老年髋部骨折术后对侧髋部再骨折的危险因素分析

目的 :探讨老年髋部发生二次骨折的相关风险因素,为预防对侧髋部再骨折提供临床依据。方法 :回顾性分析2008年12月至2014年2月378例老年髋部初次骨折患者的资料,男175例,女203例;年龄60~90岁,平均(75.53±8.04)岁;股骨颈骨折125例,股骨粗隆间骨折253例。术后随访12~36个月,平均24.9个月,32例患者发生对侧髋部再骨折,男13例,女19例;年龄72~95岁,平均(81.25±5.94)岁;股骨颈骨折7例,股骨粗隆间骨折25例。根据患者术后有无对侧髋部再骨折分为骨折组和无骨折组,比较两组患者的年龄、性别、初次骨折类型、内固定方式、卧床时间、骨质疏松情况、合并内科疾病情况、术后功能锻炼、治疗的依从性、生活环境(农村/城市)和末次随访时Harris评分,对于P0.05的因素进行多因素Logistic回归性分析。结果:骨折组与无骨折组的年龄、骨质疏松情况、合并内科疾病情况、术后功能锻炼、医疗依从性及末次随访时Harris评分比较差异均有统计学意义(P0.05)。多因素Logistic分析结果显示:骨质疏松(OR=6.793,P=0.001),高龄(OR=4.170,P=0.002),合并内科疾病(OR=3.828,P=0.005),术后功能锻炼(OR=0.297,P=0.005)以及医疗依从性(OR=0.295,P=0.007)是老年髋部骨折术后对侧髋部再骨折的主要危险因素。结论:老年髋部骨折术后对侧再骨折主要危险因素是高龄、骨质疏松、合并内科疾病、术后功能锻炼和医疗依从性。术后需加强抗骨质疏松治疗、积极治疗内科疾病,坚持功能锻炼,以预防髋部再次骨折的发生。     

二次髋部骨折相关因素研究进展

随着社会经济的发展,人口老龄化进程的加速,人民生活方式的改变,骨质疏松症已成为危害我国老年人健康的重要疾病,老年骨质疏松患者易发生髋部骨折。初次骨折治疗后,骨质疏松患者尚面临二次髋部骨折的风险,针对二次髋部骨折的风险因素,采取有效措施可降低二次髋部骨折率。本文从初次骨折类型、性别与年龄、骨代谢指标与骨密度、抗骨质疏松症的治疗、Singh指数、合并症、体重指数等方面就二次髋部骨折危险因素作一综述。     

Singh指数与股骨转子间骨折术后再骨折的相关性研究

目的比较股骨转子间骨折术后再骨折患者与未骨折患者的Singh指数,评估Singh指数在股骨转子间骨折患者中的应用价值。方法回顾性分析我院2014年1月至2016年12月期间收治并手术治疗股骨转子间患者218例,根据术后是否出现对侧髋部骨折分组,对两组患者Singh指数分级进行分析比较。结果 a)随访24～60个月,平均42.9个月。转子间骨折术后对侧髋部再发骨折发生率为5.2%,初次骨折后发生对侧骨折的间隔时间平均11.5个月;b)股骨转子间骨折术后未骨折组Singh指数分级平均为4.0级,再骨折组Singh指数分级平均3.5级,两组差异有统计学意义(P=0.05),Singh分级低于4级可作为预测股骨转子间骨折术后对侧髋部再发骨折的阈值;c)Singh指数分级与骨密度值相关性分析结果,r=0.66,P0.001,二者具有良好的正相关性。结论股骨转子间骨折患者Singh指数分级越低,相应骨质疏松程度越严重,术后对侧髋部再骨折发生率越高(P0.05)。Singh指数在评估髋部骨折术后对侧髋部再骨折风险是十分简单而有效的方法。     

