动力髋螺钉治疗老年骨质疏松性股骨粗隆间骨折

近年来随着人口的老龄化，骨质疏松性骨折逐年增加，股骨粗隆部骨折也成为老年常见损伤之一。我院从1999年4月至今收治股骨粗隆部骨折49例，其中采用动力髋螺钉(DHS)治疗老年骨质疏松性股骨粗隆骨折23例，收到良好效果，现报告如下。     

动力髋螺钉治疗股骨粗隆间骨折39例临床疗效分析

目的探讨动力髋螺钉治疗股骨粗隆间骨折的临床疗效。方法 39例股骨粗隆间骨折患者动力髋螺钉内固定治疗,观察手术时间、术后并发症、骨折临床愈合时间等手术指标。结果 39例患者均顺利完成手术,参照Harris髋关节评分标准评估,优19例,良11例,可7例,差2例,优良率达94.9%。结论动力髋螺钉治疗股骨粗隆间骨折可明显改善患者的髋关节功能,具有并发症少和一定的优越性。     

动力髋螺钉治疗股骨粗隆间骨折并发症原因分析及防治

目的探讨动力髋螺钉治疗股骨粗隆间骨折并发症的原因,并提出防治措施.方法对178 例采用动力髋螺钉治疗的股骨粗隆间骨折患者中37 例并发症进行总结分析,分析其发生的主要原因.结果 37 例出现了不同的并发症,术后感染2 例,深静脉血栓8 例,滑动螺钉穿出股骨头关节面5 例,髋内外翻或下肢旋转畸形10 例,内固定失效8 例,骨延迟愈合2 例,股骨头缺血性坏死2 例.结论造成并发症的原因是多方面的,主要原因为对骨折类型了解不充分,无菌操作不严,手术操作不规范,骨折复位不佳,术后功能锻炼不当以及过早负重.并提出预防对策：严格无菌操作,掌握手术技巧,规范手术操作,骨折解剖复位,合理处理小粗隆,重视康复训练.     

动力髋螺钉治疗股骨粗隆间骨折临床分析

目的探讨动力髋螺钉(DHS)在股骨粗隆间骨折的临床疗效分析。方法总结2003年至2007年用DHS在股骨粗隆间骨折的治疗经验。结果55例患者术后平均随访15个月,无髋内翻、钢板螺钉滑脱、折弯、折断,无加压钉穿出股骨头,无加压钉位置不良,全部骨性愈合。结论DHS治疗股骨粗隆间骨折是一种有效可靠内固定方法。     

动力髋螺钉治疗股骨粗隆间骨折34例疗效评价

股骨粗隆间骨折是老年人的常见病,传统的治疗方法(如牵引)病人卧床时间长,功能恢复困难,并发症多,会出现髋内翻、下肢外旋和短缩等畸形。自1996年4月以来,应用动力髋螺钉(DHS)内固定治疗股骨粗隆间骨折34例,经远期观察,疗效肯定。     

动力髋螺钉治疗股骨粗隆间骨折25例分析

目的 :总结动力髋螺钉 (DynamicHipScrew ,DHS)治疗股骨粗隆间骨折 2 5例的经验。方法 :2 5例股骨粗隆间骨折明确诊断后均采用DHS内固定手术治疗 (A1型 1 2例 ,A2型 1 0例 ,A3型 3例 )。结果 :经 8～ 36个月 ,平均 1 4个月随访疗效满意。结论 :术中尽可能恢复股骨粗隆部位的解剖复位 ,标准的粗螺钉牢固固定及术后早期功能锻炼是取得良好疗效的关键。     

动力髋螺钉治疗股骨粗隆间骨折

动力髋螺钉（DHS）治疗股骨粗隆问骨折是近年来被广泛接受的一种有效方法。我院自2000年8月～2005年11月共治疗89例取得满意疗效，现总结报告如下。     

AO动力髋螺钉治疗股骨粗隆间骨折的体会

我们医院自1999年至2000年采用AO动力髋螺钉治疗股骨粗隆间骨折19例,取得了满意的效果.     

