骨质疏松性髋部骨折患者髂骨活检及扫描电镜观察

目的 了解骨显微结构退变在骨质疏松性髋部骨折发病机制中的应用。方法 对14例老年髋部骨折患者和11例对照者进行了髂骨活检和扫描电镜观察。结果 老年髋部骨折患者的扫描电镜观察结果可以分为低转换和高转换两种情况，后者除骨小梁数量减少，变细等改变外，骨小梁结构显著退变。结论 因活跃的骨转移活动而导致的骨显微结构退变，是部分髋部骨折的重要原因。     

老年骨质疏松患者髋部骨折发生及死亡危险因素分析

老年骨质疏松症以骨骼矿物质含量减少、骨微结构发生改变、骨骼强度下降为特点,患者易出现低能量创伤骨折,即骨质疏松性骨折.女性约50％以上、男性的33％都有患该种疾病的可能[1],其中,髋部骨折是发病率极高的一种,基本呈现逐年增长趋势.该部位骨折手术风险性较高,术后的死亡率以及致残率也不容小觑[2].据国外研究统计,患者在...     

骨质疏松性髋部骨折股骨上端微构筑研究

目的：研究骨质疏松症患者髋部易发生骨折的微构筑改变，方法：对12例股骨头颈标本（8例老年股骨折行人工关节置换术者及4例死于其他外伤的青年作对照）进行扫描电镜观察。结果：老年组股骨头骨小梁稀疏，变细，穿孔，股骨颈皮质变薄，哈氏管扩大，骨胶原纤维排列紊乱并出现腔隙，结论：老年人因股骨上端微构筑退变，损伤而易出现髋部骨折。     

骨质疏松性髋部骨折的治疗

目的探讨骨质疏松性骨折综合治疗的疗效。方法对108例骨质疏松性骨折患者，入院后行抗骨质疏松治疗，同时积极处理严重内科合并症，全部病例争取尽快手术治疗，术后继续治疗其原发病骨质疏松症及定期复查，了解骨折愈合及功能恢复情况。结果全部病例平均住院18天后康复出院，随访18～36个月，平均27个月，根据Harris标准评定：优32例，良51例，优良率这78．3％。结论老年髋部骨质疏松性骨折综合治疗，即手术治疗骨折外，积极处理内科并存症及治疗原发病骨质疏松症，有利于提高骨折愈合率，促进患肢功能恢复，减少并发症及死亡率。     

髋部骨密度与老年骨质疏松性髋部骨折的相关性

骨质疏松是老年人的常见疾病,在骨质疏松的相关性骨折中,髋部骨折是老年人常见的骨折,其危害最严重.髋部骨折一般包括股骨颈骨折和转子间骨折,常致残甚至导致病人死亡.医疗费用昂贵,给家庭和社会带来沉重的经济负担,尤其是股骨颈骨折,极易发生骨折不愈合和股骨头缺血性坏死.     

骨质疏松性髋部骨折的治疗

目的提高髋部脆性骨折治愈率,降低伤残率。方法对108例髋部脆性骨折患者资料进行回顾性分析,平均随访23个月。探讨Singh分级、治疗措施与预后的关系。结果①SinghⅢ～Ⅵ级者行内固定术,Ⅰ～Ⅱ级者行人工关节置换,优良率为83．3％;②内固定与人工关节置换的并发症发生率分别为11．4％、7．9％（P〉0.05）;③脆性骨折经口服阿仑膦酸钠5个月后,94．4％的患者Singh分级不变;④预防使用抗生素由平均6．9d减为1．7d,术后感染未增多（P〈0.05）。结论Singh指数为基层医院了解股骨近端骨质疏松程度的一种方法;内固定或人工关节置换治疗高龄髋部脆性骨折,并发症不少;脆性骨折术后应使用阿仑膦酸钠;限制使用抗生素不会增加骨科内植物术后感染率。     

骨质疏松髋部骨折治疗体会

目的:比较骨质疏松性髋部骨折手术治疗与保守治疗的优劣,分析最佳手术治疗时机。方法:回顾性分析本院2006～01/2007～12收治骨质疏松性髋部骨折患者45例,采用不同治疗方法治疗,包括手术(闭合复位内固定术,方法有空心加压螺纹钉、DHS和Gamma钉等)及牵引术治疗,比较各种治疗方法的结果。结果:牵引治疗组骨折愈合率为72.7%,手术治疗组骨折愈合率为87.8%,采用手术治疗的患者骨折愈合率明显高于牵引治疗的患者。结论:年龄不应作为骨质疏松髋部骨折患者治疗方法选择的主要条件,在重要脏器无失代偿情况下,手术应为主要的治疗方法,牵引治疗仅适用于术前制动、复位、不能耐受手术或不愿接受手术的患者。应尽早手术。     