老年髋部骨折术后对侧髋部再骨折危险因素的荟萃分析

[目的]通过荟萃分析探讨影响老年髋部骨折术后对侧髋部再骨折的危险因素。[方法]检索Medline、Cochrane Database、Embase Database等外文医学数据库,收集2000年1月～2018年3月国外公开发表的有关老年髋部骨折术后对侧髋部再骨折危险因素的英文文献,严格评价纳入研究的质量并提取资料,应用Revman 5.3软件进行系统分析。[结果]共纳入20篇英文文献,对侧髋部再骨折患者2 542例,单侧髋部骨折对照患者27 949例。影响髋部再骨折的危险因素有患者性别(OR=1.55,95%CI 1.39～1.73,P0.01)、心脏病(OR=1.34,95%CI 1.03～1.75,P=0.03)、老年痴呆(OR=1.67,95%CI 1.29～2.15,P0.01)、呼吸系统疾病(OR=1.86,95%CI 1.06～3.27,P=0.03)、视觉障碍(OR=1.90,95%CI 1.27～2.84,P=0.002),而与年龄、BMI、ASA评分、初次髋部骨折类型、手术方案、Singh指数、BMD、抗骨质疏松药物治疗、糖尿病、高血压病、脑卒中、骨骼系统疾病、酗酒嗜好无关。[结论]女性、心脏病、老年痴呆、呼吸系统疾病、视觉障碍是老年髋部骨折术后对侧髋部再骨折的独立危险因素。     

老年人骨质疏松性髋部骨折与Singh指数和股骨近端几何结构的相关性初探

目的探讨老年性髋部骨折与Singh指数和股骨近端几何结构的关系。方法髋部骨质疏松骨折性46例。男24例,女22例;年龄56～82岁,平均(67.3±12.5)岁。对照组48例,为同期健康体检的志愿者,男25例,女23例;年龄54～79岁,平均(68.2±11.8)岁。测量两组受试者Singh指数及股骨颈轴长(FNAL)、颈干角(NSA)(髋部骨折组对其健侧进行检测),比较分析彼此间的相关性。结果老年性髋部骨折患者与对照组比较Singh指数明显降低,FNAL长于对照组,NSA较对照组大。结论 Singh指数和FNAL及NSA可以提高对老年性髋部骨质疏松骨折危险性的预测。     

高龄脆性再骨折患者的预防与干预措施研究

[目的]探讨高龄脆性再骨折患者的综合预防治疗措施及其效果.[方法]自2002年1月～20004年12月及2004年1月～2006年12月各100例高龄骨质疏松性骨折患者分为对照组与治疗组进行比较,治疗组采用综合预防治疗措施包括健康教育,骨折预测,预防跌倒,积极手术及规范抗骨质疏松治疗.对3年内再发骨折,手术对再骨折的影响,致残及死亡率进行分析.[结果]对照组100例3年内再发骨折59例占59%,其中首次髋部骨折24例,手术14例,全身各部位再发骨折13例,占对照组髋部骨折病例54%,18例卧床丧失日常生活能力,占18%, 18例出现并发症死亡,占18%.治疗组100例3年内再发骨折39例,其中首次髋部骨折39例,手术32例,全身各部位再发骨折15例,占治疗组髋部骨折病例的38%, 7例卧床丧失日常生活能力,占7%, 7例出现并发症死亡,占7%.[结论]对高龄骨质疏松性骨折患者采用综合于预措施,进行骨折预测,预防跌倒,积极手术治疗,及规范抗骨质疏松治疗能够减少再骨折发生,降低致残及死亡率.     

双髋骨质疏松的差别与髋部骨折的相关性分析

目的 探讨双侧髋部骨质疏松程度的差别与髋部骨折发牛之间的关系,为防治骨质疏松性骨折提供参考依据.方法 选取骨质疏松髋部骨折患者108例,平均年龄79.4岁,对其分别测定骨折侧和对侧髋部的Singh指数和股骨上段皮质厚度.结果 骨折侧的Singh指数平均为2.87 ±1.08,对照侧则为3.47±1.02,两者相比有显著差异(P<0.05).股骨上段皮质厚度骨折侧平均为0.59±0.16,对照侧为0.69±0.13,两者相比有显著差异(P<0.05).结论 髋部骨折往往发生在两侧髋部骨质疏松程度较为严重的一侧,故对比双髋的Singh指数和皮质骨厚度可以提高髋部骨折危险性的预测,同时在治疗上可以给予针对性的措施,以防止骨折的发生.     

