Research Of The Hidden Blood Loss Of Intertrochanteric Fracture Preoperative

Objective: In recent years, the national average age and the number of elderlypeople increase with the development of the economy and medical service ofour country which goes into the aging society. With the increase of the numberof the elderly people, many relevant problems come, senile diseases whichinclude intertrochanteric fracture as a common part is one of them.Intertrochanteric fracture refers to the fracture between the level of the base offemoral neck to the small trochanter below5cm, which accounts for about3.12%of the total bone fracture and45.26%of hip fracture. This fracture iscommon for elderly people and female is more than male. The treatment forintertrochanteric fracture can be divided into non-surgical and surgeryprimitively. Non-surgical treatment will be lying in bed for a long time withmany complications, and it is easy to increase patient mortality. Early surgicaltreatment is a positive, effective and safe method for intertrochanteric fracture,it supports patients for exercising on floor early, and it can promote fracturehealing and reduce various complications, becomes the first choice for thetreatment of intertrochanteric fracture. In recent years, surgical and anaesthetictechniques has made great progress and the surgical treatment forintertrochanteric fracture is no longer a problem for orthopedist, but themortality of intertrochanteric fracture has not significantly changed in thelast40years. Scholars have confirmed that the mortality in patients withintertrochanteric fracture is related to surgical timing, gender, preoperative orpostoperative anemia, and anemia is one of the important factors for mortality.Previous studies have confirmed that the actual blood loss in intertrochantericfracture was quite diffentent from hemoglobin and hematocrit detectedpreoperation and postoperation, so scholars was awared of hidden blood lossfor intertrochanteric fracture perioperative can not be ignored. However, the hidden blood is existence or caused by the surgical trauma, scholars have notfurther study. We speculate that significant hidden blood loss existspreoperatively in patients with intertrochanteric fracture, and which will beproved by experiments. The main purpose of this paper is to study thechatacteristics and related factors of hidden blood loss preoperative forintertrochanteric fracture patients.Methods:145patients including91patients with intertrochanteric fractureand54patients with femoral neck fracture (control group) were admitted fromMarch2012to February2013. Patients with intertrochanteric fracture include36males and55females, aged from56to92, at the average of75.7years.According to Evans-Jensen classification: Ⅰ0case,Ⅱ41cases, Ⅲ37cases,Ⅳ12cases, V1cases；elderly group(the age≥65years)83cases, non-elderlygroup(the age<65years)8cases. Patients with femoral neck fracture include22males and32females, aged from49to95, at the average of73.1years.According to Garden classification: Ⅰ0case,Ⅱ1case, Ⅲ43cases, Ⅳ10cases；elderly group(the age≥65years)48cases, non-elderly group(theage<65years)6cases. All the cases with a diagnosis of either unilateralintertrochanteric fracture or femoral neck fracture first time were assessed,and the exclusion criteria included other fractures, a pre-injury diagnosis ofanaemia, other parts of blood loss like gastrointestinal bleeds, cases ofpreoperative blood transfusion. All the patients were got blood routineexamination post-injury1days,2days and3days, and recordedhemoglobin(HGB) and hematocrit (Hct). According to Gross equation, thepreoperative hidden blood loss can be calculated by patients’ height, weightand the difference of hematocrit (Hct) from two times. SPSS13.0statisticssoftware was used for group t-test, and three consecutive days of hemoglobin(HGB) and hematocrit (Hct) of intertrochanteric fractures (experimental group)and femoral neck fractures (control group) were made for statistics analysis,and so were male-female group and elderly-nonelderly group of patients withintertrochanteric fracture. The difference was statistically significant (P<0.05).Excel mapping software can be used to draw histogram for correlated parameter comparison.Results: The mean blood loss of91patients with intertrochanteric fracturewas552.4mL calculated by Gross equation, and the average hemoglobindecreased22.1g/L. The mean blood loss of54patients with femoral was65.3mL calculated by Gross equation, and the average hemoglobin decreased3.4g/L. The difference between the two groups was statistically significant,the hidden blood loss of intertrochanteric fracture was significantly greaterthan the femoral neck frature. The mean blood loss of36male patients withintertrochanteric fracture was547.2mL calculated by Gross equation, and theaverage hemoglobin decreased20.1g/L. The mean blood loss of55femalepatients with intertrochanteric fracture was555.8mL calculated by Grossequation, and the average hemoglobin decreased23.4g/L. The mean bloodloss of83elderly (the age≥65years) patients with intertrochanteric fracturewas576.5mL calculated by Gross equation, and the average hemoglobindecreased23.9g/L. The mean blood loss of8non-elderly (the age<65years)patients with intertrochanteric fracture was302.6mL calculated by Grossequation, and the average hemoglobin decreased3.7g/L. The differencebetween the two groups was statistically significant, and the hidden blood lossof the elderly group was significantly greater than the non-elderly group.Among the tatal54patients with femoral neck fracture, the difference of bothhemoglobin (HGB) and hematocrit (Hct) between the male-female groupwas not statistically significant, and so was the elderly-nonelderly group.Conclusion: The hidden blood loss of patients with intertrochanteric fracturewas much, so the clinicians should take more attention and correspondingmeasures to reduce the preoperative and postoperative complications.