骨质疏松性髋部骨折患者股骨上端相关因素研究进展

老年髋部骨折是骨质疏松的严重并发症。由于人口日益老龄化 ,其发病率呈逐年上升。以往大量的研究已证实股骨上端骨量的减少与髋部骨折的发生密切相关 ,骨强度的 75%～ 85%是由骨量来决定 ,骨量减少是髋部骨折最重要的因素。随着研究的深入 ,导致髋部骨折骨量以外的因素逐渐明确 ,本文就近几年来与髋部骨折发生相关性较大的几方面研究作一综述。1　股骨上端的几何结构特点与髋部骨折从力学原理上分析 ,髋部骨折患者股骨上端的几何结构与骨折有一定关系。Ｆａｕｌｋｎｅｒ[1] 等发现股骨颈骨量减少一个标准差 ,髋部骨折的危险性增加2 7倍 ,…     

脂蛋白E基因多态性与骨质疏松性髋部骨折

骨质疏松症是一种多因素性疾病。主要特征是单位体积骨量减少,骨脆性增加。骨质疏松症的严重危害是并发骨折即骨质疏松性骨折:主要包括桡骨远端骨折、脊柱骨折及髋部骨折;其中髋部骨质疏松患者由于骨转换出现特异性改变,骨形成与骨吸收失耦合,导致股骨近端骨显微结构发生明显退变,骨组织力学性能下降,因此更易诱发骨折,髋部     

老年骨质疏松性髋部骨折的综合治疗效果

目的探究综合治疗方法对老年骨质疏松性髋部骨折的临床治疗效果。方法选自本院2008年1月至2013年10月收治的骨质疏松性髋部骨折的老年患者共28例,设为观察组,另选本院2008年1月至2013年10月收治的骨质疏松性髋部骨折老年患者28例,设为对照组。观察组患者接受综合治疗,对照组患者接受单纯骨科治疗,对比2组患者临床治疗效果。结果相对于对照组,观察组患者的临床治疗效果更具有显著优越性,对比具有统计学意义(P<0.05)。结论对骨质疏松性髋部骨折的老年患者应用综合治疗方法能够取得满意的临床治疗效果,且治疗后不会出现严重不良反应,具有高效安全的优点,值得临床推广。     

Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate

ABSTRACT

Objective: Strontium ranelate (SR) increases bone mineral density (BMD) in postmenopausal osteoporotic women and reduces vertebral and non-vertebral fracture incidence. Hip fracture reduction has also been observed during 3-year treatment with SR in osteoporotic women at high risk of hip fracture. The objective of this study is to analyse the association between BMD changes and hip fracture incidence during treatment with SR.

Material and methods: In this post-hoc analysis, 465 women aged over 74 years with low BMD at the femoral neck (T-score ≤ –2.4 according to NHANES normative values) were selected from the population of a recently published study (the Treatment of Peripheral Osteoporosis Study – TROPOS). BMD was assessed at the femoral neck at baseline and after a follow-up of 3 years. Hip fractures were reported by study investigators.

Results: After adjusting for age, body mass index, femoral neck BMD at baseline and number of prevalent vertebral fractures, we found that for each 1% increase in femoral neck BMD observed after 3 years, the risk to experience a hip fracture after 3 years decreased by 7% (95% CI: 1–14%) (?p = 0.04). In patients experiencing a hip fracture over 3 years of treatment with SR, femoral neck BMD increased by (mean [SE]) 3.41 (1.02)% compared to 7.23 (0.81)% in patients without hip fracture (?p = 0.02).

Conclusion: In this post-hoc analysis of women undergoing 3 years of SR treatment, an increase in femoral neck BMD is associated with a decrease in hip fracture incidence.     

Prevalence of vitamin D inadequacy in osteoporotic hip fracture patients in London

ABSTRACT

Background: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age,?or below the normal range.

Objectives: To investigate the prevalence of vitamin D inadequacy in an elderly population with hip fractures from London (UK) and compare levels with data previously presented from Glasgow (UK).

