nowinski RJ, Hatzidakis AM, et al. Intramedullary nailing of the proximal humerus: evolution, technique, and results [J]. J Shoulder Elbow Surg, 2016, 25(5): e130-138.
[14]
GiannoudisI PV, Xypnitos FN, Dimitriou R, et al. Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature [J]. J Orthop Surg Res, 2012, 7: 39-42.
[15]
Sforzo CR, Wright TW. Treatment of acute proximal humerus fractures with a polarus nail [J]. J Surg Orthop Adv, 2009, 18(1): 28-34.
[16]
Nielsen HJ. Detrimental effects of perioperative blood transfusion [J]. Br J Surg, 1995, 82(5): 582-587.
[17]
Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture [J]. J Bone Joint Surg Br, 2006, 88(8): 1053-1059.
[18]
丛宇，赵建宁. 人工关节置换术后失血的相关研究 [J]. 医学研究生学报, 2010, 23(12): 1332-1336.
[19]
Bell TH, Berta D, Ralley F, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1642 patients [J]. Can J Surg, 2009, 52(4): 295-301.
[20]
Bowdith MG, Villar RN. Do obese patients bleed more? A prospective study of blood loss at total hip replacement [J]. Ann R Coll Surg Engl, 1999, 81(3): 198-200.
[21]
Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty [J]. Clin Orthop Relat Res, 1991, (269): 98-101.
[22]
Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors [J]. Int Orthop, 2007, 31(1): 39-44.
[23]
Slappendel R, Weber EW, Benraad B, et al. Does ibuprofen increase perioperative blood loss during hip arthroplasty? [J]. Eur J Anaesthesiol, 2002, 19(11): 829-831.
[24]
刘旭东，张先龙，曾炳芳, 等. 全髋关节置换术后的隐性失血分析 [J]. 中国矫形外科杂志, 2011, 19(12): 995-997.
[25]
张殿英，付中国，徐小东, 等. 肱骨近端骨折半肩关节置换患者的隐性失血分析 [J]. 中华创伤杂志, 2014, 30(7): 643-646.
[26]
Konrad G, Audige L, Lambert S, et al. Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures [J]. Clin Orthop Relat Res, 2012, 470(2): 602-609.
[27]
Lin J. Effectiveness of locked nailing for displaced three-part proximal humeral fractures [J]. J Trauma, 2006, 61(2): 363-374.
[28]
Kazakos K, Lyras DN, Galanis V, et al. Internal fixation of proximal humerus fractures using the Polarus intramedullary nail [J]. Arch Orthop Trauma Surg, 2007, 127(7): 503-508.
[29]
Chen F, Wang Z, Bhattacharyya T. Convergence of outcomes for hip fracture fixation by nails and plates [J]. Clin Orthop Relat Res, 2013, 471(4): 1349-1355.
[30]
Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail [J]. J Bone Joint Surg Br, 1993, 75(5): 789-793.
[31]
Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture [J]. Injury, 2011, 42(2): 133-135.
[32]
Zhang YM, Liu JY, Sun XD, et al. Rivaroxaban improves hidden blood loss, blood transfusion rate and reduces swelling of the knee joint in knee osteoarthritis patients after total knee replacement [J]. Medicine （Baltimore）, 2018, 97(40): e12630.
[33]
Lawrence VA, Hilsenbeck SG, Noceck H, et al. Medical complications and outcomes after hip fracture repair [J]. Arch Intern Med, 2002, 162(18): 2053-2057.
[34]
Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement [J]. J R Coll Surg Edinb, 1981, 26(5): 295-297.
[35]
Wolf LD, Hpzack WJ, Rothman RH. Pulmonary embolism in total joint arthroplasty [J]. Clin Orthop Relat Res, 1993, 288: 219-233.
[36]
Charalambides C, Beer M, Melhuish J, et al. Bandaging technique after knee replacement [J]. Acta Orthop, 2005, 76(1): 89-94.
[1] 李立, 王红莉, 常红, 张艳. 肱骨近端骨折术后功能康复策略现状及新理念下的研究进展[J]. 中华肩肘外科电子杂志, 2023, 11(03): 284-287.
