成人股骨转子间骨折的临床特点及其变化:单中心3201例分析

发布时间：2018-06-25 23:36

本文选题：股骨转子间骨折 + 回顾性研究　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:髋部骨折是创伤骨科研究的热点,世界各地的发病率差异较大,约为89-1287/10万人口/年。股骨转子间骨折是指股骨颈基底至小转子水平以上区域发生的骨折,是髋部骨折的重要组成部分。股骨转子间骨折多发于骨质疏松的老年人群,老年人在跌倒时,下肢过度外展或内收位着地,或跌倒时侧方倒地,大转子直接撞击地面,均可发生骨折。近年来,随着我国人口老龄化问题的加剧,股骨转子间骨折正逐步成为威胁我国民众的重要公共健康问题之一。有研究显示,股骨转子间骨折患者发病年龄比股骨颈骨折高,患者的全身情况相对更差,预后也较股骨颈骨折差。研究股骨转子间骨折的临床特点,制定合理的预防措施具有重要的现实意义,但专门对其临床特征研究的文献却很少。既往报道,股骨转子间骨折占股骨近端骨折的45.26%,全身骨折的3.13%。本研究回顾性分析我院10年间诊治的成人股骨转子间骨折患者性别、年龄和骨折类型特征及其变化趋势,为此类骨折的治疗、预防提供基础数据。方法:通过人工查找放射科图片存储库回顾性收集河北医科大学第三医院2003年1月至2012年12月间诊治的成人(≥16岁)骨折患者资料,筛选出所有股骨转子间骨折患者资料,排除陈旧骨折、病理骨折及假体周围骨折等。所有影像资料由经过专门培训的本院骨科住院医师进行整理分型,股骨转子间骨折分型按AO骨折分型标准和Evans骨折分型标准分别进行分型。并由本院2名骨科主任医师及1名放射科主任医师组成质量监督小组,对住院医师的分型结果进行抽样监督检验。患者按年龄分为16-59岁的中青年、≥60岁的老年;骨折类型按AO分型分为A1型、A2型、A3型;按Evans骨折分型标准分为稳定型(EvansⅠ、Ⅱ型)和不稳定型(EvansⅢ、Ⅳ、Ⅴ型)。分析股骨转子间骨折患者年龄分布、性别构成、骨折类型构成特点,并将2003~2007年诊治的患者资料与2008~2012年诊治的患者资料进行对比分析,以了解股骨转子间骨折患者年龄、性别、骨折类型构成的变化。在本次研究中的统计学处理应用SPSS 19.0统计学软件。结果:10年间我院共诊治成人股骨转子间骨折3201例,占成人全身骨折的2.97%,占成人股骨近端骨折的43.76%。老年患者占64.98%,中青年患者占35.02%。79.13%的中青年患者为男性,57.78%的老年患者为女性。按Evans分型标准,不稳定型骨折多见,占所有股骨转子间骨折的68.92%。按AO分型标准,A2型骨折最多,占所有股骨转子间骨折的49.67%,A3型骨折最少,仅占所有股骨转子间骨折的15.93%。前后5年相比,股骨转子间骨折占同期成人全身骨折的比例下降0.31%,降低有统计学意义(?2=9.29,P=0.002);占同期成人股骨近端骨折的比例下降3.15%,降低有统计学意义(?2=7.35,P=0.007);老年患者构成比升高14.35%,升高有统计学意义(?2=71.98,P0.01);女性患者构成比升高4.04%,升高有统计学意义(?2=8.16,P=0.004);按Evans骨折分型标准,稳定型骨折(EvansⅢ、Ⅳ、Ⅴ型)构成比升高5.62%,上升有统计学意义(?2=11.7,P=0.001);按AO骨折分型标准,各型骨折构成并无明显变化(?2=3.24,P=0.198)。结论:通过对我院2003年1月至2012年12月间诊治的成人股骨转子间骨折的回顾性分析,初步了解了成人股骨转子间骨折的临床特点及其变化趋势。成人股骨转子间骨折多见于老年人;按AO骨折分型标准,以A2型骨折多见;按Evans骨折分型标准,不稳定型(EvansⅢ、Ⅳ、Ⅴ型)骨折多见。与前5年相比,后5年股骨转子间骨折患者中女性患者所占比例增高;老年患者所占的比例增高;稳定型(EvansⅠ、Ⅱ型)骨折所占的比例增高;按AO骨折分型标准的所分的各型骨折所占的比例无明显变化。
[Abstract]:Objective: hip fracture is a hot spot in the study of trauma department of orthopedics. The incidence of the disease varies widely around the world, about 89-1287/10 million people / year. Intertrochanteric fracture of femur is an important part of hip fracture, which is an important part of hip fracture. In the years, the intertrochanteric fracture of the femur is becoming one of the important public health problems threatening the people of our country. In recent years, the intertrochanteric fracture of the femur is becoming one of the important public health problems that threaten our people. The age of the intervertebral fracture is higher than that of the femoral neck fracture, the patient's general condition is worse and the prognosis is worse than that of the femoral neck fracture. It is of great practical significance to study the clinical characteristics of the intertrochanteric fracture of the femur and make a reasonable preventive measure. However, there are few literature on the clinical characteristics of the femoral intertrochanteric fracture. A retrospective analysis of the gender, age, and type of fracture type of the adult femoral intertrochanteric fracture and its trend of change in 45.26% of the total fracture of the proximal femur in the 3.13%. study in our hospital for 10 years. The data of all fractures of the adult (over 16 years old) in the Third Hospital of Hebei Medical University from January 2003 to December 2012 were collected, and all the data of the intertrochanteric fractures were screened out, and the old fractures, pathological fractures and periprosthetic fractures were excluded. All the imaging data were classified and classified by the specially trained resident Department of orthopedics resident. The types of intertrochanteric fractures were divided according to the standard of AO fracture classification and the standard of Evans fracture type. The quality supervision group was composed of 2 Department of orthopedics chief physicians and 1 chief