2010年至2011年全国83家医院成人浮髋损伤的流行病学调查与分析

Epidemiological survey of adult floating hip fractures from 2010 to 2011

目的分析2010年至2011年全国83家医院成人浮髋损伤患者的临床特点及流行病学特征。方法通过多阶段分层随机抽样，从全国31个省、市、自治区（中国香港、澳门、台湾除外）中抽取具有代表性的83家地方医院，并取得配合。收集2010年1月至2011年12月间诊治的成人（≥16岁）浮髋损伤患者的数字化影像资料和基本资料进行回顾性分析。统计分析患者年龄、性别、骨折类型及合并骨折等数据。≤45岁患者为青年组，〉45岁患者为中老年组。结果共收集成人浮髋损伤326人（335例），骨折按AO分型系统：61节段骨盆环骨折124例（含9例合并髋臼骨折），占同期61节段骨折总数的1．16％（124／10694）；62节段髋臼骨折211例，占同期62节段总数的6．65％（211／3174）；3节段股骨骨折333例（含双侧股骨骨折7例），占同期3节段总数的0．77％（333／42978）。男245例（75．15％），女81例（24．85％）；年龄16～98岁，平均41．53岁；左髋164例，右髋162例；青年患者215例，中老年患者111例，均以男性为主，分别占77．21％（166／215）和71．17％（79／111），差异无统计学意义（P〉0．05）。Muller分型A型、B型和C型分别为202、115和9例，年龄中位数及四分位间距分别是40（30．0～52．0）、37（26．0～51．0）、37（21．0～47．5）岁，差异无统计学意义（P〉0．05）。青年患者Muller A型、B型、C型分别有128、79、8例，中老年患者分别有74、36、1例，两组间各型骨折构成比差异无统计学意义（P〉0．05）。Muller A型、B型、C型浮髋损伤中股骨节段（31、32、33部位骨折）的分布差异有统计学意义（P〈0．017），Muller A型骨折与B型骨折构成比比较差异有统计学意义（P〈0．05）。在所有浮髋损伤中股骨近端合并髋臼骨折的类型所占比例最高，为39．88％（130／326）。结论浮髋损伤最常见的类型为Muller A型，患者多为青年男性，髋臼合并同侧股骨近端骨折的浮髋损伤最多见。

Objective To analyze the clinical and epidemiologic features of adult floating hip fractures in 83 hospitals between 2010 and 2011. Methods A total of 83 representative hospitals in 31 Chinese provinces and cities took part in this survey. Patients of 16 years old and older with floating hip injury were included in the present analysis who had been admitted between January 2010 and December 2011. Their data of digital radiographs and basic records were collected retrospectively and analyzed. The old, pathological and periprosthetic fractures were excluded. The radiographs of fractures were classified by experienced orthopedic residents and verified by 2 orthopedic deans and one radiologist. The gender, age, concomitant fractures and fracture classification were analyzed. Those younger than 45 years old were defined as young, and those older than 45 years old as middle-aged and old. Results A total of 326 adult patients（335 floating hip fractures） were collected. By AO classification, there were 124 cases of type 61 pelvic ring fractures, accounting for 1.16% （124/10,694） of contemporary type 61 ones, 211 cases of type 62 acetabular fractures, accounting for 6. 65% （211/3, 174） of contemporary type 62 ones, and 333 cases of femoral frac-tures, accounting for 0.77% （333/42,978） of contemporary type 3 ones. 245 cases （75. 15% ） were males and 81 （24.85%） females, 16 to 98 years of age （average, 41.35 years）. 164 left hips and 162 right hips were involved. 215 cases were young and 111 ones middle-aged and old. Males dominated the 2 groups, with a proportion of 77.21% （166/215） and 71.17% （79/111 ）, respectively, showing no significant difference between the 2 groups （ P 〉 0. 05） . According to the Muller classification, 202, 115 and 9 cases were re- spectively types A, B and C, the age median and interquartile range of which were 40 （from 30. 0 to 52.0）, 37 （from 26.0 to 51.0） and 37 （from 21.0 to 47.5） years, showing no significant difference （P 〉 0.05） . There were respectively 128, 79 and 8 cases of Muller types A, B and C in the young group, and respectively 74, 36 and 1 cases of Muller types A, B and C in the middle-age and old group, showing no significant difference between the 2 groups in constituent ratio of Muller types（ P 〉 0.05）. A significant difference was found in distribution of femoral segments （31, 32 and 33） between Muller types A, B and C （ P 〈 0. 017）. There was a significant difference between the constituent ratios of Muller types A and B （ P 〈 0.05）. Of all the floating hip fractures, the proximal femoral ones involving the aeetabulum accounted the highest proportion, being 39.88% （130/326） . Conclusions The most common type of floating hip fractures was Muller type A. Most of the patients were young men. The proximal femoral fractures involving the aeetabulum accounted for the highest proportion.