动力髋螺钉治疗股骨粗隆间骨折并发症分析

目的：分析动力髋螺钉钢板系统（dynamic hip screw,DHS）治疗股骨粗隆间骨折的并发症及其原因。方法：2002年1月至2007年12月69例股骨粗隆间骨折采用DHS治疗,男27例,女42例;年龄53-96岁,平均72．9岁;按照Evans骨折分型：Ⅰ型10例,Ⅱ型21例,Ⅲ型22例,Ⅳ型16例。术前已明确诊断的各种内科系统伴随症的51例（73．9％）,观察分析其并发症的发生情况。结果：57例出院后通过门诊及电话获得随访,随访时间8-70个月,平均41个月。围手术期发生全身系统并发症17例,死亡4例;手术局部相关并发症12人18例次。其中包括滑动髋螺钉松动后退4例、拉力螺钉穿破股骨头3例、钢板断裂1例;髋内翻5例;深部组织感染再次手术取出内固定1例;伤口愈合不良2例,骨折延迟愈合2例。结论：不稳定性粗隆间骨折应用DHS内固定失败的发生率较高,不应作为治疗首选。应根据骨折分型,结合老年患者骨质疏松情况,选择适当的术式,充分重视高龄患者系统性疾病的预防和监护,可以提高股骨粗隆间骨折的疗效并减少术后并发症。     

AO动力髋螺钉内固定治疗逆股骨粗隆间骨折

目的 :探讨AO的DHS在治疗逆股骨粗隆间骨折中的疗效。方法 :选用DHS作为内固定材料 ,术前胫骨结节牵引复位 ,C型臂X线机引导下手术DHS内固定。术后 2d股四头肌收缩锻炼。 2周CPM机练习。结果 :无 1例病人手术死亡 ,优良率 84.6%,2例患者髋部疼痛。结论 :DHS是治疗逆股骨粗隆间骨折的一个很好的办法。     

Volumetric bone mineral density using peripheral quantitative computed tomography in Japanese women

The present study evaluated a commercial device for peripheral quantitative computed tomography (pQCT) and examined the age-related changes in normal Japanese women. The volumetric bone mineral density (vBMD) of the distal radius [integral bone mineral density (BMD_I), trabecular bone mineral density (BMD_T) and cortical with subcortical bone mineral density (BMD_SC)] was measured using pQCT (Norland-Stratec XCT960) in 617 healthy women aged 20–79 years and 75 subjects with osteoporosis aged 60–89 years who exhibited at least one vertebral fracture. The short-term precision errors in vivo (CV, %) were 1.1% for BMD_I 1.1% for BMD_T and 1.2% for BMD_SC. The correlations between pQCT and dual-energy X-ray absorptiometry measurements (Lunar DPX) of the lumbar spine werer0.8 (BMD_I, BMD_T and BMD_SC). The maximal mean vBMD values were observed between 20 and 49 years; BMD_I BMD_T and BMD_SC all showed a linear postmenopausal decline averaging 1.1% per year. The overall decreases in vBMD from the peak values in those 70–79 years were 34%, 32% and 33% in BMD_I, BMD_T and BMD_SC, respectively. The diagnostic sensitivity of osteoporosis was expressed as aT-score.T-scores using pQCT were –3.0 (BMD_I), –2.4 (BMD_T) and –2.9 (BMD_SC). Bone mineral measurement of the distal radius may be useful in the evaluation of age-related bone loss and for the diagnosis of osteoporosis.     

股骨颈骨密度和股骨颈轴长与老年 髋部骨折的关系

目的 探讨股骨颈骨密度、股骨颈轴长与髋部骨折的关系，了解股骨颈骨密度、股骨颈轴长预测骨折的能力。方法 通过双能Ｘ线吸收骨密度测量仪测量髋部骨折组患者和同龄男女非骨折对照组的股骨颈轴长、股骨颈骨密度，分析比较两种测量指标预测股骨颈骨折的敏感性。结果 不同性别骨折组患者的股骨颈骨密度均明显低一南年龄、同性别对照组，差异有非常显著性意义（Ｐ〈０．０１），而骨折组与非骨折组男女股骨颈轴和莘差异无显著性意义     

