Fujita Tomoki, Takegami Yasuhiko, Ando Kei, Sakai Yasuomi, Nakashima Hiroatsu, Takatsu Shiro, Imagama Shiro
Department of Orthopedic Surgery, Gifu Prefectural Tajimi Hospital, Gifu, Japan.
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):437-442. doi: 10.1007/s00590-021-02996-0. Epub 2021 May 18.
Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case-control methods.
This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type.
The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27-3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11-3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272).
The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.
对于骨科医生而言，预防二次髋部骨折是必不可少的。我们旨在明确二次髋部骨折的发生率和持续时间，比较二次髋部骨折患者与单侧骨折患者的生存率和行走能力，并采用匹配病例对照方法确定二次髋部骨折的危险因素。
这项在单一三级急诊中心进行的回顾性研究纳入了119例二次髋部骨折患者，这些患者于2007年至2017年在我们机构接受了双侧手术（二次髋部骨折组 [A组]）。对照组（B组）由357例在年龄、性别和骨折类型上与A组匹配的患者组成。
二次髋部骨折的发生率为7.6%，从初次骨折到二次髋部骨折的平均间隔时间为22.8个月。A组中术后行走能力下降的患者明显更多。初次骨折后的五年生存率在A组为65.0%，在B组为50.6%（P = 0.346）。痴呆和心脏病被确定为独立危险因素（痴呆：HR 2.08，95% CI 1.27 - 3.41，P = 0.004；心脏病：HR 1.27，95% CI 1.11 - 3.22，P = 0.019）。瓣膜病也被发现是心脏病的一个危险因素（P = 0.0272）。
二次髋部骨折的发生率并不低。虽然有或没有二次髋部骨折的患者生存率没有差异，但二次髋部骨折患者的行走能力恶化。痴呆和心脏病可能是老年患者二次髋部骨折的危险因素，瓣膜病可能与心脏病患者的二次髋部骨折有关。
