髋部骨折1266例流行病学调查分析

目的探索髋部骨折的流行病学特点，以期对老年髋部骨折的防治提供科学依据。方法回顾性分析上海复旦大学附属华东医院2008年-2012年1266例髋部骨折住院患者的临床资料。统计分析髋部骨折患者年龄、性别、致伤原因、好发季节、骨折类型、主要伴发病等的分布以及治疗方式、转归、住院天数和住院费用等资料。结果髋部骨折患者平均年龄为76．77±12．26岁，女性为78．83土10．20岁，显著高于男性的72．60土14．75岁，P〈0．001；全组老年人占89．42％，发病高峰年龄段为80～89岁，占42．1％，男女比例1：2．01。好发季节为冬季。老年患者的致伤原因以跌倒为主（91．08％）。1266例髋部骨折患者中，股骨颈骨折占48．34％，股骨粗隆间骨折占51．03％，股骨头骨折占0．63％。股骨粗隆间骨折平均年龄为78．69土11．39岁，显着高于股骨颈骨折的74．77±12．83岁，P〈0．001。髋部骨折的基本治疗方式为手术治疗，占86．02％；中青年组手术治疗的有效（痊愈＋好转）率为100％，老年组为98．76％，老年组围手术期死亡率为1．24％（12／966）。老年组的住院天数（20．5±9．5）d较中青年组（16．9±7．7）d长。髋部骨折手术治疗的人均费用：老年组为（5．16±1．82）万元，高于中青年组的（3．98±2．70）万元，从2008年（4．03±2．28万元）到2012年（5．51±1．90万元）逐年增高。结论髋部骨折是以老年人占绝大多数、以跌倒为主要致伤原因的骨质疏松性骨折；老年人髋部骨折手术治疗虽然有较大风险，但仍是其主要有效治疗手段；老年人髋部骨折手术治疗住院时间较长，费用较高，给患者家庭和社会造成沉重的经济负担。

The Epidemiological analysis of 1266 patients with hip fractures

Objective To analyze epidemiological and clinical characteristics of elderly patients with hip fractures to establish evidences for prevention and treatment of hip fractures in elderly population. Methods Clinical data, including gender, age, causes, season, fracture types, complications, treatment procedures, length ofhospitalizationandinpatient cost, of 1266 hospitalized patients for hip fracture in Shanghai Huadong Hospital between January 2008 and December 2012 were reviewed and analyzed. Results Mean age of all hip fracture patients was 76.77 4- 12.26 years. Female patients was significantly older than male （78.83 ± 10.20 versus 72.60 ± 14.75, P 〈 0.001） with a male-to-female ratio of 1 ： 2.01. Patients at 80-89 years had the highest proportion （42.1%）. Hip fracture occurred more frequently in winter. Slipping was the leading cause in the elderly group （91.08%）. Of 1266 cases of hip fracture, femoral neck fracture, inter-trochanteric fractureandfemoralheadfracturewere48.34%, 51.03%and0.63%, respectively. Mean age of inter-trochanteric fracture patients （78.69 4±11.39） was significantly higher than femoral neck fracture patients （74.77 4±12.83） （P〈 0.001）. Surgical procedures were performed in 1 089 patients （86.02%）. The surgical outcomes （completely recovered or become better） was 100% in younger group and 98.76% in elderly group. Perioperative mortality in elderly group was 1.24%. Mean hospital stay in elderly group was longer than younger group （20.53 ± 9.53 days versus 16.91 4±7.74 days）. The average inpatient cost in elderly patients receiving surgical treatment was higher than that in younger group （51,600 ± 18 200 RMB versus 39 800 ± 27 000 RMB）. Conclusion The majority of hip fracture patients were elderly. Slipping and osteoporosis were the leading causes. In spite of accumulating operative risks with aging, surgical treatment remains the predominant management strategy. However, economic burdens on family and society should be taken into consideration.