Hannon Matthew, Hadjizacharia Pantelis, Chan Linda, Plurad David, Demetriades Demetrios
University of Southern California, Los Angeles, California, USA.
J Trauma. 2009 Dec;67(6):1384-8. doi: 10.1097/TA.0b013e31819ea3e0.
Fractures of the tibia and femur are common after automobile versus pedestrian (AVP) injuries. This study evaluates the effect of age on the type of fracture and the incidence and type of associated injuries.
All patients involved in an AVP crash from January 1, 1995, through June 30, 2006, were included in the study. Variables obtained from our trauma registry included age, gender, Injury Severity Score, Abbreviated Injury Scale, intra-abdominal and spine injuries, and mortality. Patients were divided into three age groups for analysis: younger than 15 years, 15 years to 55 years, and older than 55 years. The incidence and type of associated injuries were assessed according to the presence or absence of fractures of the tibia only, femur only, or combined femur and tibia fractures.
A total of 6,652 patients had AVP crashes and 1,936 (29%) had tibia or femur fractures (tibia, 20%; femur, 7%; tibia/femur, 3%). The incidence of tibia fractures increased with age ranging from 13% in those younger than 15 years to 25% in those older than 55 (p < 0.001). Combined tibia and femur fractures were also more common in adults and isolated femur fractures were more common in children. Hollow viscus injury was 1.8% in those with lower extremity fractures and 0.9% in those without (p = 0.0013). Mortality was 10% in those with fractures and 6% in those without (p < 0.0001) and was 20% in those with tibia and femur fractures.
Age affects the incidence and type of lower extremity fractures after AVP injuries. The presence of lower extremity fracture is associated with a higher incidence of chest, spine, and intra-abdominal injuries. It is advisable that all patients with lower extremity fractures after AVP injuries be evaluated by a surgeon familiar with these injury patterns.
在汽车与行人碰撞（AVP）损伤后，胫骨和股骨骨折很常见。本研究评估年龄对骨折类型以及相关损伤的发生率和类型的影响。
纳入1995年1月1日至2006年6月30日期间所有参与AVP碰撞的患者。从我们的创伤登记处获取的变量包括年龄、性别、损伤严重程度评分、简明损伤定级、腹腔内和脊柱损伤以及死亡率。患者被分为三个年龄组进行分析：15岁以下、15岁至55岁以及55岁以上。根据仅胫骨骨折、仅股骨骨折或股骨和胫骨联合骨折的情况评估相关损伤的发生率和类型。
共有6652例患者发生AVP碰撞，其中1936例（29%）发生胫骨或股骨骨折（胫骨骨折占20%；股骨骨折占7%；胫骨/股骨骨折占3%）。胫骨骨折的发生率随年龄增长而增加，从15岁以下人群中的13%增至55岁以上人群中的25%（p<0.001）。胫骨和股骨联合骨折在成年人中也更常见，孤立的股骨骨折在儿童中更常见。下肢骨折患者中空脏器损伤的发生率为1.8%，无下肢骨折患者中为0.9%（p = 0.0013）。骨折患者的死亡率为10%，无骨折患者为6%（p<0.0001），胫骨和股骨骨折患者的死亡率为20%。
年龄影响AVP损伤后下肢骨折的发生率和类型。下肢骨折的存在与胸部、脊柱和腹腔内损伤的较高发生率相关。建议所有AVP损伤后下肢骨折的患者由熟悉这些损伤模式的外科医生进行评估。
