股骨转子间骨折临床特征的变化趋势:一项基于医院的回顾性研究

Epidemiological trends in the clinical features of intertrochanteric fractures:a hospital-based retrospective study

目的:分析10年间河北医科大学第三医院股骨转子间骨折临床特征的变化趋势。方法:收集2010年1月1日至2019年12月31日河北医科大学第三医院确诊为股骨转子间骨折的住院患者的一般资料、疾病相关信息及影像学资料,按照入院时间分为两组,即2010年1月至2014年12月(前5年组)和2015年1月至2019年12月(后5年组),比较两组患者的性别、年龄、致伤原因、骨折Evans分型、合并疾病、住院天数及是否手术治疗。结果:共纳入股骨转子间骨折患者6 125例,男2 664例,女3461例;男、女比例为0.77∶1。高发年龄段男性为70~79岁,女性为80~89岁。前5年组2 314例,男、女比为0.91∶1;后5年组3 811例,男、女比例为0.70∶1。两组性别构成比差异有统计学意义( χ2=25.265, P<0.05)。前5年组高发年龄段为70~80岁(31.9%,739/2 314),后5年组高发年龄段为80~90岁(34.5%,1 313/3 811)。两组70~79岁年龄段性别构成比差异有统计学意义( χ2=0.024, P<0.05)。6 125例患者有明确致伤原因,其中83.9%(5 140/6 125)为跌倒和室内活动损伤致骨折,前5年组跌倒和室内活动损伤致骨折的比例75.4%(1 745/2 314)较后5年组89.1%(3 395/3 811)低,两组差异有统计学意义( χ2=14.363, P<0.05)。共调取3 560例股骨转子间骨折患者的X线或CT检查,其中高发骨折类型为EvansⅡ、Ⅲ型。前5年组Ⅱ型骨折占比最高(38.1%,239/628),后5年组Ⅲ型骨折占比最高(39.5%,1 159/2 932);两组骨折分型比较差异有统计学意义( χ2=183.569, P<0.05)。6 125例骨折中,4 846例合并其他内科疾病,占79.1%。前、后5年组合并内科疾病种类比较差异有统计学意义( χ2=8.916, P<0.05)。手术治疗患者共5 184例,前5年组为1 925例,后5年组为3 259例;患者住院时间中位数分别为14 d和12 d;四分位数间距均为8 d。两组手术患者住院时间差异有统计学意义( Z=-9.909, P<0.001)。 结论:股骨转子间骨折临床特征的变化趋势为女性多于男性,跌倒和室内活动损伤为最常见致伤原因,好发骨折类型为Evans Ⅱ、Ⅲ型,有老龄化趋势,合并内科疾病明显增多,但住院总天数有下降趋势。

Objective To analyze the epidemiological characteristics of all the patients with intertrochanteric fracture admitted to the Third Hospital of Heibei Medical University in the past 10 years.Methods Data of patients with intertrochanteric fracture admitted to our hospital from January 1,2010 to December 31,2019 were retrospectively analyzed.According to the year of admission,all the patients were divided into two groups:the first five years(group A)and the last five years(group B).Gender,age,injury cause,Evans classification,complicated diseases,length of hospital stay and whether surgical treatment or not were compared.Results A total of 6,125 patients with intertrochanteric fracture were included in the study,including 2,664 males and 3,461 females with a male to female ratio of 0.77∶1.The peak age was 70-79 for males and 80-89 for females.There were 2,314 cases in group A(male to female ratio was 0.91∶1)and 3,811 cases in group B(0.70∶1),showing significant differences between the 2 groups in the male to female ratio(χ2=25.265,P<0.05).The peak age ranged from 70 to 80 years(31.9%,739/2,314)in group A and from 80 to 90 years(34.5%,1,313/3,811)in group B.There were significant differences between the 2 groups in the sex ratios of age groups from 70 to 79 years(χ2=0.024,P<0.05).In all the 6,152 patients with a definite injury cause,the fall and indoor activity accounted for the highest proportion(83.9%,5,140/6,125),and the proportion of group A was 75.4%(1,745/2,314)while the proportion of group B was 89.1%(3,395/3,811)showing a significant differences between the 2 groups in injury cause(χ2=14.363,P<0.05).Based on X-ray films or computer tomography(CT)of 3,560 patients,the Evans type II and III were the most common types.Type II accounted for the highest proportion in group A(38.1%,239/628)while type III did in group B(39.5%,1,159/2,932).There were significant differences between the 2 groups in the proportion of Evans classification(χ2=183.569,P<0.05).Of all the 6,125 fracture cases,4,846 fracture patients(79.1%)were complicated with medical diseases.There was a statistically significant difference between the 2 group of the patients who were complicated with medical diseases(χ2=8.916,P<0.05).A total of 5,148 patients were treated by operation and 1,925 patients were in group A while the other 3,259 cases were in group B.In group A,the median hospitalization was 14 days and the quartile interval was 8 days.In group B,the median hospitalization and the quartile interval was 12 days and 8 days respectively.There were significant differences between the 2 groups in length of hospital stay for patients treated by surgery(Z=-9.909,P<0.001).Conclusion The intertrochanteric fractures admitted to the Third Hospital of Heibei Medical University in the past 10 years were more common in females than in males.Fall and indoor activity was the most common injury cause.Evans types II and III prevailed.The fractures showed an aging trend by comparing the former 5 years and latter 5 years.The number of intertrochanteric fracture patients complicated with medical diseases increased significantly,but the total days of hospitalization was on the decline.