Study On Postoperative Hidden Blood Loss In Treatment Of Femoral Intertrochanteric Fracture By Gamma3Trochanteric Interlocking Intramedullary Nail

Objective:To analyze the characteristics of hidden hemorrhage in femoral intertrochanteric fracture and the inherent related factors, so as to provide references for evaluation on clinical perioperative blood loss and the treatment, by the study on gender, fracture type, mean corpuscular haemoglobin concentration (MCHC) before and after operation, and the corresponding clinical indicators of patient with femoral intertrochanteric fracture who were treated by fixation of Gamma3trochanteric interlocking intramedullary nail.Methods:617patients with femoral intertrochanteric fracture admitted in Shanghai Sixth People’s Hospital from September2010to March2012were screened based on clinical data of Gamma3trochanteric interlocking intramedullary nail. And84cases with the corresponding condition and complete medical records were selected. Blood routine on the operation day and the third day after operation (about48h) and the intraoperative and postoperative blood loss were recorded. Gross equation was used to calculate the amount of postoperative blood loss. It subtracted the dominance blood loss (the sum of intraoperative and postoperative volume of drainage), namely the postoperative hidden blood loss. The patients were divided according to gender, age (elder group and younger group) and fracture type (simple fracture with complex fractures) to analyze the related factors of postoperative hidden blood loss. Laboratory data of the cases were obtained from medical library of Shanghai Sixth People’s Hospital, and the intraoperative blood loss and postoperative drainage were measured by the writer. Data were analyzed with SPSS17.0. Results:Based on Evans classification, the84patients were divided into the simple fractures (a total of48cases, including12cases of type Ⅰ and36cases of type Ⅱ) and complex fractures (a total of36cases, including26cases of type Ⅲ and10cases of type IV). There were42male and42female patients, with the mean age of78.3years (60-97years). The average operation time was53min and the average operation records blood loss was120.42ml. There were34cases in the elder group (greater than or equal to80years old), preoperative MCHC was107.00g/L, while postoperative MCHC was89.94g/L; There were50cases in the younger group (less than80years old):preoperative MCHC was117.54g/L, while postoperative MCHC was94.18g/L; A total of53patients with intraoperative and postoperative blood transfusion, and postoperative MCHC was92.46g/L; the mean postoperative blood loss was841.71ml, and average postoperative hidden blood loss was721.29ml.Conclusion:Gamma3trochanteric interlocking intramedullary nail is used for inner fixation treatment. Perioperative blood loss is greater than the blood loss in the operation record and postoperative drainage. The hidden blood loss accounts for82.59%, which has a certain relationship with age and fracture type. Postoperative anemia should be alert to in clinical work. Blood routine should be rechecked. And the surgical risk can be correctly evaluated and be treated timely.