【作者】 陈桂珍；

【导师】 王伟；

【作者基本信息】 天津医科大学 ， 流行病与卫生统计学， 2003， 硕士

【摘要】 目的 骨折是一种常见的、突发性的损伤，对患者本人及其家庭、社会都造成极大的痛苦和负担。骨折不仅影响患者的生存质量，造成潜在的寿命损失，同时还会使社会劳动力在一定程度上有所损失，造成国家和个人的资源浪费。为此，探讨骨折发生的流行病学特征和相关危险因素，确定高危人群，制定有针对性的骨折预防措施，从而减少骨折的发病率及致残率，减轻骨折给人们带来的痛苦和经济负担，对提高患者乃至整个人群的生存质量，具有现实意义。 方法 本文通过回顾调查及现况调查的方法，对1994年1月至2002年12月天津市天津医院、河西骨科医院这两所医院收治的2730例骨折患者的住院病历资料进行了骨折流行病学调查，以了解天津地区骨折发生的流行病学特征。在描述性分析的基础上，采用了对数线性模型和对应分析等统计学方法对资料进行全面、深入的分析。又在天津医院等4所医院随机抽取了在2002年12月至2003年3月住院患者中的140例骨折患者和148例非骨折患者作为对照，进行病例对照研究，应用logistic回归模型进行单因素及多因素分析，以揭示骨折的危险因素，为加强社区卫生保健及健康教育提供依据，从而指导社区卫生服务工作。 结果 在骨折的流行病学特征的分析中，本研究显示：调查患者平均年龄为41.70±18.50岁，其中15～59岁年龄段的发病人数最多(76.5％)，0～14岁年龄组与60岁以上年龄组发病人数较少。骨折患者职业分布中工人所占比例最大，占45.8％，其余依次为干部、学生。应用圆形分布法可看出，骨折住院病人的住院时间有集中趋势，即5月上旬(5月5日)～11月下旬(11月20日)。骨折半数以上在路途中发生(54.0％)，其次是在工作单位和家中。本次调查多为单发性骨折，占74.1％。骨折部位以胫腓骨为最多，占16.0％，其余依次为股骨颈、髌骨、踝骨。骨折多由于自身原因引起，骨折伤害直接原因以交通事故、骑车或行走时跌伤、高处坠落较多，分别占30.5％，26.8％，26.0％。患者大部分为急诊入院，占88％，其次为一般门诊，危重患者所占比例较少，为2.1％；而出院情况大部分为好转，占57.5％。在本研究中，单发性骨折住院日明显短于多发性骨折。平均住院日排在前五位的骨折依次为：椎骨骨折、股骨干骨折、腔肿骨骨折、股骨粗隆间骨折、股骨颈骨折。多发性骨折的住院费用明显高于单发性骨折，椎骨骨折住院费用最高。 本文采用对数线性模型对骨折病人的年龄、性别和骨折发生时间进行综合分析的结果显示：年龄、性别和月份对骨折的发生有交互效应。男性在10～49岁年龄组骨折发生情况多于女性：50～59岁年龄组在IO月份骨折发生人数低于平均水平：男性在3、4、巳9这四个月比其它月份更容易发生骨折。采用对数线性模型对骨折病人的年龄、性别和骨折发生原因进行综合分析的结果显示：女性更容易因为跌倒造成骨折，40岁年龄组人群多因交通事故造成骨折，而60岁以上年龄组多因跌倒造成骨折。 采用对应分析方法，对年龄与医疗付费方式之间的关系进行分析，显示：10M0岁年龄组主要通过商业保险，而30而9岁年龄组则主要通过社会医疗保险，70岁年龄组主要通过公费医疗，10岁以下年龄组主要通过自费来支付费用。 应用lOgistiC回归模型进行单因素及多因素分析，单因素分析结果表明：随着年龄的增加，发生骨折的风险也相应地增加；随着文化程度的增加，骨折的危险性减少；体力劳动者发生骨折的危险性大于脑力劳动者；骨骼系统疾病。经常饮酒、孕次、使用镇静药、服用减少骨量的药物均是骨折发生的危险因素。而多喝奶、18岁以前增加体育活动、充足的睡眠及使用增加骨量的药物可以减少骨折的发生。多因素分析结果表明：体力劳动者发生骨折的危险性高于脑力劳动者；有骨骼系统疾病者是危险因素；服用雌激素是保护性因素。 结论 综上所述，骨折的发生可能与年龄、文化程度、体育锻炼、行为习惯、健康状况及药物史等因素有关。为降低骨折在人群中的发生，要大力开展社区卫生服务，开展健康教育与健康促进，使人们自觉地采纳有益于健康的行为和生活方式，不断提高社区人群的保健意识和创伤 范意识，消除和减轻影响健康的危险因素，预 骨折的发生，以提高患者乃至整个人群的生存质量。更多还原

