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1.
目的探讨股骨近端髓内钉-螺旋刀片(PFNA)治疗老年骨质疏松性股骨转子间骨折的初期疗效。方法2005年11月~2006年12月采用PFNA内固定治疗37例老年骨质疏松性股骨转子间骨折患者。男17例,女20例;年龄72~89岁,平均79.2岁。骨折按AO分类标准:A1型14例,A2型16例,A3型7例,均为闭合性骨折。其中7例合并一种内科疾病,28例合并两种以上内科疾病。所有患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PFNA。结果37例中,2例死亡,其中1例因术后病情加重,于术后第17天死亡;另1例于术后3个月死于颅内出血。其余35例获3~15个月(平均12个月)随访,其中2例因合并症而长期卧床;其他33例于术后第3天离床活动,1周后部分负重,4周后逐渐过渡到完全负重。33例中29例伤肢基本恢复伤前功能,4例因合并症加重而患肢功能较伤前减退。X线片示35例存活的患者骨折全部一期愈合,平均愈合时间为9周。所有患者均无感染、骨不连及内固定失效等并发症发生。根据Harris功能评分:优12例,良17例,可5例,差1例,优良率为82.9%。结论PFNA治疗老年骨质疏松性股骨转子间骨折的初期疗效较好,内固定可靠,允许早期功能锻炼。  相似文献
2.
股骨转子下骨折内固定失败原因分析   总被引:47,自引:0,他引:47  
目的分析股骨转子下骨折内固定失败的原因,提出避免并发症的方法。方法1993年1月至2004年1月,收治股骨转子下骨折内固定失败患者39例,男34例,女5例;年龄21~65岁,平均37岁。致伤原因:骑自行车摔伤3例,步行摔伤1例,车祸伤28例,高处坠落伤7例。骨折类型:Sein-sheimerⅡA型5例,ⅡB型2例,ⅡC型1例,ⅢA型18例,ⅢB型1例,Ⅳ型3例,Ⅴ型9例。原手术方式包括切开复位钢丝捆扎固定1例,切开复位梅花钉加钢丝捆扎固定13例,闭合复位Russell-Taylor重建钉固定1例,切开复位135°动力髋螺钉固定6例,切开复位钢板固定18例。术后8周内失败2例,8周至6个月失败26例,超过6个月失败11例。内固定失败形式包括骨折内翻畸形35例、拉力螺钉切出股骨头2例、股骨干过度内移2例。内固定失败原因是术中骨折未解剖复位、内固定不坚强、过早完全负重以及拉力螺钉位置不良。结果对骨折内固定进行翻修,切开复位梅花钉固定2例,交锁髓内钉固定23例,135°动力髋螺钉固定6例,钢板固定4例,人工关节置换4例。随访19~37个月,平均23个月。骨折愈合时间11~13个月,平均11.5个月。结论由于偏心负载,股骨转子下区可以产生很高的弯曲负荷。采用髓外内固定时,术中应重建股骨内侧皮质稳定性并植骨。  相似文献
3.
手术治疗高龄髋部骨折的围手术期并发症   总被引:42,自引:0,他引:42  
目的探讨手术治疗高龄(≥80岁)髋部骨折患者住院期间并发症的预防和处理方法。方法回顾性分析1996年1月至2004年3月198例行手术治疗的高龄髋部骨折患者的病例资料,男55例,女143例;年龄80~98岁,平均85.2岁。股骨颈骨折93例,其中GardenⅠ型2例、Ⅱ型10例、Ⅲ型52例、Ⅳ型29例;股骨转子间骨折105例,其中EvanⅠ型3例、Ⅱ型37例、Ⅲ型39例、Ⅳ型26例。麻醉采用局麻加基础麻醉2例、全麻38例、连续硬膜外麻醉158例。股骨颈骨折的手术方法包括人工双极股骨头置换(骨水泥型)77例、全髋关节置换(混合型)13例、加压空心螺钉固定3例;股骨转子间骨折均采用闭合复位滑动式鹅头钉固定。结果人工股骨头置换平均手术时间53min,平均出血110ml;全髋关节置换平均手术时间94min,平均出血165ml;螺钉固定平均手术时间35min,平均出血30ml;滑动式鹅头钉固定平均手术时间40min,平均出血60ml。17例行关节置换者术中应用骨水泥时出现一过性血压下降。全部患者平均住院18.6d,住院期间死亡2例。术后36例(18.2%)出现并发症,其中中枢神经系统(13例)和心血管系统(13例)并发症最为高发。未出现与手术相关的并发症。入院至手术时间平均6d,其中7d以上者46例,术后出现并发症9例(19.6%);7d及以内者152例,出现并发症27例(17.8%),两者差异无统计学意义(%2=8.62,P>0.05)。结论高龄髋部骨折应尽量采用创伤小、快速的麻醉及手术方法,充分的术前准备和积极预防、正确处理并发症是保证手术成功的重要因素。  相似文献
4.
