| Objective:The main purpose of this paper is to discuss the incidence of femoral intertrochanteric fractures and its epidemiological characteristics,through respective analysis of clinical data of patients who meet the criteria,to compare the domestic and foreign death risk factors for hip fractures with the Meta analysis.To provide the scientific guidance for the prevention and treatment of femoral intertrochanteric fractures.Methods:In this study,we first observed the clinical cases observation for the intertrochanteric fractures and retrospectively analyzed the incidence of fracture and combined with a large number of literature to analyze the epidemiological distribution characteristics,and then assess the risk factors for the death of hip fracture by Meta analysis.Part 1The clinical data of this research came from the General Hospital of Tianjin Medical University from January 2013 to December 2015,all the datas were intertrochanteric fractures.A total of 179 cases of hospitalized patients with intertrochanteric fractures were classified according to the inclusion criteria and exclusion criteria,among which 66 males,113 females,aged 52 to 96 years,with an average years of(76.98±9.74).Clinical data,including age,gender,injury causes,fracture types,the distribution of comorbidities,treatment procedures,length of hospitalization were recorded and analyzed.The count data to rate or percentage and the ?2 test was used in comparison between the sample.Measurement data to mean±SD and the t test was used in the comparison between the sample.Using SPSS13.0 statistical software to conduct the statistics analysis and descriptive analysis cases.Part 2In addition to the Cochrane Library,PubMed,CNKI,Wanfang Data,EMBASE and Medline were searched for reference in both English and Chinese on death risk factors for hip fractures in old people.And we also filter out those articles which met the inclusion and exclusion criteria or reference.All studies were reviewed by two reviewers independently,and doing literature screening,data extraction and quality assessment using the guidelines set by the QUOROM(Quality of Reporting of Meta-analysis)statement,and analysis using RevMan5.3 software Meta analysis.We used I2 and chi-square test for heterogeneity of the studies included in the test using quantitative and qualitative assessment simultaneously when P<0.05(bilateral)was considered statistically significant.If I2> 50%,there is heterogeneity,by using stochastic models.Fixed model for quantitative analysis when heterogeneity is not high and less than 50%(I2).In addition,for those variables which may have an impact on results because of two different treatments,we used subgroup analyzes to explore.P<0.05(bilateral)was considered statistically significant.Results Part1The basic information of patients of the 179 intertrochanteric fractures was as follows: 66 male,113 female;age(76.98±9.74);The top three age groups were respectively 81 ~ 90 years old(71 cases,39.66%),71 ~ 80 years old(50 cases,27.93%)and 61 ~ 70 years old(36 cases,20.11%);the top three injury causes were fall down injury(86.03%)?high falling injury(8.38%)and traffic injury(4.47%).According to AO classification,31-A1 type 83 cases,accounting for 46.37%;31-A2 type 55 cases,accounting for 30.73%;31-A3 type 41 cases,accounting for 22.91%.According to Evans classification,?,?,?,?,? was respectively 90 cases(50.28%),48 cases(26.82%),27 cases(15.08%),10 cases(5.59%)and 4 cases(2.23%).The surgical treatment was 93.30%(167/179),the non-surgical treatment was 6.70%(12/179).In various kinds of comorbidities,merging of one kind of comorbidities was 32.4%(58/179),merging of two kinds of comorbidities was 29.1%(52/179),merging of three kinds of comorbidities was 12.3%(22/179),combination of four kinds of comorbidities was 6.1%(11/179),the combination of five kinds of comorbidities was 1.1%(2/179).Among all the intertrochanteric fracture patients,with the deep venous thrombosis accounted for 12.8%(23/179).Part2According to inclusion and exclusion criteria,we have included in the study of 20 literatures,including 59462 patients,the overall result of publication bias was measured with a funnel plot and there is no large bias.The results of Meta analysis show that: in the various risk factors,older than 60 years old,male,ASA score,diabetes before fracture,cardiovascular disease before fracture,the respiratory system disease before fracture,cerebrovascular disease before fracture,osteoporosis,hypertension and dementia before fracture had statistical differences,indicates the above elements were the major risk factors for hip fracture in the elderly,but fracture type,body mass index(BMI),the delay time from fracture to surgery had no statistical differences,explained that these three elements were not the risk factors for hip fracture in the elderly.Conclusions(1)The majority of hip fracture patients were elderly.Slipping and osteoporosis were the leading causes.(2)As the growth of the age,the probability of femoral intertrochanteric fractures had an increasing trend year by year,and the female patients with femoral intertrochanteric fractures are more than male patients.(3)In the AO classification,31-A1 type was the most;in the Evans classification,?type was the most.Surgical treatment remains the predominant management strategy in the femoral intertrochanteric fracture.Among various kinds of comorbidities,hypertension had the highest incidence,followed by the diabetes mellitus.The deep venous thrombosis with the highest incidence in age group of 81-90 years.(4)The results of Meta analysis show that: in the various risk factors,older than 60 years old,male,ASA score,diabetes before fracture,cardiovascular disease before fracture,the respiratory system disease before fracture,cerebrovascular disease before fracture,osteoporosis,hypertension and dementia before fracture were the major risk factors for hip fracture in the elderly,therefore the treatment and prevention of hip fractures in older adults was the main problem for clinicians.(5)The high mortality in elderly patients with hip fracture may be the result of joint action of many factors,such as the physiological status in the elderly,chronic disease before fractures and so on.Before treatment,we should fully understand the patient's body function and health status,fully evaluate the operation risk,choose appropriate surgical type,improve the effect of patients with postoperative function recovery,reduce the possibility of complications. |
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