Clinical Study On The Effect Of PFNA Treatment Timing On Perioperative Blood Loss In Femoral Intertrochanteric Fractures

OBJECTIVE: Intertrochanteric fracture is one type of hip fracture that occurs frequently in the elderly and its incidence increases year by year as the population ages.Older people generally have poor health conditions,often complicated with various medical diseases such as heart,cerebrovascular disease,diabetes,etc.,and the bones are mostly loose,even minor injuries may lead to fractures.Older patients are often accompanied by one or more underlying diseases,and if not actively treated,the underlying diseases are likely to be aggravated together.Moreover,many elderly patients choose conservative treatment because of the traditional view,and the adverse consequences of conservative treatment are increased incidence of complications such as pressure sores,respiratory and urinary tract infections.In recent years,the problem of recessive blood loss has received more and more attention in clinical practice.It is common in various traumatic diseases.If it is not treated in time,it will have a major impact on the patient's recovery,physical function and even life.Because surgery can reduce long-term bedridden complications and reduce the rate of death and disability,it has gradually become the mainstream choice for the treatment of intertrochanteric fractures in the past half century,but how to choose the best treatment timing experts to take the lead.This study investigated whether different surgical timings can affect perioperative bleeding volume based on the application of anti-rotation proximal femoral nails in the treatment of femoral intertrochanteric fractures,and provide a reference for the choice of clinical timing.Methods: The clinical data of patients with femoral intertrochanteric fracture who underwent PFNA surgery in our department of orthopedics from September 2016 to October 2018 were retrospectively analyzed.The time from injury to surgery was divided into 48 hours.The early surgery group and the extended surgery group recorded the height,weight,body mass index,hemoglobin and hematocrit,operative time,intraoperative blood loss,length of hospital stay,and total hospitalization cost of all patients before and after surgery,according to Gross and other equations calculated perioperative blood loss and recessive blood loss,and the above data were statistically analyzed.RESULTS: A total of 82 patients were enrolled in the study.The early group was 41 patients with an average age of(76.59 ± 10.19)years;the delayed group was 41 patients with an average age of(73.95 ± 13.30)years.The operation time(65.54±15.41),intraoperative blood loss(54.7 ± 2.5),hospitalization time(9.56±3.13),and total hospitalization cost(41014.32±6566.81)in the early group were significantly lower than those in the delayed group(90.59±26.97,78.8 ± 4.7,12.73±4.12,45415.26±6090.51);hemoglobin was(103.59±2.01)G/L on the third day after operation,and hematocrit was(27.05±0.53)%.Hemoglobin on the third day after postoperative period.It was(101.39±2.31)G/L,and the hematocrit was(25.92 ±0.61)%.The hemoglobin and hematocrit on the third day after operation in the early group were higher than those in the delayed group,which was statistically significant(P<0.05).The total blood loss in the early group was(930.09±247.22)ml,the recessive blood loss was(801.39±128.11)ml,the total blood loss in the delayed group was(1046.78±327.93)ml,and the recessive blood loss was(967.98±123.53)ml.The total blood loss and recessive blood loss in the early group were lower than those in the delayed group,and there was statistical significance between the two groups(P<0.05).Conclusion: The choice of injury to the time of surgery is very important for the amount of bleeding in patients.Surgery within 48 hours if the patient's physical condition and family's economic condition are allowed,the amount of bleeding during surgery can be significantly shortened.Time and hospital stay can also help reduce the cost of hospitalization for patients.Most importantly,the amount of bleeding during perioperative period will be significantly reduced,which is worthy of reference by clinicians.