[2] 左楠, 刘岩, 孙大辉, 刘哲闻, 杨光. 胸大肌三角肌入路与经三角肌外侧入路治疗肱骨近端骨折的疗效分析[J]. 中华肩肘外科电子杂志, 2023, 11(03): 252-257.
[3] 宗宇宁, 薛海鹏, 韩天宇, 张昊, 王帅, 马翔宇, 纪振钢, 周大鹏. 解剖状骨水泥占位器在治疗内侧柱缺失型肱骨近端骨折中的实用性的有限元分析[J]. 中华肩肘外科电子杂志, 2023, 11(03): 242-251.
[4] 车娟, 刘俊阳. 肱骨近端骨折围手术期深静脉血栓发生因素分析[J]. 中华肩肘外科电子杂志, 2023, 11(02): 146-149.
[5] 张晓萌, 杨杰, 刘海, 王艳华, 张一翀, 张立佳, 熊晨, 唐缪田, 张殿英. 科研创新就在我们身边[J]. 中华肩肘外科电子杂志, 2023, 11(01): 1-6.
[6] 刘兵, 马翔宇, 杨超, 周大鹏. 应用Philos钢板联合个体化髓内解剖型骨水泥占位器治疗老年骨质疏松性肱骨近端骨折的临床疗效[J]. 中华肩肘外科电子杂志, 2022, 10(04): 293-299.
[7] 丁小方, 杨黎黎, 周海涛, 纪坤羽, 杨鹏杰, 杨坤, 吕昊润, 王元利, 付中国. 基于"悬臂-杠杆重建-不稳定"理论的老年肱骨近端粉碎骨折术后康复策略探讨[J]. 中华肩肘外科电子杂志, 2022, 10(03): 232-238.
[8] 张伟, 成冬冬, 崔胜宇, 徐又佳, 刘巍, 丁一, 朱新辉. 两种内固定对中老年肱骨近端合并肱骨干骨折的疗效及功能预后：前瞻性队列研究[J]. 中华肩肘外科电子杂志, 2022, 10(03): 207-213.
[9] 程邦君, 黄燕峰, 罗轶, 何耀华. 两种手术方法治疗Neer Ⅲ型肱骨近端骨折的临床研究[J]. 中华肩肘外科电子杂志, 2021, 09(04): 335-340.
[10] 祝相如, 张聿达, 李绪文, 刘国明, 梁承志, 扈延龄. 自体髂骨块植骨结合Calcar螺钉重建内侧柱治疗复杂肱骨近端骨折[J]. 中华肩肘外科电子杂志, 2021, 09(03): 244-248.
[11] 徐小东, 王颜华, 刘洋, 杨雨润, 朱前拯, 杨欢, 陈星佐, 王立强, 陈瀛, 林朋. 老年肱骨近端骨折患者围手术期隐性失血情况分析[J]. 中华肩肘外科电子杂志, 2021, 09(02): 164-168.
[12] 赵彦瑞, 刘洋, 单磊, 周君琳. 锁定钢板结合异体腓骨治疗老年肱骨近端Neer III、IV型骨折的疗效分析[J]. 中华肩肘外科电子杂志, 2021, 09(02): 159-163.
[13] 金万通, 薛海鹏, 周大鹏, 刘兵, 纪振钢, 马翔宇, 杨超, 张昊, 韩宁, 宗宇宁, 张咏晧, 马泽方. 3D打印结合PMMA骨水泥髓内支撑技术在老年肱骨近端骨质疏松性骨折中的应用[J]. 中华老年骨科与康复电子杂志, 2022, 08(05): 276-284.
[14] 杨良栋, 张华泽, 何举仁, 高艳刚, 李栋. 锁定钢板与交锁髓内钉固定治疗老年Neer分型2、3部分肱骨近端骨折的疗效比较[J]. 中华老年骨科与康复电子杂志, 2022, 08(02): 96-103.
[15] 赵阔, 王忠正, 王宇钏, 张浚哲, 郭家良, 郑占乐, 陈伟, 张英泽. 双反牵引复位器联合MIPO技术治疗肱骨近端骨折的初步应用[J]. 中华老年骨科与康复电子杂志, 2021, 07(06): 321-325.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号