骨质疏松性骨折与骨密度关系的研究进展

骨质疏松症是老年人的常见病和多发病,其最大的危害是导致骨折的发生。随着老年人口的增加,骨质疏松性骨折的发病率也显著增高,这已经引起了医学研究者的普遍关注。近年来对运用骨密度检测来预测骨质疏松性骨折的研究很多,但是还没有形成一个定论,故对运用骨密度检测来预测骨质疏松性骨折的研究现状作一简单综述。     

Quantitative computed tomography for measuring bone mineral density in athletes

We studied the effect of different training patterns on vertebral trabecular and cortical bone mineral density (BMD) in male athletes using quantitative computed tomography. Vertebral trabecular (t) and cortical (c) BMDs of the first three lumbar vertebrae were measured using single energy quantitative computed tomography in 51 athletes including 10 weight lifters (mean age 20 years), 13 soccer players (mean age 27 years), 28 wrestlers (mean age 17 years), and 45 age-matched volunteers (mean age 21 years). Measured BMDs were correlated with age, body height and weight, training hours per week, sports years, and type of physical activity. Vertebral tBMDs were found to be 44%, 23%, and 24% higher in the weight lifters, soccer players, and wrestlers, respectively, compared with the volunteers. The corresponding cBMDs were 18%, 6%, and 11% higher than that of volunteers. There was significant correlation between the trabecular and cBMD, and height of the athletes, sports years, training hours per week, and physical activity. The most significant correlation with BMD was the type of physical activity. Both the height of the subjects and physical activity variables showed variations of 47% and 32% in trabecular and cBMD, respectively. According to the multiple analysis of variance (MANOVA) only the physical activity factor was effective, with a significance level ofP<0.01; the other factors and interactions were not effective (P>0.05) on trabecular and cBMD. Different training patterns have a different anabolic effect on both trabecular and cBMDs of the vertebrae, and this effect is more pronounced on the trabecular compartment. Weight lifting showed the highest anabolic effect on both trabecular and cBMDs compared with soccer playing and wrestling. Of the independent variables, physical activity showed the highest anabolic effect on the vertebrae. These results may have implications for devising exercise strategies to reduce the possibility of fracture in old age.     

Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography

A high degree of uncertainty and irritation predominates in the assessment and comparison of radiation dose values resulting from measurements of bone mineral density of the lumbar spine by photon absorptiometry and X-ray computed tomography. The skin dose values which are usually given in the literature are of limited relevance because the size of the irradiated volumes, the relative sensitivity of the affected organs and the radiation energies are not taken into account. The concept of effective dose, sometimes called whole-body equivalent dose, has to be applied. A detailed analysis results in an effective dose value of about 1 µSv for absorptiometry and about 30 µSv for computed tomography when low kV and mAs values are used. Lateral localizer radiographs, which are necessary for slice selection in CT, mean an additional dose of 30 µSv. Lateral X-ray films of the spine which are frequently taken in combination with absorptiometry result in a dose of 700 µSv or more. The concept of effective dose, the basic data and assumptions used in its assessment and a comparison with other dose burdens (for example the natural background radiation, of typically 2400 µSv per year) are discussed in detail.     

容积性定量CT测量股骨近端骨密度准确性研究

目的通过分别对比容积性定量CT(vQCT)、双能X射线吸收法(DXA)与灰化法测量股骨近端骨密度结果,确定并对比相关性,进行指导临床骨质疏松诊断及治疗。方法选取20个尸体股骨近端标本,先使用DXA骨密度仪扫描,测得骨矿含量(BMC)及骨密度(BMD)。再对标本相同部位行64层螺旋CT扫描,数据导入OsteoCAD软件自动分析得出骨密度值。应用灰化法得出标本灰质量密度。所有资料进行统计分析分别确定并对比vQCT及DXA测量的骨密度值与灰密度之间的相关性。结果vQCT测量股骨颈骨密度与灰质量密度线性相关性较好(r=0.852,P0.01),DXA与灰质量密度的相关性略差(r=0.807,P0.01)。结论vQCT测得的骨密度较DXA与灰质量密度线性相关性更好,可靠性高,对于诊断骨质疏松,预测骨质疏松性骨折,评价、指导骨质疏松骨折手术更有应用价值。     