radiologists in our hospital. The results of the inpatient's classification were sampled and examined. The patients were divided into 16-59 years old and 60 years old. The folding types were divided into A1, A2 and A3 type according to the AO classification. According to the standard of Evans fracture classification, it was divided into stable type (Evans I, type II) and unstable type (Evans III, IV, V type). The age distribution, sex composition and fracture type of the intertrochanteric fracture patients were analyzed, and the data of the patients diagnosed and treated in 2003~2007 year and the patient data of the patients were diagnosed and treated in 2008~2012 years. A comparative analysis was made to understand the changes of age, sex and type of fracture of the intertrochanteric fracture of the femur. In this study, SPSS 19 statistics software was used in this study. Results: in 10 years, 3201 cases of intertrochanteric fractures were diagnosed and treated in our hospital, accounting for 2.97% of adult total fracture, accounting for the age of adult femoral proximal fracture of 43.76%.. 64.98% of the patients in the year were young and middle-aged, young and middle-aged were male and 57.78% of the elderly were women. According to the Evans classification standard, the unstable fractures were common, and the 68.92%. of all femoral intertrochanteric fractures was based on the AO classification standard, and the most A2 type fractures accounted for 49.67% of all femoral intertrochanteric fractures, and the A3 type fractures were the least, only accounted for the least type of type of fracture of the femoral intertrochanteric fracture. Compared with the 5 years before and after the intertrochanteric fracture of the femur, the proportion of intertrochanteric fracture in the same period of adult total body fracture decreased by 0.31%, and the decrease was statistically significant (? 2=9.29, P=0.002); the proportion of the proximal femur fracture in the same period decreased by 3.15%, decreased statistically (? 2=7.35, P=0.007), and the proportion of the elderly patients was increased by 14.35%, and increased. There were statistical significance (? 2=71.98, P0.01); the proportion of female patients was 4.04%, and the increase was statistically significant (? 2=8.16, P=0.004). According to the standard of Evans fracture classification, the composition ratio of the stable fracture (Evans III, IV, V) was increased by 5.62%, and the increase was statistically significant (2=11.7, P=0.001), and there was no significant change in the composition of fractures according to the standard of AO fracture (? 2? =3.24, P=0.198) conclusion: through a retrospective analysis of the intertrochanteric fracture of the adult femur between January 2003 and December 2012 in our hospital, the clinical characteristics and the trend of the intertrochanteric fracture of the adult femur are preliminarily understood. The intertrochanteric fracture of the adult femur is often seen in the elderly; the AO fracture classification standard is more common in the type of A2 type fracture; according to the Evans bone, the fracture of the femoral intertrochanteric fracture is more common. The proportion of fractures in the unstable type (Evans III, IV, V type) is common. Compared with the first 5 years, the proportion of women in the 5 years of intertrochanteric fracture increases; the proportion of the elderly patients is higher; the proportion of the stable type (Evans I, type II) fractures increases; the proportion of the types of fractures according to the standard of AO fracture classification is proportional to the proportion of fractures. There was no obvious change.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】