Hinton R Y, Lincoln A, Crockett M M, Sponseller P, Smith G
The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
J Bone Joint Surg Am. 1999 Apr;81(4):500-9. doi: 10.2106/00004623-199904000-00007.
Fractures of the femoral shaft in children are caused by major musculoskeletal trauma and result in high direct and indirect medical costs. To date, the American literature has focused on treatment options and outcomes, but the epidemiology of these injuries has been generalized from Scandinavian studies reported in the 1970s and early 1980s. The goals of the current study were (1) to determine the age, gender, and race-specific rates and mechanisms of fractures of the femoral shaft in children in a large United-States-based population and (2) to identify associations between the rates of these fractures and multiple sociodemographic indicators. Such information is vital for preventive efforts.
The Hospital Discharge Database of the Maryland Health Services Cost Review Commission for the years 1990 through 1996 was used to obtain demographic data on 1485 cases of acute fracture of the femoral shaft in patients who were less than eighteen years old, and data from the United States Bureau of the Census for the state of Maryland for the year 1990 were used to obtain denominator data. Reliable external-cause data were available from the 1995 and 1996 databases for 472 patients. Small-area analysis was performed at the zip-code level to determine associations between numerous sociodemographic indicators and the rate of femoral shaft fracture.
The annual rate of femoral shaft fracture in children was 19.15 per 100,000. With regard to age, there was a bimodal distribution, with peaks at two and seventeen years. Boys had higher rates of fracture than did girls at all ages, and blacks had higher rates than did whites. The primary mechanisms of fracture were age-dependent and included falls, for children less than six years old; motor vehicle-pedestrian accidents, for those six to nine years old; and motor-vehicle accidents, for teenagers. Firearm-related injuries accounted for 15 percent of the fractures among black adolescents. Adverse socioeconomic conditions were significantly associated with higher rates of fracture.
The rates and mechanisms of femoral shaft fractures in children depend on age, gender, and race. For children living in the United States today, the epidemiology of these fractures is different than that described in earlier, Scandinavian reports.
儿童股骨干骨折由严重的肌肉骨骼创伤引起，导致高昂的直接和间接医疗费用。迄今为止，美国文献主要关注治疗方案和结果，但这些损伤的流行病学情况是从20世纪70年代和80年代初报道的斯堪的纳维亚研究中推断出来的。本研究的目的是：（1）确定美国一个大型人群中儿童股骨干骨折的年龄、性别和种族特异性发病率及骨折机制；（2）确定这些骨折发病率与多个社会人口统计学指标之间的关联。此类信息对预防工作至关重要。
利用马里兰州卫生服务成本审查委员会1990年至1996年的医院出院数据库，获取1485例18岁以下股骨干急性骨折患者的人口统计学数据，并使用1990年美国马里兰州人口普查局的数据获取分母数据。1995年和1996年的数据库中有472例患者的可靠外部原因数据。在邮政编码层面进行小区域分析，以确定众多社会人口统计学指标与股骨干骨折发病率之间的关联。
儿童股骨干骨折的年发病率为每10万人19.15例。在年龄方面，呈现双峰分布，高峰出现在2岁和17岁。各年龄段男孩的骨折发病率均高于女孩，黑人的发病率高于白人。骨折的主要机制因年龄而异，6岁以下儿童主要为跌倒；6至9岁儿童为机动车与行人事故；青少年为机动车事故。与枪支相关的伤害占黑人青少年骨折的15%。不良的社会经济状况与较高的骨折发病率显著相关。
儿童股骨干骨折的发病率和机制取决于年龄、性别和种族。对于如今生活在美国的儿童，这些骨折的流行病学情况与早期斯堪的纳维亚报告中描述的不同。
