成年股骨颈骨折临床特征分析:一项基于医院的回顾性研究

目的分析天津市天津医院股骨颈骨折患者的临床特征。方法收集2016年1月1日至2017年12月31日在天津市天津医院出院的股骨颈骨折患者资料并进行回顾性研究,统计患者的性别、年龄、骨折分型、受伤机制及治疗方法等并进行分析比较。结果共筛选出符合条件的患者2150例,男736例,女1414例,不同年龄段患者男、女分布的差异有统计学意义(χ^2=91.63,P<0.001)。青年(18~44岁)患者中,男性多于女性,中年(45~64岁)、老年(≥65岁)患者中,女性多于男性。骨折类型以移位型为主(75.56%,1646/2150),移位率青年患者最低(55.17%,64/116),老年患者最高(81.91%,1159/1415)。三个年龄段患者的主要受伤机制均为摔倒青年61.21%(71/116),中年80.29%(497/619),老年91.24%(1291/1415)]。不同年龄段患者治疗方式的差别有统计学意义(χ^2=1057.11,P<0.001),中、青年患者无论骨折是否移位,主要治疗方式均为内固定术;中年无移位患者采用内固定术的比例(86.22%,169/196)高于移位患者(62.88%,266/423)(χ^2=34.93,P<0.001)。老年患者中无移位者多采用内固定术,移位者多采用半髋置换术。陈旧性股骨颈骨折患者年龄(中位年龄74岁)大于新鲜骨折患者(中位年龄70岁)(Z=-2.777,P=0.005)。陈旧性股骨颈骨折患者移位率(92.41%,73/79)高于新鲜股骨颈骨折患者(75.95%,1573/2071)(χ^2=11.48,P=0.001)。陈旧性股骨颈骨折患者多采用全髋置换术,新鲜骨折患者采用内固定术、半髋置换术、全髋置换术比例相差不大,内固定术最多。结论股骨颈骨折老年女性患者最多;移位患者多于无移位患者;青、中、老年患者受伤机制均为摔倒;中、青年患者多采用内固定术治疗,老年患者主要采用关节置换术治疗。

Clinical characteristics analysis of adult femoral neck fracture:a retrospective hospital-based study

Objective To analyze the clinical characteristics of patients with femoral neck fracture in Tianjin Hospital.Methods Data of femoral neck fracture patients discharged from Tianjin Hospital from January 1,2016 to December 31,2017 were retrospectively analyzed.The gender,age,fracture type,injury mechanism and treatment method were collected.Results Total of 2,150 eligible patients including 736 males and 1414 females were selected.There were significant differences in the gender distribution in different age groups(χ^2=91.63,P<0.001).Among young patients,males were more than females,while among middle-aged and elderly patients,females were more than males.The main type of fracture was displaced type(75.56%,1,646/2,150),the displaced rate was the lowest in young patients(55.17%,64/116),while it was the highest in old patients(81.91%,1,159/1,415).The main injury mechanism of the three age groups were fallsyoung 61.21%(71/116),middle 80.29%(497/619),eldly 91.24%(1,291/1,415)].There was a significant difference in the treatment methods between different age groups(χ^2=1,057.11,P<0.001).The main treatment method for young and middle-aged patients was internal fixation,no matter whether the fracture was displaced or not.The proportion of undisplaced patients with internal fixation(86.22%,169/196)was higher than that of displaced patients with internal fixation(62.88%,266/423)in middle-aged group(χ^2=34.93,P<0.001).In the elderly,more patients used internal fixation in undisplaced group,while more patients used hemiarthroplasty in displaced group.The age of old femoral neck fracture(median age was 74)was older than that of fresh fracture(median age was 70)(Z=-2.777,P=0.005).And the displaced rate of patients with old femoral neck fracture(92.41%,73/79)was higher than that of the fresh ones(75.95%,1,573/2,071)(χ^2=11.48,P=0.001).The patients with old femoral neck fracture usually adopt total hip replacement,while the proportion of three kinds of operation(internal fixation,hemiarthroplasty,total hip replacement)were similar among the fresh ones,and the internal fixation was the most.Conclusion Femoral neck fracture is the most common in elderly women.The patients with displaced fracture are more than that with undisplaced fracture.Falling is the main injury mechanism in both young and old people.Internal fixation is commonly used in young and middle-aged patients,while arthroplasty is often used in elderly patients.