老年髋部骨折患者股骨上端机械强度的测定

目的了解老年髋部骨折和老年骨质疏松的关系.方法选择我院1996～2001年间收治的50岁以上的老年髋部骨折202例,测定其健侧股骨上端机械强度(Singh指数),同时选择门诊50岁以上其它原因摄骨盆X线片而无骨盆和股骨上端骨折的患者105例,测定其右侧股骨上端机械强度,测得的数值作对比分析.结果 50～60岁组和61～70岁组有非常显著差异性(P＜0.01),而70岁以上二者无显著差异性(P＞0.05).结论老年髋部骨折患者其股骨上端机械强度明显下降,测定Singh指数对预测髋部骨折有重要意义.     

老年髋部骨折风险与Singh指数相关性研究

目的 探讨应用Singh指数预测老年人骨质疏松性骨折,并为发现高危人群提供简便廉效的方法.方法 本文统计了888例因受轻微外伤致股骨颈或粗隆间骨折患者的情况,拍骨盆正位片并用Singh六级分类法统计股骨上端骨小梁级数,并对骨折进行分型;运用SPSS软件探索不同性别、髋部不同骨折部位之间Singh指数分级差异;年龄、骨折分型与Singh指数的等级相关性等.结果 男性平均级数4.11±1.52,女性平均级数为3.08±1.40;股骨颈骨折患者为3.60±1.54,而粗隆间骨折的平均级数为3.12±1.43;两组数据经独立样本t检验均示P=0.000,具有非常显著的差异.Spearman等级相关分析显示:年龄与Singh指数具有非常显著地正相关性;而骨折分型方法中只有股骨颈骨折Garden分型与指数具有一定程度的负相关性.结论 Singh指数可作为有效的骨质疏松性髋部骨折风险评估的方法,尤其是对女性股骨颈骨折具有较大的预示意义;骨质疏松症是老年人髋部骨折的高危因素,其判断标准是股骨上端骨小梁级数下降男性低至Ⅳ级,女性低至Ⅲ级.     

髋部骨折患者中股骨颈强度的测定

目的：了解老年髋部骨折和老年骨质疏松的关系。方法：选择1998年至2003年收治的50岁以上老年髋部骨折80例,测定其健侧股骨上端强度（Singh指数）,同时选择门诊50岁以上其他原因摄骨盆X线片而无骨盆和股骨上端骨折的患者90例,测定其左侧股骨上端强度,将测得的数值作对比分析。结果：50～60岁组和61～70岁组股骨上端强度与对照组比较差异有统计学意义（P〈0.01）,而70岁以上组的强度与对照组比较差异无统计学意义（P〉0.05）。结论：老年髋部骨折患者其股骨上端强度明显下降,测定Singh指数对预测髋部骨折有重要意义。     

髋臼骨折与开放骨折

随着交通事业的发展,由高能量损伤所致的髋臼骨折与开放性骨折日益增多。X线片结合CT检查及螺旋CT三维成像有助于髋臼骨折的诊断。骨折分型广泛采用Lelournel分型及AO分型。保守治疗的应用范围趋于局限,更多地采用手术治疗,强调髋臼骨折的理想复位、坚强内固定和早期功能活动。须注意正确选择手术入路,防止坐骨神经损伤、异位骨化和静脉血栓等手术并发症。而对于开放性骨折,目前强调早期充分清创和固定骨折,及早闭合伤口,注意使用抗生素,早期进行功能锻炼,以促进骨折的愈合和功能的恢复。     

Hip fractures

Hip fractures are the most common reason for orthopaedic admission. There are approximately 65,000 per year in England and Wales and they cause significant morbidity and mortality. Knowledge of these fractures and their treatment is vital to ensure optimization of these patients and to improve patient outcomes.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

The significance of segmental fibular fractures in the management of associated tibial fractures

One hundred seventy-six patients with 179 tibial shaft fractures (between March 2003 and August 2007) with a minimum of 4 months follow up were retrospectively reviewed by the author. Twenty-nine of these fractures were found to have segmental fibular fractures. These 29 fractures were analysed and compared with the total of 179 tibial fractures. Segmental tibial fractures with and without segmental tibial comminution were also analysed and compared.The segmental fibular fracture group had a greater incidence of associated injuries, associated fractures, open tibial fractures, Gustilo III B type fractures, major flap procedures, bony infection and bone grafting procedures which was statistically significant. The coincidence of segmental fibular fractures and segmental tibial fracture with segmental comminution indicated a bad prognosis. Segmental fibular fracture (associated with tibial fracture) appear more severe injury than segmental tibial fracture.     