95°DCS治疗股骨粗隆间及粗隆下粉碎性不稳定骨折   总被引:29,自引:5,他引:24  
目的研究和评价95°DCS(动力髁螺钉)在股骨粗隆间及粗隆下粉碎性不稳定骨折中的应用。方法自1998年8月~2003年1月对23例髋部骨折(股骨粗隆间骨折15例,股骨粗隆下骨折8例)采用闭合复位95°DCS内固定治疗。结果全部病例均得到10个月~3年随访,主要指标为颈干角、髋关节伸屈活动度等。骨折全部愈合,无钢板松动、断裂、骨不连等并发症,1例轻度髋内翻。优16例,良6例,优良率95.7%。结论95°DCS能提供有效的固定,其治疗髋部骨折是DCS的另一种用处,是值得推荐的治疗粉碎性不稳定股骨粗隆间和粗隆下骨折的方法之一。  相似文献
5.
Alcohol intake as a risk factor for fracture   总被引:27,自引:8,他引:19  
High intakes of alcohol have adverse effects on skeletal health, but evidence for the effects of moderate consumption are less secure. The aim of this study was to quantify this risk on an international basis and explore the relationship of this risk with age, sex, and bone mineral density (BMD). We studied 5,939 men and 11,032 women from three prospectively studied cohorts comprising CaMos, DOES, and the Rotterdam Study. Cohorts were followed for a total of 75,433 person-years. The effect of reported alcohol intake on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson model for each sex from each cohort. Covariates examined included age and BMD. The results of the different studies were merged using weighted -coefficients. Alcohol intake was associated with a significant increase in osteoporotic and hip fracture risk, but the effect was nonlinear. No significant increase in risk was observed at intakes of 2 units or less daily. Above this threshold, alcohol intake was associated with an increased risk of any fracture (risk ratio [RR]=1.23; 95% CI, 1.06–1.43), any osteoporotic fracture (RR=1.38; 95% CI, 1.16–1.65), or hip fracture (RR=1.68; 95% CI, 1.19–2.36). There was no significant interaction with age, BMD, or time since baseline assessment. Risk ratios were moderately but not significantly higher in men than in women, and there was no evidence for a different threshold for effect by gender. We conclude that reported intake of alcohol confers a risk of some importance beyond that explained by BMD. The validation of this risk factor on an international basis permits its use in case-finding strategies.  相似文献
6.
医源性因素对DHS治疗髋部骨折疗效的影响   总被引:27,自引:0,他引:27  
目的探讨动力性髋螺钉(dvnamic hip screw,DHS)治疗髋部骨折中出现的各种失误和并发症与医源性因素的关系,并提出相应对策。方法 回顾总结316例DHS治疗髋部骨折中出现的失误和并发症,并分析其原因。结果258例得到随访,32例出现了不同程度的失误和并发症,发生率12.4%。其中因失误致颈钉位置欠佳6例,长度不当4例;术后并发症颈钉穿出股骨头4例;术后切口感染3例,其中骨不愈合1例;髋内翻4例,其中钢板断裂1例;畸形愈合6例;下肢外旋畸形2例;骨不愈合3例。结论 DHS治疗髋部骨折疗效肯定,出现的失误和并发症与术前准备、适应症的选择、DHS的选用、手术技术及术后功能锻炼指导等医源性因素有关。  相似文献
7.
80岁以上髋部骨折术后早期并发症分析   总被引:21,自引:0,他引:21  
目的探讨80岁以上髋部骨折早期并发症的发生原因及预防。方法回顾1995年5月~2002年12月62例80岁以上高手术风险性髋部骨折的手术治疗,对其出现的早期并发症的原因进行分析。结果本组术后早期发生并发症共14例,其中下肢深静脉血栓形成3例,心功能衰竭3例,肺部感染3例,消化道应急性溃疡2例,切口感染2例,术后早期死亡1例。结论高龄髋部骨折术后早期并发症率高,应给予认真对待,对其有可能出现的并发症应进行积极的预防。  相似文献
8.
