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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

Analysis of clinical features of 3201 cases of adult intertrochanteric fractures: a single center experience

摘要:

目的 分析10年间单中心诊治的成人股骨转子间骨折患者临床特征及其变化趋势.方法 回顾性分析河北医科大学第三医院2003年1月至2012年12月诊治的成人(年龄≥16岁)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培训的本院骨科住院医师进行整理分型,并由本院2名骨科主任医师及一名放射科主任医师进行监督检验,统计年龄、性别、骨折类型等数据.将2003年1月至2007年12月诊治的患者资料与2008年1月至2012年12月诊治的患者资料进行对比分析.结果 10年间成人股骨转子间骨折3 201例,占成人全身骨折的2.97%,占成人股骨近端骨折的43.76%.≥60岁的老年患者占64.98%,16 ~59岁的中青年患者占35.02%.中青年患者中男性多见(79.13%),老年患者中女性多见(57.78%).按Evans分型标准,不稳定型骨折多见(68.92%).按AO分型标准,A2型骨折最多(49.67%),A3型骨折最少(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%(x2=9.29,P=0.002),占同期成人股骨近端骨折的比例下降3.15%(x2=7.35,P=0.007);老年患者构成比升高14.35%(x2=71.98,P<0.01);女性患者构成比升高4.04%(x2=8.16,P=0.004);稳定型骨折构成比升高5.62%(x2=11.7,P=0.001);前后5年AO各型骨折构成无明显变化(x2=3.24,P =0.198).结论 成人股骨转子间骨折多见于老年人,A2型骨折多见,不稳定型(EvansⅢ、Ⅳ、Ⅴ型)骨折多见.与前5年相比,后5年女性患者构成比、老年患者构成比及稳定型(Evans Ⅰ、Ⅱ型)骨折的构成比均增高.

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abstracts:

Objective To analyze the gender,age,fracture classification and variation trend of adult intertrochanteric fractures treated in a single-center hospital in ten years.Methods The data of adult (age ≥ 16 years)intertrochanteric fractures admitted to the Third Hospital of Hebei Medical University from January 2003 to December 2012 were collected retrospectively.All the fractures were acute and the pathological or periprosthetic fractures were excluded.The radiography of fracture were classified by same experienced orthopedic resident and verified by two orthopedic deans and one radiologist.The gender,age and fracture classification were analyzed and compared between January 2003 to December 2007 and January 2008 to December 2012.Results A total of 3 201 cases were collected.The adult intertrochanteric fractures accounted for 2.97% of all adult fractures and 43.76% of adult proximal femoral fractures.Of all fractures 64.98% were elderly(≥60 years) and 35.02% were middle-aged(16-59 years).In elderly,female were common (57.78%) while in middle-aged were male commonly (79.13%).According to Evans classification,instable fractures were more common (68.92%).According to AO classification,the most common type was A2 (49.67%) and the least was A3 (15.93%).Comparing between January 2003 to December 2012 and January 2008 to December 2012,the proportion of intertrochanteric fracture of adult fracture was decreased by 0.31% (x2 =9.29,P =0.002) and the proportion of intertrochanteric fracture of adult proximal femoral fractures was decreased by 3.15 % (x2 =7.35,P =0.007).The proportion of elderly patients,female and stable fractures was increased by 14.35 % (x2 =71.98,P < 0.01),4.04% (x2 =8.16,P =0.004) and 5.62% (x2 =11.7,P =0.001),respectively.The proportion of AO classification was not significantly verified (x2 =3.24,P =0.198).Conclusions The intertrochanteric fractures are most common in elderly patients,A2-type of AO Classification and stable (Evans Ⅲ,Ⅳ,Ⅴ) in Evans classification.Compared with the previous five years,the proportions of female,elderly and stable (Evans Ⅰ,Ⅱ) fracture increase in last 5 years.

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