股骨近端病理性骨折患者围手术期的临床特征分析

doi:10.19723/j.issn.1671-167X.2019.05.014

Abstract

Abstract:

Objective: To investigate the perioperative clinical characteristics of patients with patholo-gical fracture of proximal femur. Methods: A retrospective study reviewed 28 patients who received proximal resection and tumor hemiarthroplasty for malignant proximal femoral tumor in Peking University First Hospital from January 2011 to February 2017. According to the fracture, the patients were divided into two groups: pathological fracture group and non-pathological fracture group. We investigated the clinical characteristics during perioperative period between the two groups. Results: Of the 28 patients, 14 (50.0%) patients suffered pathological fracture, and there was no significant difference between the two groups in the patient’s age, gender, limb involvement, and tumor source (P>0.05). There was no significant difference between the two groups in hemoglobin (HGB), hematocrit (Hct), and lower extremity thrombosis. The albumin (ALB) of pathological fracture group were lower in contrast to non-pathological fracture group (P=0.031). There was no significant difference between the two groups in decline of HGB and Hct on postoperation day 1, operative time, bleeding during operation, time for walking with help of ambulation aid postoperative, and postoperative hospital stay (P>0.05). On post-operation day 7, HGB (P=0.025) and Hct (P=0.039) of pathological fracture group were significant lower in contrast to non-pathological fracture group. Whereas, the total blood loss calculated by Gross equation of pathological fracture group was significant higher in contrast to non-pathological fracture group [(2 066.3±419.8) mL vs. (786.0±152.6) mL, P=0.039]. The patient needed blood transfusion during operation (7/14 vs. 1/14, P=0.033) and postoperative (8/14 vs. 1/14, P=0.013) in pathological fracture group were more than in non-pathological fracture group. At last, Barthel daily life ability score (P=0.009) of pathological fracture group was lower in contrast to non-pathological fracture group, and visual analogue scale (VAS) score was higher (P<0.001). They were almost equal when the patients were discharged (P>0.05). Conclusion: Patients with pathological fracture had lower ALB during perioperative period. Pathological fracture had no effect on operative time, bleeding during operation and function outcomes. However, the patients with pathological fracture had more total blood loss and lower HGB, Hct in contrast to the patients without pathological fracture. Blood transfusion was more needed in pathological fracture patients.

Key words: Fractures, spontaneous, Bone neoplasms, Femoral fractures, Perioperative period

CLC Number:

R683.42

Yun-peng CUI,Chuan MI,Bing WANG,Yuan-xing PAN,Yun-fei LIN,Xue-dong SHI. Perioperative clinical characteristics of patients with pathological fracture of proximal femur[J].Journal of Peking University(Health Sciences), 2019, 51(5): 875-880.

Figures/Tables 4

Figure 1

Table 1

Table 2

Table 3

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Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Age/years, $x ?$ ±s	63.6±3.5	59.6±2.9	0.210^b
Female, n (%)	7 (50.0)	4 (28.6)	0.440^c
Left limb involvement, n (%)	5 (35.7)	10 (71.4)	0.128^c
Lower extremity thrombosis, n (%)			>0.999^c
Deep venous thrombosis	0	0
Inter-muscular venous thrombosis	2 (14.3)	1 (7.1)
Tumor source, n			0.678^c
Primary tumor	5	3
Metastatic tumor	9	11
VAS score, $x ?$ ±s	8.2±0.2	4.0±0.3	<0.001^b
Barthel daily life ability score, $x ?$ ±s	33.2±4.5	60.6±9.1	0.009^a
HGB/(g/L), $x ?$ ±s	113.0±6.2	127.4±5.1	0.087^a
Hct/%, $x ?$ ±s	33.1±1.8	37.0±1.5	0.103^a
ALB/(g/L), $x ?$ ±s	35.6±1.5	40.1±1.2	0.031^a
Pre-ALB/(mg/L), $x ?$ ±s	186.5±22.5	244.0±18.1	0.056^a

Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Operative time/min, $x ?$ ±s	214.3±20.8	188.6±9.9	0.194^b
Bleeding during operation/mL, $x ?$ ±s	953.4±332.9	414.3±66.0	0.246^b
Blood transfusion during operation, n (%)	7 (50.0)	1 (7.1)	0.033^c

Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Short-term prognosis
Time for walking with help of ambulation aid/d, $x ?$ ±s	15.8±1.2	14.3±0.9	0.333^a
Postoperative hospital stay/d, $x ?$ ±s	18.5±1.8	18.8±1.8	0.910^a
VAS score-discharge, $x ?$ ±s	2.9±0.2	2.6±0.1	0.482^b
VAS score decline, $x ?$ ±s	5.4±0.3	1.4±0.2	<0.001^b
Barthel daily life ability score-discharge, $x ?$ ±s	38.8±2.9	42.9±5.5	0.477^a
Drainage
Time/d, $x ?$ ±s	6.3±0.8	4.1±0.3	0.069^b
Volume/mL, $x ?$ ±s	759.8±158.2	380.3±60.4	0.085^b
Laboratory examination of postoperation day 1
HGB/(g/L), $x ?$ ±s	93.8±4.2	106.5±4.7	0.055^a
HGB decline/(g/L), $x ?$ ±s	19.2±3.9	20.9±3.2	0.745^a
Hct/%, $x ?$ ±s	27.2±1.2	30.9±1.2	0.042^a
Hct decline/%, $x ?$ ±s	5.9±1.1	6.1±1.2	0.893^a
ALB/(g/L), $x ?$ ±s	27.8±1.0	31.8±1.2	0.018^a
ALB decline/(g/L), $x ?$ ±s	7.6±1.1	8.5±1.0	0.594^a
Laboratory examination of postoperation day 7
HGB/(g/L), $x ?$ ±s	90.0±5.3	107.6±5.0	0.025^a
Hct/%, $x ?$ ±s	26.3±1.7	30.9±1.2	0.039^a
Total perioperative blood loss/mL, $x ?$ ±s			0.164^b
Postoperation day 1	1 219.0±203.6	781.4±118.4	0.164^b
Postoperation day 7	2 066.3±419.8	786.0±152.6	0.030^b
Blood transfusion postoperation within 7 days, n (%)	8 (57.1)	1 (7.1)	0.013^c

Perioperative clinical characteristics of patients with pathological fracture of proximal femur

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