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

doi:10.3877/cma.j.issn.2095-5790.2021.02.011

Abstract

Abstract:

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

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.

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References 29

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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）
组别	例数	年龄（岁，±s）	男	女	左	右	低	高	高血压	糖尿病	冠心病	受伤到手术时间（h，±s）	BMI （kg/m²，±s）
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

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）
组别	例数	年龄（岁，±s）	男	女	左	右	低	高	高血压	糖尿病	冠心病	受伤到手术时间（h，±s）	BMI （kg/m²，±s）
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

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±124.4^a	237.9±69.4	480.4±100.3^a	66.9±7.7
C组	15	795.9±182.1^b	255.3±71.3	540.5±123.3^b	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

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±124.4^a	237.9±69.4	480.4±100.3^a	66.9±7.7
C组	15	795.9±182.1^b	255.3±71.3	540.5±123.3^b	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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