青少年Tillaux骨折治疗体会

Tillaux骨折常见于青少年,如何治疗目前尚存争议。2003年1月～2008年3月,我科共收治9例青少年Tillaux骨折患者,1例骨折移位〈2mm者非手术治疗,8例骨折移位〉2mm者采用切开复位内固定治疗,均取得满意疗效。     

Femoral neck fractures after removal of hardware in healed trochanteric fractures

IntroductionHardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention.Materials and methodsA comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition.ResultsOverall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or fall, in 87.5% of the cases, mostly subcapital, and with no prevalence between displaced and undisplaced fractures. The clinical presentation was that of a spontaneous fracture, and most of the patients consulted because of hip pain and presented in the emergency room walking by themselves which led to delayed diagnosis in several instances. Radiological diagnosis was mostly with radiographs, though in some cases CT scans or MRI were necessary. The overall median incidence of this complication was 14.5% after hardware removal because of pain or discomfort in healed trochanteric fractures.ConclusionThe risk factors for FNFARIHTF seem to be preexisisting systemic osteoporosis, local osteoporosis as a result of preloading by the fixation device in the femoral neck, and the removal of hardware from the femoral neck, with reduction of the strength of the neck. The clinical presentation may be obscure as most of the patients complain of hip pain of some days or weeks, and arrive in the hospital walking. Therefore, the attending physician should be alert in order to request the appropriate radiological investigation and if this is not clear CT scan or MRI should be done in order to diagnose promptly these “spontaneous” fractures. Treatment should be replacement surgery in most cases; however, there is some place for internal fixation especially in undisplaced fractures or younger patients. The occurrence of the femoral neck fracture after hardware removal may be prevented with re-osteosynthesis and the use of bone chips or bone substitutes. Finally, the relatively high incidence of this complication should alert orthopaedic surgeons to reduce the removal of hardware in healed trochanteric fractures to very selected cases.     

Difficult pediatric hand fractures

Most pediatric hand fractures heal uneventfully due to the bone's growth potential. However, the severity of open physeal fractures of the distal phalanx and phalangeal neck fractures may be underestimated. With careful evaluation and treatment, a good outcome can usually be produced.     

Individuals who sustain nonosteoporotic fractures continue to also sustain fragility fractures

Summary This retrospective case control study was done in order to investigate whether patients who sustain a nonosteoporotic fracture early in life also continue to sustain fragility fractures later in life. All patients who had been treated at the Department of Orthopedics in Malmo with a tibial shaft fracture from 1949 to 1963 (n = 767) or an ankle fracture from 1961 to 1965 (n = 786) were included in this study. At the time of follow-up in 1992, 231 of the patients who sustained a tibial shaft fracture and 260 of the patients who sustained an ankle fracture were still living in the city of Malmö. Objective registration was done of all subsequent fractures that these former patients had sustained. Comparison was done with corresponding data from double numbers of age- and sex-matched controls who at that time (1950s and 1960s) had no such fractures. At the time of the fracture as well as today, the controls were living in the area of Malmö. Individuals with earlier tibial or ankle fractures had an increased incidence of fractures generally classified as fragility fractures. There was no difference in this respect between men and women, nor whether the initial fracture had been diaphyseal or metaphyseal. We conclude that sustenance of fractures early in life may serve as a predictor for fragility fractures later in life.     

Talar fractures associated with ipsilateral femoral shaft fractures: report of three cases

Talar fractures associated with ipsilateral femoral shaft fractures have been occasionally reported, but an unexpectedly high potential for simultaneous occurrence of the fractures in head-on collisions has not been well documented. We treated three patients with ipsilateral femoral shaft and talar fractures in a 2-year period starting in 2000. The patients were male, aged 25, 34 and 40 years, polytraumatized with other injuries. In all cases, the fractures occurred in the right lower extremities of drivers involved in head-on collisions. The talar fractures were not detected at the initial diagnosis. We considered that the feet had been dorsiflexed and exposed to an axial load from the front when the drivers pushed the brake pedals. This condition was considered to cause both fractures. Careful examination should be carried out to rule out talar fractures in swollen feet associated with femoral shaft fractures in head-on collisions.