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Abstract：
Introduction A demographic survey of femoral pertrochanteric fractures provides several important information for the healthcare system of a country since this fracture is commonly seen in the elderly and has a poor postoperative functional prognosis that is a burden on society. The importance of accurately classifying pertrochanteric fractures as stable or unstable cannot be understated. However, the use of plain radiograph images alone is known to underestimate fracture severity with low inter- or intra-observer agreement. Computed tomography (CT) images offer information for a more accurate classification of pertrochanteric fractures. With this three-dimensional (3D) CT-based study using the revised Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification, the purpose of this study is to elucidate the epidemiological demography of patients with pertrochanteric fractures. Material and methods We retrospectively collected 808 patients from five hospitals, classified into two groups: stable (A1) or unstable (A2). Age, gender, fracture laterality, and surgery timing were identified as epidemiological variables. Patients with both preoperative plain radiographs and 3D CT scans were included in the study. The exclusion criteria were AO/OTA A3 type fractures, pathological fractures, previous ipsilateral surgery, 60 years old or younger, and conservatively treated patients. The primary outcome involved detailing the total number of fractures based on classification (A1 or A2) and variables. The secondary outcome involved a comparison between the A1 and A2 groups. Results The mean age of patients at the time of surgery was 85 years (range: 61-103 years). There were 637 female and 171 male patients. There were 463 left-sided fractures and 345 right-sided fractures. Of the 808 patients, 371 (45.9%) were classified to have A1 fractures, and 437 (54.1%) had A2 fractures. The age at surgery, gender, fracture laterality, and surgery timing between the A1 and A2 groups were compared. The mean and standard deviation of the age at surgery for patients in the A1 and A2 groups were 84.9±7.7 and 86.9±6.8, respectively. The number of patients for each age distribution of 61-69, 70-74, 75-79, 80-84, 85-89, 90-94, and 95 or older for the A1 and A2 groups was 18 and 7, 18 and 12, 43 and 44, 76 and 82, 107 and 132, 79 and 110, and 30 and 50, respectively, showing that the difference in categorial distribution was statistically significant (p=0.002). Overall, 278 females and 93 males were classified to have A1 fractures compared with 359 females and 78 males with A2 fractures (p=0.01). There were 166 right-sided and 205 left-sided stable A1 fractures and 179 right-sided and 258 left-sided A2 fractures (not significant (NS)). Among the total number of A1 and A2 surgeries by month, the most were in December with 77 surgeries (37 and 40, respectively), and the least was in June with 37 (18 and 19, respectively). The seasonal classification for A1 and A2 surgeries is as follows: spring with 172 (74 and 98, respectively), summer with 150 (70 and 80, respectively), autumn with 193 (90 and 103, respectively), and winter with 208 (97 and 111, respectively) (NS). Conclusion In this demographic study of 808 patients with pertrochanteric fractures classified by 3D CT images, 371 had A1 fractures and 437 had A2 fractures. A2 fractures were significantly more in females with an age peak of 85-89 years.
摘要：
介绍股骨粗隆部骨折的人口统计学调查为一个国家的医疗保健系统提供了一些重要信息，因为这种骨折常见于老年人，并且术后功能预后不良，这给社会带来了负担。不能低估将股骨转子骨折准确分类为稳定或不稳定的重要性。然而,已知仅使用X线平片图像会低估骨折严重程度,且观察者间或观察者间的一致性较低.计算机断层扫描（CT）图像提供了更准确的股骨转子骨折分类信息。通过这项基于三维（3D）CT的研究，使用修订的Arbeitsgemeinschaftfür骨修复/骨科创伤协会（AO/OTA）分类，本研究的目的是阐明股骨粗隆间骨折患者的流行病学人口学特征。材料与方法我们回顾性收集了来自五家医院的808例患者，分为两组：稳定（A1）或不稳定（A2）。年龄,性别,断裂侧向性,和手术时机被确定为流行病学变量。该研究包括术前平片和3DCT扫描的患者。排除标准为AO/OTAA3型骨折,病理性骨折,以前的同侧手术，60岁或更年轻，保守治疗的患者。主要结果包括根据分类（A1或A2）和变量详细说明骨折总数。次要结果涉及A1和A2组之间的比较。结果手术时患者的平均年龄为85岁（范围：61-103岁）。有637名女性和171名男性患者。左侧骨折463例，右侧骨折345例。在808名患者中，371（45.9％）被分类为A1骨折，437例(54.1%)有A2骨折。手术的年龄，性别,断裂侧向性,比较A1组和A2组的手术时机。A1组和A2组患者手术年龄的平均值和标准差分别为84.9±7.7和86.9±6.8。A1和A2组的每个年龄分布为61-69、70-74、75-79、80-84、85-89、90-94和95或以上的患者人数分别为18和7、18和12、43和44、76和82、107和132、79和110以及30和50，显示分类分布差异有统计学意义(p=0.002)。总的来说,278名女性和93名男性被归类为A1骨折，而359名女性和78名男性被归类为A2骨折（p=0.01）。右侧和左侧稳定性A1骨折166例，左侧稳定性A1骨折205例，右侧和左侧A2骨折179例，左侧A2骨折258例（不明显（NS））。在按月计算的A1和A2手术总数中，最多的是在12月，有77例手术(分别为37例和40例)，最少的是6月份的37（分别为18和19）。A1和A2手术的季节性分类如下：春季为172（分别为74和98），夏季150（分别为70和80），秋季为193（分别为90和103），冬季为208（分别为97和111）（NS）。结论本研究对808例经3DCT图像分类的股骨粗隆间骨折患者,371有A1骨折，437有A2骨折。年龄峰值为85-89岁的女性中，A2骨折明显增多。
