Comparison of perioperative blood loss between proximal femoral nail anti-rotation and cemented hemiarthroplasty for unstable intertrochanteric fractures in the elderly
Yang Zhengyang
Wang Ye
Liu Dajun
Li Jie
Jiang Wei
Zhong Xiaoming
Abstract：Objective To investigate the differences in perioperative blood loss and the influencing factors of hidden blood loss(HBL)between proximal femoral nail anti-rotation(PFNA)and cemented bipolar hemiarthro-plasty(CBH)for the treatment of elderly patients with unstable intertrochanteric femoral fractures.Methods A retrospective analysis was conducted on 56 elderly patients with unstable intertrochanteric femoral fractures admitted to our department from Jan.2023 to Jan.2024.There were 21 males and 35 females aged 73-96(mean 82.6)years.The injury causes included road traffic accidents(16 cases)and falls(40 cases).Patients were divided into PFNA group(n=24)and CBH group(n=32)based on surgical approaches.The intraoperative blood loss,postop-erative drainage volume,transfusion volume,hemoglobin(Hb)levels,hematocrit(Hct)levels,VAS,and Harris scores were compared between the two groups.The total blood loss(TBL)and HBL were calculated using the Gross,Bourke,and Camarasa formulas,and their differences were analyzed.Univariate t-test and multiple linear re-gression were used to analyze risk factors for HBL in such patients.Results Based on the Gross,Bourke,and Ca-marasa formulas,the PFNA group had significantly higher TBL[mL,1275.57(928.90,1588.58),1010.20(769.71,1232.76)and 1548.66(1261.01,1966.17)]and HBL[mL,985.57(648.95,1296.08),794.74(496.37,1311.59),1283.71(966.01,1731.17)),compared to the CBH group[TBL:mL,871.44(701.76,1 022.63),714.01(627.80,858.84),1013.38(823.00,1653.18);HBL:mL,500.53(334.31,621.33),351.27(201.47,453.07),620.28(489.05,1108.98)](allP＜0.05).However,the PFNA group showed much less overt blood loss than the CBH group(intraoperative blood loss:mL,120.00(110.00,150.00)vs.225.00(150.00,300.00);postoperative drainage volume:mL,135.83±24.30 vs.184.06±34.63,both P＜0.05).At 1 and 3 months postoperatively,the VAS scores were also much higher in the PFNA group[5(4,6)and 3(3,4)]than those in the CBH group[3(3,4)and 2(2,3)](both P＜0.05),while the Harris scores were much lower(45.9±6.9 and 61.8±5.7 vs.60.9±3.0 and 77.0±4.2)(both P＜0.05).But at 6 months postopera-tively,there were no significant differences in VAS and Harris scores between the two groups(both P＞0.05).Uni-variate and multiple linear regression analyses identified that age ≥ 80 years,surgical approach of PFNA,Evans typeⅣ classification,general anesthesia,comorbid hypertension or diabetes mellitus,pre-injury anticoagulant use,and time from injury to surgery ≥5 d were significant influencing factors for HBL(all P＜0.05).Conclusion Com-pared with CBH,PFNA for elderly patients with unstable intertrochanteric femoral fractures results in greater TBL and HBL,higher VAS scores and lower Harris scores within 3 months.Fracture classification,hypertension,diabetes mellitus,long-term preoperative anticoagulant use,anesthesia method,age,and delayed surgery after injury are signif-icant influencing factors for HBL.
Keywords：Intertrochanteric fracturesProximal femoral nail anti-rotationCementHemiarthroplastyPerioperative blood lossHidden blood loss
Publication Date：2025-08-15
Online Publishing Date：2025-08-27(First online date of this platform, not the publication date of the document)
Pages：8( 594-601 )