Research design and methods: A retrospective patient audit was carried out over a 17‐month period (September 2003–January 2005). Patient records were searched for hip fracture admissions and cross matched with vitamin D analysis carried out within 3 days of the hip fracture admission. The resulting records were hand searched to exclude patients with a hip fracture resulting from high impact/trauma.

Results: There were data for 103 hip fracture patients, 79.6% of the patients were women (n = 82). The mean age at the time of fracture was 73.4 years, 100% were aged 60 years or over and 41% were aged 75 years or over. Around 20% of the patients were receiving supplementation with calcium and/or vitamin D and were not excluded from the analysis. The mean vitamin D level was 32.1?nmol/L (12.9?ng/mL), SD = 19.4 (7.8), however, it is likely that the true mean is lower since in approximately 15% of cases vitamin D levels were reported as < 12.5?nmol/L, but were transcribed at 12.5?nmol/L in order to allow a numerical value to be calculated. Ninety-nine per cent of patients had a vitamin D level < 80?nmol/L, 94.2% < 70?nmol/L and 81.6% < 50?nmol/L.

There were no significant differences by patient age or sex, however, there were significant seasonal differences in vitamin D. In the year from September 2003 to August 2004, 82.8% of summer admissions had vitamin D levels < 70?nmol/L compared with 98.0% in winter (?p = 0.04). Mean vitamin D levels in the 30 patients with parathyroid hormone (PTH) levels above the reference range were significantly lower than levels in the 71 patients within the range: mean 19.9?nmol/L, SD = 16.2 versus mean 37.5?nmol/L, SD = 18.5 (?p < 0.0001). Furthermore, 50% of the patients with PTH levels above the reference range had vitamin D levels < 12.5?nmol/L, reflecting extremely low levels of vitamin D.

Conclusions: This study confirms almost universal vitamin D inadequacy among 103 patients admitted to hospital with hip fracture in London, although the prevalence of inadequacy is slightly lower than that seen in a similar study carried out in Glasgow.     

Estimation of resource utilization associated with osteoporotic hip fracture and level of post-acute care in China

ABSTRACT

Objective: Research suggests that the incidence and cost of treating osteoporotic hip fracture (OHF) in China is rising. The purpose of this study was to estimate resource utilization associated with OHF, including hospital length of stay (LOS) and inpatient costs, and to examine the level of post-acute care for osteoporosis among patients hospitalized for OHF in Shanghai, China.

Methods: This was a retrospective study of 2855 patients aged 50 years and older who were hospitalized for bone fragility hip fractures in 13 districts of Shanghai in the 2000. One hundred and one patients were randomly selected and interviewed to determine the treatments and associated costs for the 6-month period following hospitalization. Log linear regressions with bootstrapping resampling were conducted for LOS and hospital cost data to estimate the average LOS and associated costs after adjusting for demographic and comorbid characteristics.

Results: Hospital records of 2855 patients (mean age, 73.6 ± 9.9 years) were reviewed. For women, mean LOS (35 days) was longer for those greater than 60 years of age; however, mean cost of hospital stay (15?082?RMB) increased to a peak at age 65–74 years (18?932 RMB). For men, mean LOS (34 days) and mean cost of hospitalization (13?149 RMB) both increased with age. Only 14% of patients hospitalized for OHF received treatment for osteoporosis. Due to the small number of patients and sampling that was taken largely for geographical convenience, care should be taken when generalizing these data into other areas of China.

Conclusions: OHF is associated with substantial resource utilization in Shanghai, China. Although patients hospitalized with OHF should be considered for osteoporosis therapy to alleviate economic and patient burden, most patients with OHF received no such treatment.     

红元胶囊对老年髋部骨折术后凝血及骨代谢指标的影响

目的探讨红元胶囊对老年患者髋部骨折术后凝血及骨代谢指标的影响。方法老年髋部骨折60例,均为股骨粗隆间骨折,将患者随机分为试验组(30例)和对照组(30例)。试验组口服红元胶囊3粒,3次/d;对照组行低分子肝素钙皮下注射。两组患者同时用药至术后35 d。观察两组患者的凝血功能[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原含量(FIB)、D-二聚体含量(DDI)]、骨质疏松三项(TPINP、β-Crosslaps、N-MID)和肿胀及疼痛消失时间。结果两组患者FIB、DDI较术前均降低,而APTT和PT与手术前比较均延长,但两组用药后比较差异无统计学意义(P>0.05)。两组患者骨质疏松三项均升高(P<0.01);试验组患肢肿胀程度、缩短疼痛持续时间方面优于对照组,差异有统计学意义(P<0.01)。两组预防下肢深静脉血栓效果比较,差异无统计学意义(P>0.05)。结论红元胶囊可以防治老年髋部骨折术后深静脉血栓,对骨折愈合起到积极作用,同时能有效改善患者术后并发症。     

