河北医科大学第三医院2003-2012年成人胫骨近端骨折的流行病学调查

Epidemiological investigation and analysis of adult proximal tibia fractures in the Third Hospital of Hebei Medical University during 2003 and 2012

目的调查成人胫骨近端骨折的流行病学特征,并分析其变化趋势。方法利用医学影像计算机存档与传输系统及病案查询系统,收集2003年1月—2012年12月10年间河北医科大学第三医院骨科诊治的胫骨近端骨折的患者资料进行回顾性分析,将2003—2007年资料定为Ⅰ组,2008—2012年资料定为Ⅱ组,统计两组患者性别、年龄、骨折类型等数据并进行对比分析。结果10年间,共诊治成人骨折107648例,其中胫腓骨骨折18432例,胫骨近端骨折3655例,占同期胫腓骨骨折的19.8%（3665/18432）,占全身骨折的3.4%（3655/107648）。3655例成人胫骨近端骨折中,男性占70.5%（2575/3655）,31~40岁组共707例,构成比最高（27.5%）；女性占29.5%（1080/3655）,41~50岁组共224例,构成比最高（20.7%）。按AO分型,41-A1型1227例,构成比最高（33.6%）。关节内骨折1651例,其中男1150例,女501例；关节外骨折2004例,男1425例,女579例,男女比例差异无统计学意义（字2=0.918, P〉0.05）。Ⅰ、Ⅱ组分别为1909例和1746例,分别占同期胫腓骨骨折的18.7%（1909/10234）和21.3%（1746/8198）,差异有统计学意义（字2=13.364, P0.05）。Ⅰ、Ⅱ组男女比例分别为2.5：1（1371/538）和2.2：1（1204/542）,差异无统计学意义（字2=3.583, P〉0.05）；60岁以上年龄段构成比分别为8.4%（161/1909）和12.8%（224/1746）,差异有统计学意义（字2=18.697, P〈0.01）。Ⅱ组41-B型构成比（39.5%,690/1746）高于Ⅰ组（35.1%,671/1909）,差异有统计学意义（字2=7.45, P 〈0.01）；Ⅱ组41-C 型构成比（16.1%,281/1746）低于Ⅰ组（19.0%,362/1909）,差异有统计学意义（字2=5.177, P〈0.05）。结论近10年,成人胫骨近端骨折占胫腓骨骨折的19.8%,占全身骨折的3.4%。男性约占70%,多见于31~40岁；女性约占30%,多见于41~50岁。前后5年相比,60岁以上年龄段构成比升高了4.4%,关节内骨折和关节外骨折的构成比未发生明显变化。

Objective To investigate the epidemiological features and trends of adult proximal tibia fractures. Methods The data of patients with proximal tibia fractures between 2003 and 2012 at the Orthopaedics Department of the Third Affiliated Hospital of Hebei Medical University were collected and analyzed through the PACS system and case reports checking system. The data between 2003 and 2007 were classified as group Ⅰ, while the data between 2008 and 2012 were classified as group II. Statistical data included gender, age and fracture type and comparison analysis was done to both groups. Results A total of 107 648 adult fractures were selected with 18 432 tibia and fibula fractures and 3 655 proximal tibia fractures. The proximal tibia fractures accounted for 19. 8%（3 665/18 432） of the tibia and fibula fractures and 3. 4%（3 665/107 648） of the total fractures. There were 2 575 males （70. 5%, 2 575/3 655） and the peak range of highest age distribution （27. 5%） was 31-40 years old with 707 fractures. There were 1 080＆nbsp;females （29. 5%, 1 080/3 655） and the peak range of highest age distribution （20. 7%） was 41-50 years old with 224 fractures. According to the AO classification, there were 1 227 fractures in 41-A1 subtype with the highest proportion of 33. 6%. A total of 1 651 intraarticular fractures with 1 150 males and 501 females and 2 004 extraarticular fractures with 1 425 males and 579 females were selected. There was no statistically significant difference in sex ratios（字2 =0. 918, P〉0. 05）. 1 909 cases and 1 746 cases were classified as group Ⅰ and II respectively, accounting for 18. 7%（1 909/10 234） and 21. 3%（1 746/8 198） of the proximal tibia fractures（字2 =13. 364, P0. 05）. The sex ratios were 2. 5：1（1 371/538） and 2. 2：1（1 204/542） respectively （字2 =3. 583, P〉0. 05） and the proportion of fractures older than 60 were 8. 4%（161/1 909） and 12. 8%（224/1 746）（字2 =18. 697, P〈0. 01）. The proportion of 41-B in group II （39. 5%, 690/1 746） was higher than that in group Ⅰ （35. 1%, 671/1 909） （字2 =7. 45, P〈0. 01） and the proportion of 41-C in group II （16. 1%, 281/1 746） was lower than that in groupⅠ（19. 0%, 362/1 909） （字2 =5. 177, P〈0. 05）. Conclusions Adult proximal tibia fractures account for 19. 8% of the tibia and fibula fractures and 3. 4% of the total fractures. Males account for nearly 70% and are mostly seen between 31 to 40 years old. While females account for nearly 30% and are mostly seen between 41 to 50 years old. The proportion of fractures for patients who are older than 60 years increases 4. 4%. There is no change in proportions of extraarticular and intraarticular fractures.