Fujimoto K, Shinkai S, Kondou H, Konishi M, Kouno H, Kimura K, Okumura H
Department of Public Health, Ehime University School of Medicine.
Nihon Koshu Eisei Zasshi. 1996 Jul;43(7):532-44.
Hip fracture among the elderly has increasingly attracted public health concern in Japan. For the purpose of revealing the epidemiological features of hip fracture, post-treatment prognosis, and related factors, we studied all cases of hip fracture which occurred in Ehime Prefecture during 1992 who were admitted to hospitals or clinics, and followed up the cases for a subsequent two years. The incidence rate of hip fracture was 29.2 per 100,000 for males, and 84.0 for females, which are much lower than in Europe and the Untied States. Compared with rates reported previously in Japan, the age--specific incidence rates for males in Ehime were almost identical to the respective rates estimated by a nationwide survey and the rates for Tottori. However, the rate for males 80 years old or more was found to be lower than the corresponding rate for Kagawa. In females, the age--specific incidence rates for Ehime were similar to the Japanese averages, and the rates for Tottori and Kagawa. Falling from a standing position was a leading cause of hip fracture among older patients. Osteosynthesis was the main treatment modality elected trochanteric fractures. On the other hand, prosthetic replacement was predominant in cervical fracture. Multivariate analysis using a multiple logistic model showed that medical facility category, age, type of treatment, and cause of fracture had statistically significant relations to mobility at the time of discharge. Of patients who could walk at the time of discharge, 83.7% (159/190) were alive two years after discharge. Multiple logistic model analysis identified gender as a significant contributing factor to this mortality. Among the survivors, 81.8% (130/159) retain the ability to walk. Logistic model analysis revealed that older age experience a significantly higher risk in losing mobility.
老年人髋部骨折在日本日益引起公众健康关注。为揭示髋部骨折的流行病学特征、治疗后预后及相关因素，我们研究了1992年在爱媛县住院或就诊的所有髋部骨折病例，并对这些病例进行了为期两年的随访。髋部骨折的发病率男性为每10万人29.2例，女性为每10万人84.0例，远低于欧洲和美国。与日本此前报告的发病率相比，爱媛县男性的年龄别发病率与全国调查及鸟取县估计的相应发病率几乎相同。然而，发现80岁及以上男性的发病率低于香川县的相应发病率。在女性中，爱媛县的年龄别发病率与日本平均水平以及鸟取县和香川县的发病率相似。站立位跌倒在老年患者中是髋部骨折的主要原因。骨合成是转子间骨折选择的主要治疗方式。另一方面，人工关节置换在颈椎骨折中占主导地位。使用多元逻辑模型的多因素分析表明，医疗机构类别、年龄、治疗类型和骨折原因与出院时的活动能力有统计学上的显著关系。出院时能够行走的患者中，83.7%（159/190）在出院两年后仍存活。多元逻辑模型分析确定性别是该死亡率的一个重要影响因素。在幸存者中，81.8%（130/159）保留了行走能力。逻辑模型分析显示，年龄较大者失去活动能力的风险显著更高。