髋部骨密度和几何结构与老年妇女髋部骨折关系的研究

目的 探讨老年妇女髋部骨折与髋部骨密度（BMD）和股骨近端几何结构的关系。方法 髋部骨质疏松骨折的妇女57例和无骨折妇女60例，测量腰椎，股骨近端骨密度及股骨颈轴长（FNAL），颈干角（NSA）（髋部骨折组对其健侧进行检测），比较，提示彼此间的相关性。结果 老年妇女髋部骨折患者与对照组比较；股骨近端骨密度明显降低，FNAL长于对照组，NSA较对照组大。结论 股骨近端骨密度和FNAL及NSA可以提高对老年妇女髋部骨质疏松骨折危险性的预测。     

老年人髋部骨折与骨质疏松发病率的相关性研究

目的探讨老年人髋部骨折与骨质疏松发病率的相关性。方法选取本院2011年2月～2013年2月诊治的髋部骨折老年患者91例,均为单侧骨折。将健侧作为对照组,将髋部骨折侧作为观察组,分别行骨密度测定,分析老年人髋部骨折与骨质疏松发病率的相关性。结果依60岁～、66岁～、〉71岁的顺序,老年髋部骨折患者两侧骨密度均不同程度地下降。健侧骨密度明显高于患侧骨密度,差异有统计学意义（P〈0.05）。依60岁～、66岁～、〉71岁的顺序,老年髋部骨折患者骨质疏松发病率明显升高,差异有统计学意义（P〈0.05）。Pearson相关性分析显示老年患者髋部骨折与骨质疏松发病率存在显著的正相关性（r=0.419,P=0.012）。结论老年人髋部骨折与骨质疏松发病率存在明显的正相关性,骨质疏松发病率越高,老年人髋部骨折发生率越高。     

循证护理在髋部骨折合并高血压患者围手术期的应用

目的 探讨循证护理在髋部骨折合并高血压患者围手术期的应用效果.方法 将200例髋部骨折合并高血压患者随机分成试验组与对照组各100例,试验组根据患者具体情况提出护理问题,进行系统的文献查询,实施循证护理;对照组常规护理.结果 试验组患者健康教育知识掌握程度、患者满意度、并发症发生率均明显高于对照组(P＜0.05),患者的年龄、文化程度、血压等与对照组比较差异均无显著性(P＞0.05);试验组术后两周髋关节功能Harris评分为(94.3±1.6),对照组为(85.2±1.2).结论 循证护理能有效提高患者的生活质量,降低患者的残障率和死亡率,缩短住院天数,减轻患者的经济负担,提高患者对护理的满意度.     

经皮球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折

目的研究球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法我院2006年12月至2008年12月,采用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折26例33个伤椎,均经单侧椎弓根置入可扩张球囊使骨折塌陷椎体复位,然后使用骨水泥充填椎体,观察术后症状改善及骨折复位情况。结果随访5个月至2．5年,平均1．1年。平均疼痛视觉评分由术前（8．8±0．2）分到术后（2．1±0．2）分和最终随访（2．5±0．4）分,差异有统计学意义（P〈0．01）;手术椎体前中柱平均高度由术前（12．7±0．4）mm到术后（22．0±0．5）mm和最终随访（21．0±0．5）mm,差异有统计学意义（P〈0．01）;Cobb角平均由术前（23．2±0．6）°到术后（11．1±0．4）°和最终随访（11．7±0．4）°,差异有统计学意义（P〈0．01）。3例5个椎体发生骨水泥渗漏,2例出现邻近阶段椎体压缩性骨折,无其他严重并发症的发生。结论球囊扩张椎体后凸成形术可有效恢复骨质疏松性椎体压缩性骨折椎体的高度,缓解疼痛,改善患者的功能,明显减少骨水泥的渗漏,是一种安全、有效的治疗方法。