| Purpose:Exploring of artificial femoral head replacement on the efficacy of fractures in elderly patients with intertrochanteric affect perioperative blood loss and hidden blood loss factor of variation.Material and method:A retrospective study of December 2009 to December 2014, Affiliated Hospital of Liaoning University of Traditional Chinese Orthopedics department with two hemiarthroplasty treatment of intertrochanteric fracture cases, 68 cases selected for analysis, age 65-89 years old(The average age 75.7 ± 7.3 years),according to the Evans classification: 35 cases of type II, III type in 25 cases, 8 cases of type IV. Of which 35 males and 33 females. Old age group of 32 patients(aged ≥75 years), non-elderly group of 36 patients(age <75 years). 38 cases of obese(BMI greater than 28), 30 cases of non-obese group(BMI 28 or less). Consolidation of various medical disorders group and no medical illness groups. According to preoperative and postoperative HCT, weight, height, etc., using Gross equation to calculate the total amount of blood loss in patients, then calculate the amount of hidden blood loss in patients.Results:1. 68 cases of intertrochanteric fractures in patients with postoperative hematocrit, hemoglobin changes: HCT appear in the first five days minimum, for 29.66 percent, the first day of the first five days of HCT difference of 11.54%; HGB the lowest value in the first five days, was 99.09 g / L, the first day of the first five days of the HGB difference of 21.01 g / L. Gradually decreased of blood from the index value, the first five days to reach the lowest, from the 6th day of blood index values rebounded. 2. 35 cases of male group intertrochanteric fracture patients, postoperative blood return HGB, HCT maximum difference appear in the first five days, that HGBd1-5: To 33.89 g / L, HCTd1-5: for 10.57% according hidden blood loss after Gross equation derived for 490.03ml; 33 female group intertrochanteric fracture patients, postoperative blood return HGB, HCT also now the biggest difference between the first five days, that HGBd1-5: to 31.21 g / L, HCTd1-5: 9.75%, according to the hidden blood loss after Gross equation derived 516.71 ml. Male and female patients blood group targets five days, hematocrit(HCT), hemoglobin(HGB) the difference between the increments to reach the maximum difference between the first five days, and then gradually decreased. The group of patients with blood indicators HGB, HCT value statistical analysis, P> 0.05, not statistically significant.(d1-n: with the difference between the first day of the n-th day) 3. 68 cases of intertrochanteric fractures in elderly patients, 32 cases of patients, hematocrit(HCT), hemoglobin(HGB) index difference between the average of first to fourth days increased gradually, and the difference was decreased is began to occur in the fifth day. The difference of fourth days in 6 days is most obvious, namely the HGBd1-4: 39.24g/L, HCTd1-4: 11.52%. According to the calculation of implicit Gross equation is obtained after the blood loss was 550.32ml; non elderly group of patients with 36 columns, the blood routine index difference between the first 5 days of increased gradually, but from the sixth day HGB, HCT difference was decreased. The difference in blood in 6 days, fifth days of the maximum difference, namely, HGBd1-5: 30.83g/L, HCTd1-5: 9.31%. According to the Gross equation obtained occult blood loss 509.64 ml. The two groups of patients with red cell volume(HCT), hemoglobin(HGB) indicator values for statistical analysis, the difference was statistically significant(P < 0.05), recessive non elderly group of blood loss is far less than the older group of patients. 4. Influence of hidden blood loss univariate results showed that sex, BMI(whether obesity) factors hidden blood loss was not affected. ASA classification, whether the combined medical illness, injury and surgery, operative time, intraoperative whether RBC(P <0.05) to a certain extent. Younger, lower ASA classification, the less consolidated medical illness, injury to the shorter operation time and operation time, blood loss, the less hidden. And the right amount of intraoperative transfusion of red blood cells, helps to reduce blood loss hidden blood loss. 5. 68 cases of intertrochanteric fractures in patients with overt bleeding average weight was 338.97 m L,average bleeding amount of hidden blood loss 549.02 m L, the total average weight of 887.99 m L. Dominantblood loss and occult blood loss accounted for the total blood loss ratio is about 2/5, 3/5. Through the calculation for overt bleeding amount is 0.617 times the occult blood loss, that is the main source of hidden blood loss blood loss in patients with postoperative blood loss. 6.68 cases of intertrochanteric fracture patients were followed up for 90-100 results of 20 cases; 80-89 33 cases, 70-79 13 cases, less than 70 points in 2 cases.Conclusion:1. Hidden blood loss is the main reason for femoral intertrochanteric fracture in peri operation period of blood loss, should be in the postoperative timely assess and reasonable congestion capacity. 2. Age, ASA classification, with medical illness, injury and surgery and operative time, blood loss is related to the impact of the hidden factors. Younger, lower ASA classification, the less consolidated medical illness, injury to the shorter operation time and operation time, blood loss will be reduced recessive.For elderly patients, and should merge the various diseases in Department of internal medicine patients pay special attention, pay attention to the hidden blood loss situation, timely and appropriate to supplement the blood volume, in order to reduce the risk of such patients in peri operation period of. 3. The minimum value of HCT is mainly concentrated in the 3-5 days after operation, blood transfusion events mainly occurred at this stage, and the first 2 days after surgery is relatively stable period. 4. Gender, obese had no influence on the hidden blood loss. 5. Artificial femoral head replacement is effective in the treatment of IFF( fracture treatment of femoral trochanter). |
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