本文選題：股骨轉(zhuǎn)子間骨折 + 回顧性研究�。� 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:髖部骨折是創(chuàng)傷骨科研究的熱點,世界各地的發(fā)病率差異較大,約為89-1287/10萬人口/年。股骨轉(zhuǎn)子間骨折是指股骨頸基底至小轉(zhuǎn)子水平以上區(qū)域發(fā)生的骨折,是髖部骨折的重要組成部分。股骨轉(zhuǎn)子間骨折多發(fā)于骨質(zhì)疏松的老年人群,老年人在跌倒時,下肢過度外展或內(nèi)收位著地,或跌倒時側(cè)方倒地,大轉(zhuǎn)子直接撞擊地面,均可發(fā)生骨折。近年來,隨著我國人口老齡化問題的加劇,股骨轉(zhuǎn)子間骨折正逐步成為威脅我國民眾的重要公共健康問題之一。有研究顯示,股骨轉(zhuǎn)子間骨折患者發(fā)病年齡比股骨頸骨折高,患者的全身情況相對更差,預后也較股骨頸骨折差。研究股骨轉(zhuǎn)子間骨折的臨床特點,制定合理的預防措施具有重要的現(xiàn)實意義,但專門對其臨床特征研究的文獻卻很少。既往報道,股骨轉(zhuǎn)子間骨折占股骨近端骨折的45.26%,全身骨折的3.13%。本研究回顧性分析我院10年間診治的成人股骨轉(zhuǎn)子間骨折患者性別、年齡和骨折類型特征及其變化趨勢,為此類骨折的治療、預防提供基礎數(shù)據(jù)。方法:通過人工查找放射科圖片存儲庫回顧性收集河北醫(yī)科大學第三醫(yī)院2003年1月至2012年12月間診治的成人(≥16歲)骨折患者資料,篩選出所有股骨轉(zhuǎn)子間骨折患者資料,排除陳舊骨折、病理骨折及假體周圍骨折等。所有影像資料由經(jīng)過專門培訓的本院骨科住院醫(yī)師進行整理分型,股骨轉(zhuǎn)子間骨折分型按AO骨折分型標準和Evans骨折分型標準分別進行分型。并由本院2名骨科主任醫(yī)師及1名放射科主任醫(yī)師組成質(zhì)量監(jiān)督小組,對住院醫(yī)師的分型結(jié)果進行抽樣監(jiān)督檢驗�；颊甙茨挲g分為16-59歲的中青年、≥60歲的老年;骨折類型按AO分型分為A1型、A2型、A3型;按Evans骨折分型標準分為穩(wěn)定型(EvansⅠ、Ⅱ型)和不穩(wěn)定型(EvansⅢ、Ⅳ、Ⅴ型)。分析股骨轉(zhuǎn)子間骨折患者年齡分布、性別構(gòu)成、骨折類型構(gòu)成特點,并將2003~2007年診治的患者資料與2008~2012年診治的患者資料進行對比分析,以了解股骨轉(zhuǎn)子間骨折患者年齡、性別、骨折類型構(gòu)成的變化。在本次研究中的統(tǒng)計學處理應用SPSS 19.0統(tǒng)計學軟件。結(jié)果:10年間我院共診治成人股骨轉(zhuǎn)子間骨折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%的中青年患者為男性,57.78%的老年患者為女性。按Evans分型標準,不穩(wěn)定型骨折多見,占所有股骨轉(zhuǎn)子間骨折的68.92%。按AO分型標準,A2型骨折最多,占所有股骨轉(zhuǎn)子間骨折的49.67%,A3型骨折最少,僅占所有股骨轉(zhuǎn)子間骨折的15.93%。前后5年相比,股骨轉(zhuǎn)子間骨折占同期成人全身骨折的比例下降0.31%,降低有統(tǒng)計學意義(?2=9.29,P=0.002);占同期成人股骨近端骨折的比例下降3.15%,降低有統(tǒng)計學意義(?2=7.35,P=0.007);老年患者構(gòu)成比升高14.35%,升高有統(tǒng)計學意義(?2=71.98,P0.01);女性患者構(gòu)成比升高4.04%,升高有統(tǒng)計學意義(?2=8.16,P=0.004);按Evans骨折分型標準,穩(wěn)定型骨折(EvansⅢ、Ⅳ、Ⅴ型)構(gòu)成比升高5.62%,上升有統(tǒng)計學意義(?2=11.7,P=0.001);按AO骨折分型標準,各型骨折構(gòu)成并無明顯變化(?2=3.24,P=0.198)。結(jié)論:通過對我院2003年1月至2012年12月間診治的成人股骨轉(zhuǎn)子間骨折的回顧性分析,初步了解了成人股骨轉(zhuǎn)子間骨折的臨床特點及其變化趨勢。成人股骨轉(zhuǎn)子間骨折多見于老年人;按AO骨折分型標準,以A2型骨折多見;按Evans骨折分型標準,不穩(wěn)定型(EvansⅢ、Ⅳ、Ⅴ型)骨折多見。與前5年相比,后5年股骨轉(zhuǎn)子間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;穩(wěn)定型(EvansⅠ、Ⅱ型)骨折所占的比例增高;按AO骨折分型標準的所分的各型骨折所占的比例無明顯變化。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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