Bone mineral density in patients with cervical and trochanteric fractures of the proximal femur

The bone mineral density (BMD) of the proximal femur, spine and radius shaft was determined in 75 women with atraumatic fractures of the proximal femur (FXf) (average age: 70.1±9.6 years) and 51 controls of similar age. Fractures were classified as either cervical (n=36) or trochanteric (n=39) on the basis of radiographic and surgical finding. The BMD of spine and proximal femur was determined by dual-photon absorptiometry (Lunar DP3) and the BMD of the radius shaft by single photon absorptiometry. The BMD of patients with FXf was significantly decreased over all skeletal sites compared to controls of similar age. No significant correlation was found between age and the BMD of the femoral neck in patients with FXf. Patients with trochanteric FXf were older and thinner (average: age, 72.9±9.4 years; weight, 53.1±7.8 kg) compared with patients with cervical fractures (age, 67.2±8.9 years; weight, 59.3±8.3 kg). Likewise the BMD of trochanteric FXf was lower at all measured sites: femoral neck, 0.548±0.066 g/cm² vs 0.624±0.055 g/cm² (P<0.001); L2-L4, 0.799±0.115 g/cm² vs 0.925±0.106 g/cm² (P<0.001); radius shaft, 0.454±0.057 g/cm² vs 0.502±0.083 g/cm² (P<0.05). Of the patients with trochanteric fractures 66% had concomitant vertebral fractures, while this occurred in only 28% of the patients with cervical fractures (P (Fisher)=0.0007). In summary, females with trochanteric FXf are older, thinner, have less bone mass in all measured sites and suffer with a significantly greater frequency of vertebral fractures. These patients have a generalized osteoporosis of the skeleton. Patients with cervical FXf seem to have more specific loss of the proximal femur (regional osteoporosis). The physiopathological process leading to trochanteric and cervical fractures is probably different.     

Vertebral bone density in icelandic women using quantitative computed tomography without an external reference phantom

Vertebral trabecular bone mineral density (BMD) was measured in 187 healthy Icelandic women, age 35–64 years, by quantitative computed tomography (QCT) with the use of internal references (muscle and subcutaneous fat) instead of the traditional external references (phantoms). We found a mean 2.4 mg/cm³ (1.8%) bone loss per year in the age range 35–64 years. There was an accelerated phase (exponential) after menopause, with 4% loss per year for the first 1–5 years after menopause or 5-fold trabecular bone loss compared with the subsequent 11–15 years after menopause. Reproducibility was found to be 1.9%. This method thus compares with traditional QCT measurements and is highly reproducible. We find QCT using internal references a promising method for assessing fracture risk in perimenopausal women and for follow-up in osteoporotic patients.     

密云地区腰椎定量CT骨密度测量分析

目的 探讨腰椎QCT骨密度测量的峰值骨量,骨量丢失,骨质疏松症发病率, 为临床诊断和治疗提供依据。方法 整理在本院进行腰椎QCT骨密度测量的患者222例。其中：男性97例,年龄30~87岁,平均63.3岁;女性125例,年龄23~87岁,平均63.1岁。按照世界卫生组织提出新的年龄分段方法,分为3组：青年组＜44岁、45＜中年组＜59岁、老年组＞60岁。利用SPSS19.0对数据进行处理,计量资料采用 方式表示,偏相关分析、线性回归分析、独立样本T检验、多因素方差分析检验,P＜0.05表示差异有显著性,计数资料采用卡方检验。结果 男女性峰值骨量出现于青年组,女性峰值高于男性;中年后骨量开始丢失,老年后女性较男性丢失明显（P＜0.05）;女性骨质疏松症发病率高于男性。结论 QCT腰椎骨密度测量精准、简便、快捷具有广泛的临床应用价值;对人体骨量的变化,诊断、预防骨质疏松症;预测骨质疏松性骨折起着重要作用