Chiu Hsien-Jane, Chan Chien-Lung, Hsu Jin-Chyr, Chung Chi-Yu, Yu I-Liang, Renn Jenn-Huei, Chang Nien-Tzu, Yang Nan-Ping
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
J Orthop Sci. 2013 May;18(3):456-64. doi: 10.1007/s00776-013-0365-6. Epub 2013 Mar 6.
The relationship between psychiatric disorders and musculoskeletal injuries is interesting but has not been investigated in depth.
A retrospective cohort study, based on a large-sample nationwide database, was performed during 2000-2005 in Taiwan.
All subjects matching the inclusion criteria of psychiatric-associated ICD9-CM diagnostic codes in 2000 were selected as the inception cohort population. Another cohort-based case-control study was designed, and one sex-matched and age-matched (1:1) control group randomly selected from the population without any prevalent psychiatric disorder in 2000 and incident psychiatric disorder in 2001-2005 was used for comparison.
64,662 Taiwanese people with any prevalent psychiatric disorder were enrolled in this study in 2000. The 6-year cumulative incidences of orthopedic injuries were 13.61/10,000 for femoral neck/femur fracture and 4.64/10,000, 3.40/10,000, 3.25/10,000, and 3.09/10,000 for radius/ulna or hand fracture, tibia/fibula or patella fracture, ankle or foot fracture, and humeral fracture, respectively. Compared with the control group, this Taiwanese population with prevalent psychiatric disorders had fewer incidences of all orthopedic injuries during the 6 years since 2000, and their cumulative incidence ratios ranged from 0.04 to 0.4 for the different injury sites. For lower-limb fractures, compared with the age stratum of less than 20-years-old, the odds ratios (OR) for the age strata 80-years-old or more and 60-79-years-old were 15.84 (95 % CI 4.55-55.20) and 6.11 (95 % CI 1.92-19.49), respectively. The people with organic psychotic conditions had a significantly greater tendency to suffer upper-limb and lower-limb fractures than those with other psychiatric diagnoses (the ranges of ORs were 3.23-16.67 and 2.13-25.00, respectively).
Subjects with prevalent psychiatric disorders had fewer occurrences of orthopedic injuries than the general population. Among this specific population, an organic psychotic condition and old age were risk factors for suffering fracture of a limb.
精神疾病与肌肉骨骼损伤之间的关系很有趣，但尚未得到深入研究。
一项基于全国大样本数据库的回顾性队列研究于2000年至2005年在台湾进行。
将2000年符合精神疾病相关ICD9-CM诊断编码纳入标准的所有受试者选为起始队列人群。设计了另一项基于队列的病例对照研究，并从2000年无任何精神疾病且2001年至2005年无新发精神疾病的人群中随机选取一个性别匹配和年龄匹配（1:1）的对照组进行比较。
2000年有64,662名患有任何精神疾病的台湾人参与了本研究。骨科损伤的6年累积发病率分别为：股骨颈/股骨骨折13.61/10,000，桡骨/尺骨或手部骨折4.64/10,000，胫骨/腓骨或髌骨骨折3.40/10,000，踝关节或足部骨折3.25/10,000，肱骨骨折3.09/10,000。与对照组相比，这一患有精神疾病的台湾人群在2000年以来的6年中所有骨科损伤的发病率较低，不同损伤部位的累积发病率比值在0.04至0.4之间。对于下肢骨折，与20岁以下年龄组相比，80岁及以上和60 - 79岁年龄组的优势比（OR）分别为15.84（95%可信区间4.55 - 55.20）和6.11（95%可信区间1.92 - 19.49）。患有器质性精神障碍的人比其他精神疾病诊断的人更容易发生上肢和下肢骨折（OR范围分别为3.23 - 16.67和2.13 - 25.00）。
患有精神疾病的受试者骨科损伤的发生率低于一般人群。在这一特定人群中，器质性精神障碍和老年是肢体骨折的危险因素。
