Singh指数与股骨转子间骨折术后再骨折的相关性研究

Singh Index in Hip re-fractures After Intertrochanteric Fractureoperation

目的比较股骨转子间骨折术后再骨折患者与未骨折患者的Singh指数,评估Singh指数在股骨转子间骨折患者中的应用价值。方法回顾性分析我院2014年1月至2016年12月期间收治并手术治疗股骨转子间患者218例,根据术后是否出现对侧髋部骨折分组,对两组患者Singh指数分级进行分析比较。结果a)随访24~60个月,平均42.9个月。转子间骨折术后对侧髋部再发骨折发生率为5.2%,初次骨折后发生对侧骨折的间隔时间平均11.5个月;b)股骨转子间骨折术后未骨折组Singh指数分级平均为4.0级,再骨折组Singh指数分级平均3.5级,两组差异有统计学意义(P=0.05),Singh分级低于4级可作为预测股骨转子间骨折术后对侧髋部再发骨折的阈值;c)Singh指数分级与骨密度值相关性分析结果,r=0.66,P<0.001,二者具有良好的正相关性。结论股骨转子间骨折患者Singh指数分级越低,相应骨质疏松程度越严重,术后对侧髋部再骨折发生率越高(P<0.05)。Singh指数在评估髋部骨折术后对侧髋部再骨折风险是十分简单而有效的方法。

Objective To compare the Singh index of patients with contra-lateral hip re-fractures and non-fractures after operation of intertrochanteric fractures and investigate the value of Singh index in patients with intertrochanteric fractures.Methods Records from 218 cases undergoing surgery for intertrochanteric fracture at our hospital from January 2014 to December 2016 were retrospectively reviewed,the patients were divided into a re-fracture group and no-re-fracture group according to presence or absence of re-fracture on the contra-lateral hip after operation.Singh index grading were compared between the two groups.Results a)All patients were followed up from 24 to 60 months with an average of 42.9 months,the incidence of contra-lateral hip re-fractures after intertrochanteric fractures was 5.2%,and the interval between the first fractures and the contralateral fractures was 11.5 months;b)The Singh index of the non-fracture group after intertrochanteric fracture was graded at an average of 4.0,whilein the re-fracture group itwas 3.5,P =0.05.The difference between the two groups was statistically significant.The Singh index lower than grade 4 can be used as a threshold for predicting contra-lateral hip re-fractures after intertrochanteric fractures.c) The correlation index of Spearman about Singh index and BMD was 0.66,P<0.001,which had a significant correlation.Conclusion The lower the Singh index of patients with intertrochanteric fractures,the more severe of the reduction in bone loss,and the incidence of contralateral hip fractures is higher (P<0.05).The Singh index is a simple and effective method for assessing contralateral hip fracture after operation of intertrochanteric fractures.