Levy A R, Mayo N E, Grimard G
Department of Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada.
Am J Epidemiol. 1995 Aug 15;142(4):428-36. doi: 10.1093/oxfordjournals.aje.a117651.
Two distinct subtypes of hip fracture, transcervical and pertrochanteric, can be distinguished on the basis of the anatomical location of the injury. While the epidemiology of hip fractures has been well described, typically, little or no distinction is made between these subtypes. The objective of this study was to compare and contrast age- and sex-specific rates of transcervical and pertrochanteric fractures in Quebec, Canada. The data for this study were obtained from a database containing records of all persons discharged from all hospitals in Quebec from 1981 to 1992. Rates of hip fractures were calculated by using the population aged 50 years and older as the denominator, and changes in rates over time were assessed using Poisson regression. There were no statistically significant trends in the changes in rates over time (i.e., 95 percent confidence intervals overlapped the null value). Among women below age 70 years, transcervical fractures were more common, whereas among older women, pertrochanteric fractures predominated. Among men, pertrochanteric fractures predominated at all ages. There was a marked seasonal variation in the occurrence of all hip fractures combined: Compared with the summer months, the relative risk of all hip fractures during the winter was 1.32 (95 percent confidence interval 1.28-1.36). The results of this study indicate that the two subtypes of hip fracture, transcervical and pertrochanteric, have different patterns of occurrence, suggesting different risk factor profiles. Clearly, a multidisciplinary research approach is needed before it will be possible to untangle the complex relation between the metabolic processes occurring at the level of the individual and the distribution of the disease in the population.
根据损伤的解剖位置，可以区分出两种不同类型的髋部骨折，即经颈骨折和转子周围骨折。虽然髋部骨折的流行病学情况已有详尽描述，但通常对这些亚型未作区分或区分甚少。本研究的目的是比较和对比加拿大魁北克省经颈骨折和转子周围骨折的年龄和性别特异性发病率。本研究的数据来自一个数据库，该数据库包含了1981年至1992年期间魁北克省所有医院出院患者的记录。髋部骨折发病率以50岁及以上人群为分母进行计算，并使用泊松回归评估发病率随时间的变化。发病率随时间的变化没有统计学上的显著趋势（即95%置信区间与零值重叠）。在70岁以下的女性中，经颈骨折更为常见，而在老年女性中，转子周围骨折占主导。在男性中，转子周围骨折在所有年龄段都占主导。所有髋部骨折合并发生存在明显的季节性差异：与夏季相比，冬季所有髋部骨折的相对风险为1.32（95%置信区间1.28 - 1.36）。本研究结果表明，经颈骨折和转子周围骨折这两种髋部骨折亚型具有不同的发生模式，提示风险因素分布不同。显然，在理清个体层面发生的代谢过程与人群中疾病分布之间的复杂关系之前，需要采用多学科研究方法。
