多发骨创伤的多中心流行病学分析  

Multicenter epidemiological study on multiple bone trauma

作　　者：马颖宏 孙志坚 李庭[1] 费晗 葛宇峰 谭哲伦 高士翔 朱诗宇 周子荐 金鑫[3] 蒋协远[1] Ma Yinghong;Sun Zhijian;Li Ting;Fei Han;Ge Yufeng;Tan Zhelun;Gao Shixiang;Zhu Shiyu;Zhou Zijian;Jin Xin;Jiang Xieyuan(Department of Orthopedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]中山大学附属第七医院骨科,广州518107 [3]华中科技大学同济医学院附属协和医院骨科,武汉430022 [4]北京大学第四临床医学院

出　　处：《骨科临床与研究杂志》2025年第2期96-103,共8页Journal Of Clinical Orthopedics And Research

基　　金：北京市科技新星计划(交叉合作课题)。

摘　　要：目的探讨多发骨创伤的流行病学特征及不良预后危险因素。方法于北京积水潭医院和国内多家医院前期共建的多中心多发骨创伤数据库中收集2019年12月至2023年12月收治的多发骨创伤患者临床资料,包括年龄、性别、受伤时间、致伤原因、受伤部位、并发症及治疗情况等。采用t检验或χ^(2)检验比较组间资料,通过多因素Logistic回归分析患者入院期间截肢和死亡的危险因素。结果共纳入8248例多发骨创伤患者,男女比为1.82∶1,平均年龄(47.2±18.5)岁。2019年12月至2023年12月年均发病人数呈增长趋势。致伤原因以交通伤为主,占比66.7%。损伤部位以骨盆和胸部损伤为主,平均骨折部位2.7处。常见并发症为休克(28.0%)和颅脑损伤(15.6%),15.8%患者收入ICU治疗。12.5%患者住院期间发生下肢深静脉栓塞,肺栓塞发生率为0.3%。0.9%患者行急诊截肢治疗,住院患者死亡率0.4%。多因素Logistic回归分析结果显示,下肢骨折(OR=1.855,P=0.038)、输血(OR=5.451,P<0.05)、急诊行外固定架(OR=3.679,P<0.05)、收入ICU(OR=2.706,P<0.05)是多发骨创伤患者急诊截肢的独立危险因素。脊柱骨折(OR=2.868,P=0.007)、肺栓塞(OR=16.838,P<0.05)、收入ICU(OR=14.440,P<0.05)是患者死亡的独立危险因素。结论多发骨创伤发病率近年呈增长趋势,患病人群以青壮年居多,伤情复杂且治疗费用高。交通伤和重物砸伤为主要致病因素,骨盆、胸部为主要受伤部位,常合并有休克和颅脑损伤,四肢多发伤以下肢见多。下肢骨折、输血、急诊行外固定架、收入ICU是患者急诊截肢的独立危险因素;脊柱骨折、肺栓塞、收入ICU是患者死亡的独立危险因素。Objective To explore the epidemiological characteristics of multiple bone traumas in various regions of China,and to enhance the understanding of disease prevention and treatment as well as the quality of medical care.Methods Clinical data of patients with multiple bone trauma admitted from December 2019 to December 2023 were collected from the multicenter polytrauma database jointly established by Beijing Jishuitan Hospital and several domestic hospitals.The data included age,gender,time of injury,cause of injury,injured body parts,complications,and treatment status.T-tests or chi-square tests were used to compare the data between groups,and multivariate logistic regression analysis was conducted to identify the risk factors for amputation and death during hospitalization.Results A total of 8,248 patients with multiple bone trauma were included,with a male-to-female ratio of 1.82:1 and an average age of(47.2±18.5)years.The annual incidence of cases from December 2019 to December 2023 showed an increasing trend.Traffic injuries were the leading cause of injury,accounting for 66.7%.Pelvic and chest injuries were the most common sites of injury,with an average of 2.7 fracture sites.Common complications included shock(28.0%)and cranial brain injury(15.6%),with 15.8%of patients admitted to the ICU for treatment;12.5%of patients developed deep vein thrombosis of the lower limbs during hospitalization,and the incidence of pulmonary embolism was 0.3%.Emergency amputation was performed in 0.9%of patients,and the in-hospital mortality rate was 0.4%.The results of the multivariate Logistic regression analysis showed that lower limb fractures(OR=1.855,P=0.038),blood transfusion(OR=5.451,P<0.05),emergency external fixation(OR=3.679,P<0.05),and admission to the ICU(OR=2.706,P<0.05)were independent risk factors for emergency amputation in patients with multiple bone trauma.Spinal fractures(OR=2.868,P=0.007),pulmonary embolism(OR=16.838,P<0.05),and admission to the ICU(OR=14.440,P<0.05)were independent risk factors for patient

关 键 词：多发骨创伤 数据库 流行病学 

分 类 号：R683[医药卫生—骨科学]