The aim of this study was to assess the relationship between morbidity from hip fracture and that from other osteoporotic fractures by age and sex based on the population of Sweden. Osteoporotic fractures were designated as those associated with low bone mineral density (BMD) and those that increased in incidence with age after the age of 50 years. Severity of fractures was weighted according to their morbidity using utility values based on those derived by the National Osteoporosis Foundation. Morbidity from fractures other than hip fracture was converted to hip fracture equivalents according to their disutility weights. Excess morbidity was 3.34 and 4.75 in men and women at the age of 50 years, i.e. the morbidity associated with osteoporotic fractures was 3–5 times that accounted for by hip fracture. Excess moribidity decreased with age to approximately 1.25 between the ages of 85 and 89 years. On the assumption that the age- and sex-specific pattern of fractures due to osteoporosis is similar in different communities, the computation of excess morbidity can be utilized to determine the total morbidity from osteoporotic fractures from knowledge of hip fracture rates alone. Such data can be used to weight probabilities of hip fracture in different countries in order to take into account the morbidity from fractures other than hip fracture, and to modify intervention thresholds based on hip fracture risk alone. If, for example, a 10-year probability of hip fracture of 10% was considered an intervention threshold, this would be exceeded in women with osteoporosis aged 65 years and more, but when weighted for other osteoporotic fractures would be exceeded in all women (and men) with osteoporosis. Received: 1 May 2000 / Accepted: 1 December 2000  相似文献
9.
An Assessment Tool for Predicting Fracture Risk in Postmenopausal Women   总被引:14,自引:14,他引:7  
Due to the magnitude of the morbidity and mortality associated with untreated osteoporosis, it is essential that high-risk individuals be identified so that they can receive appropriate evaluation and treatment. The objective of this investigation was to develop a simple clinical assessment tool based on a small number of risk factors that could be used by women or their clinicians to assess their risk of fractures. Using data from the Study of Osteoporotic Fractures (SOF), a total of 7782 women age 65 years and older with bone mineral density (BMD) measurements and baseline risk factors were included in the analysis. A model with and without BMD T-scores was developed by identifying variables that could be easily assessed in either clinical practice or by self-administration. The assessment tool, called the FRACTURE Index, is comprised of a set of seven variables that include age, BMD T-score, fracture after age 50 years, maternal hip fracture after age 50, weight less than or equal to 125 pounds (57 kg), smoking status, and use of arms to stand up from a chair. The FRACTURE Index was shown to be predictive of hip fracture, as well as vertebral and nonvertebral fractures. In addition, this index was validated using the EPIDOS fracture study. The FRACTURE Index can be used either with or without BMD testing by older postmenopausal women or their clinicians to assess the 5-year risk of hip and other osteoporotic fractures, and could be useful in helping to determine the need for further evaluation and treatment of these women. Received: 7 November 2000 / Accepted: 23 May 2001  相似文献
10.
The objectives of the present study were to estimate 10 year probabilities of osteoporotic fractures in men and women according to age and bone mineral density (BMD) at the femoral neck. Risks were computed from the incidence of a first hip, distal forearm, proximal humerus and symptomatic vertebral fracture from patient records in Malmo¨, Sweden and future mortality rates for each year of age from Poisson models using the Swedish patient register and statistical year book. Fracture probability was computed using the Swedish population and cut-off values for T-scores based on the NHANES III female population. We assumed that the risk of fracture increased with decreasing BMD as assessed by meta-analysis in independent studies. The 10-year probability of any fracture was determined from the proportion of individuals fracture-free from the age of 45 years. With the exception of forearm fractures in men, 10 year probabilities increased with age and T-score. In the case of hip and spine fractures, fracture probabilities for any age with low BMD were similar between men and women. The effect of age on risk independently of BMD suggests that intervention thresholds should not be at a fixed T-score but vary according to absolute probabilities. Intervention thresholds based on hip BMD T-scores are similar between sexes. Received: 14 December 2000 / Accepted: 2 July 2001  相似文献
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