Effect Of Osteoporosis On Hidden Blood Loss After Intertrochanteric Fracture Surgery

Objective: Most of the elderly patients in C hina have osteoporosis,which can easily lead to intertrochanteric fractures after a fall,which seriously affects the quality of life of patients.Conservative treatment of intertrochanteric fractures was slower.Long-term patient braking can lead to a variety of serious bed complications such as hemorrhoids,hypostatic pneumonia,and the like.Therefore,for its treatment,it currently tends to be treated surgically.At present,the surgical methods of intertrochanteric fractures are various,including intramedullary nail fixation(PFNA/INTERTAN)and dynamic hip screw fixation(DHS).The choice of a suitable surgical procedure is very important.In recent years,PFNA internal fixation has often been used to treat intertrochanteric fractures of the femur,and the efficacy has been clearly confirmed.Patients with intertrochanteric fractures often have a large amount of blood loss after surgery.The blood loss components include intraoperative and postoperative dominant blood loss and postoperative hidden blood loss.Blood loss is a common complication after hip fracture.A large amount of blood loss will reduce the body function of the patient,resulting in slower wound healing and delayed exercise,which not only increases hospitalization time,cost,but also increases the incidence of various postoperative complications,resulting in increased patient mortality.This article explores the relationship between the degree of osteoporosis in elderly patients and the perioperative hidden blood loss,dominant blood loss and total blood loss after PFNA internal fixation.Methods: This article selected patients who underwent PFNA internal fixation for intertrochanteric fractures in Dalian Municipal Central Hospital from October 2016 to September 2018.Review and record the general condition,age,gender,and body mass index(BMI)of the relevant case data.During the hospitalization,the amount of dominant blood loss during and after surgery was recorded,and hemoglobin,hematocrit,and bone mineral density of the patient were measured on the 2nd day after admission and 1,3,5,and 7 days after surgery.The amount of hidden blood loss is calculated by the Gross equation and the dominant blood loss is derived.Patients were divided into three groups according to the degree of osteoporosis,namely,the normal bone density group(n=9),the bone mass reduction group(n=17),and the osteoporosis group(n=24).Total blood loss,dominant blood loss,and hidden blood loss were calculated from changes in hemoglobin levels before and after surgery.Evaluate whether there is a difference in perioperative hidden blood loss in patients with different bone mineral density.After all the data has been checked,the SPSS software is used for data analysis.One-way ANOVA was used to compare the measurement data groups of each group.An independent samp le t-test was used to compare the two groups.The difference was statistically significant with p<0.05.Results: The patients who were finally included in the paper after strict screening according to the inclusion criteria were 50 patients.All patients underwent PFNA internal fixation for intertrochanteric fractures.There were no significant differences in age,weight,and operation time between the three groups.In the normal bone mass group,the total blood loss after bone loss and osteoporosis group were(890.60±87.12)m L,(959.69±82.51)m L,(1059.93±118.97)m L,and the dominant blood loss was(107.22±16.91)m L,(104.23±13.83)m L,(106.27±14.58)m L,and the hidden blood loss were(783.39 ±82.40)m L,(855.46 ±82.75)m L,and(954.41 ±113.09)m L,respectively.There were significant differences in hidden blood loss and total blood loss between the three groups(P<0.05).There was no significant difference in dominant blood loss(P>0.05).Conclusion: Hidden blood loss is the main cause of blood loss after intertrochanteric fracture surgery.Age and degree of osteoporosis were the main influencing factors.The vital signs of patients should be monitored strictly after operation and possible complications should be prevented.Combination of prevention and treatment should be achieved.