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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (02) : 164 -168. doi: 10.3877/cma.j.issn.2095-5790.2021.02.011

所属专题： 文献；

论著

老年肱骨近端骨折患者围手术期隐性失血情况分析
徐小东1, 王颜华2, 刘洋3, 杨雨润1, 朱前拯1, 杨欢1, 陈星佐1, 王立强1, 陈瀛1,†(), 林朋1,†()   
  1. 1. 100029　北京，中日友好医院骨科
    2. 100029　北京，中日友好医院急诊科
    3. 100029　北京，中日友好医院手术麻醉科
  • 收稿日期:2021-01-15 出版日期:2021-05-05
  • 通信作者: 陈瀛, 林朋
  • 基金资助:
    国家自然科学基金(31640045)

Clinical analysis of hidden blood loss during treatment of elderly proximal humeral fractures

Xiaodong Xu1, Yanhua Wang2, Yang Liu3, Yurun Yang1, Qianzheng Zhu1, Huan Yang1, Xingzuo Chen1, Liqiang Wang1, Ying Chen1,†(), Peng Lin1,†()   

  1. 1. Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
    2. Emergency Department, China-Japan Friendship Hospital, Beijing 100029, China
    3. Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2021-01-15 Published:2021-05-05
  • Corresponding author: Ying Chen, Peng Lin
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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.

Xiaodong Xu, Yanhua Wang, Yang Liu, Yurun Yang, Qianzheng Zhu, Huan Yang, Xingzuo Chen, Liqiang Wang, Ying Chen, Peng Lin. Clinical analysis of hidden blood loss during treatment of elderly proximal humeral fractures[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(02): 164-168.

目的

探讨老年肱骨近端骨折患者围手术期的隐性失血情况以及骨折分型对隐性失血的影响，以期为临床提供相关资料。

方法

回顾性分析2014年6月至2020年6月在中日友好医院骨科住院治疗的116例老年肱骨近端骨折患者的临床资料。所有患者均行肱骨近端锁定接骨板（proximal humeral internal locking system, PHILOS）内固定治疗。根据肱骨近端骨折粉碎程度Neer分型系统分为3组：A组Ⅱ型33例、B组Ⅲ型68例、C组Ⅳ型15例。计算患者的总失血量、显性失血量、隐性失血量及隐性失血比例并对三组患者的失血情况进行比较。

结果

116例患者总失血量（710.0±140.9） ml，隐性失血量（475.0±107.0）ml，隐性失血比例（66.9±6.9）%。A组患者总失血量（651.3±128.5） ml，显性失血量（234.9±65.9）ml，隐性失血量（432.2±95.5） ml，隐性失血比例（66.3±6.2） %。B组患者总失血量（718.3±124.4）ml，显性失血量（237.9±69.4）ml，隐性失血量（480.4±100.3） ml，隐性失血比例为（66.9±7.7）%。C组患者总失血量（795.9±182.1）ml，显性失血量（255.3±71.3）ml，隐性失血量（540.5±123.3）ml，隐性失血比例（68.0±3.9）%。在总失血量和隐性失血量方面，三组之间差异均有统计学意义（P<0.05），并且随着骨折粉碎程度加重，总失血量和隐性失血量均逐渐增多。

结论

隐性失血是老年肱骨近端骨折患者围手术期失血的主要组成部分；骨折粉碎程度越重的患者隐性失血越多，更应受到重视。

关键词: 老年, 肱骨近端骨折, 隐性失血, 骨折类型
Background

Proximal humeral fracture is one of the most common senile osteoporotic fractures, accounting for about 5%-6% of all the fractures. With the rapid progress of population aging, the number of elderly proximal humeral fractures also appears an increasing trend. Many elderly patients with proximal humeral fractures often suffer from anemia of different extent, which affects the prevention and treatment of complications, prevents postoperative functional recovery and increases mortality, but doesn't get the enough attention it deserves.

Objective

To analyze hidden blood loss (HBL) of elderly patients with proximal humeral fractures and the influence of fracture classification on HBL to provide relevant data for clinical practice.

Methods

From June 2014 to June 2020, clinical data of 116 cases with aged proximal humeral fractures treated with PHILOS in China-Japan Friendship Hospital were retrospectively analyzed. All the cases were divided into A-group (33 cases) , B-group (68 cases) and C-group (15 cases) according to Neer classification system. Total blood loss (TBL) , HBL and proportion of hidden blood loss (PHBL) were calculated based on hematocrit changes, which were compared among the three groups.

Results

Of all the 116 patients, the average TBL, HBL and PHBL were (710.0 ± 140.9) ml, (475.0 ± 107.0) ml and (66.9 ± 6.9) %. The average TBL, HBL and PHBL of A-group were (651.3 ± 128.5) ml, (432.2 ± 95.5) ml and (66.3 ± 6.2) %; the average HBL,TBL, HBL and PHBL of B-group were (718.3 ± 124.4) ml, (480.4 ± 100.3) ml and (66.9 ± 7.7) %; the average TBL, HBL and PHBL of C-group were (795.9 ± 182.1) ml, (540.5 ± 123.3) ml and (68.0 ± 3.9) %; furthermore, the differences between the three groups were statistically significant (P<0.05, respectively) . In addition, with the aggravation of fracture type, TBL and HBL increased gradually.

Conclusion

HBL was the most part of TBL after internal fixation with PHILOS for elderly proximal humeral fractures; moreover, the cases of more comminuted fractures had more HBL, which were worthy of special attention.

Key words: Proximal humeral fracture, Elderly, Hidden blood loss, Fracture type
表1 患者的一般情况
组别 例数 年龄（岁，±s） 性别 伤侧 致伤能量 合并疾病 受伤到手术时间（h，±s） BMI （kg/m2，±s）
男 女 左 右 低 高 高血压 糖尿病 冠心病
A组 33 73.6±4.8 11 22 16 17 27 6 18 7 9 34.9±20.9 23.3±5.9
B组 68 74.8±3.9 21 47 38 30 53 15 37 14 18 50.8±50.3 23.5±5.5
C组 15 73.0±6.4 4 11 7 8 9 6 10 4 5 52.9±55.8 23.7±5.4
检验值   t=1.447 x2=0.219 x2=0.730 x2=2.885 x2=0.791 x2=0.260 x2=0.292 t=0.710 t=0.042
P值   0.240 0.896 0.694 0.236 0.673 0.878 0.864 0.494 0.959
表2 各组患者的失血情况比较（±s）
组别 例数 TBL（ml） VBL（ml） HBL（ml） PHBL（%）
A组 33 651.3±128.5 219.1±52.9 432.2±95.5 66.3±6.2
B组 68 718.3±124.4a 237.9±69.4 480.4±100.3a 66.9±7.7
C组 15 795.9±182.1b 255.3±71.3 540.5±123.3b 68.0±3.9
总数 116 710.0±140.9 234.9±65.9 475.0±107.0 66.9±6.9
F值   6.519 1.813 6.253 0.340
P值   0.002 0.168 0.003 0.713
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