【Abstract】 Objective Fracture is a common and unexpectable hurt, which cause deep pain and large burden to patients, their family and society. Fracture not only affect patient’s quality of life, potentially loss in lives, but also damnify social labour in certain degree and cause social and individual resource waste. This report is intended to test epidemiological character of fracture and relative risk factors, confirming high risk group and establishing prevention measures can decrease incidence of fracture and deformity rate, decrease pain and economical burden brought by fracture, which can improve fracture patients and all people’s quality of life. It has practical meaning .Methods Using retrospective study and cross-sectional investigation, we treated a epidemiological investigation of 2730 patients in hospital with fracture in Tianjin hospital and Hexi orthopaedics hospital, in order to find out epidemiological character hi Tianjin. On the base of descriptive analyze, we apply log-linear model and correspondence analysis to in-depth analyze data. Random select 140 the fractures as case group and 148 the non-fractures as control group to have case control study. Data was analyzed with logistic regression. To comprehensively determine the risk factors of fracture , confirming high risk group, and establishing detailed prevention measures. It can provide foundations of community health service and health education, then guide community medical and health work.Results This study is based on describes analysis. The finding shows the average age was 41.70yr, and the proportion of 15~59yr was the topmost (76.5%) , while the proportion of up to 60yr and aged 0 to 14 were the least. The occupational proportion was the worker was more than the cadre and student. The circular distribution showed there were central tendency from May to November. There was half more of the whole (54.0%) that happened on the road, some others happened in the office and home. The majority of the fracture was single fracture(74.1%). Tibia and fibula fracture were the most (16.0%), and the others were thighbone neck, kneecap and anklebone. The reasons of the fracture were traffic accident (30.5%), tumble (26.8%),falling from high(26.0%).Most of the patients were emergency treatment(88.0%)and leave hospital, most of them were on the mend(57.5%). The average hospital day (AHD) of the single facture was lower than the compound fractures, and vertebra, thighbone trunk, tibia and fibula, thighbone tubercle, thighbone neck facture’s AHD are the first to the fifth. The hospitalization expenses of compound fracture was more the single facture’s and the vertebra fracture is the most of each position fracture.Base on the describing analysis of the data, the log liner model was applied to analyze the age, sex, happen time of fracture. The results shows there were interaction among the age, sex, happen time of fracture. The fracture was befell on Male more than female aged 10 to 49. The 50~59yr was lower than others in October. The fracture was befell on Male in Mar, April, August and September more than other months.The log liner model was applied to analyze the age, sex, happen reason of fracture too. The results show the tumble was the main reason in female; the traffic accident was main reason of 40yr group while the tumble was the main reason in up to 60yr group.The fashion of spending was studied by the method of corresponding analysis was applied to analyze. The result shows most of the 10~20yr group spent by commercial insurance, the 30~69yr group spent mainly by social hospitalization insurance, up to 70yr spent at public health service, while the group under lOyr spent at their own expenses.The simple factor analysis showed that the risk factors for fracture patients were age, physical work, disease of bone, drink liquer, pregnancy number of times, take tranquilizer. The protective factors were milk-drinking, physical training, enough sleep.Logistic regression analysis confirmed that occurrence of fracture was mainly related更多还原