80岁以上老年人髋部骨折的手术治疗：附117例临床分析

目的通过对１１７例８０岁以上老年人髋部骨折手术治疗临床分析，探讨其手术的必要性、可行性、手术指征及禁忌证。方法回顾性分析１１７例患者的术前并存症、术前准备、手术方式、术中情况、术后处理及随访情况。结果本组无术中死亡病例，平均住院时间为２３天。１０７例获得随访，随访率９１．５％，平均随访２８个月。预后：良（疼痛消失，功能好，恢复生活自理能力）７７例，占７２．０％；尚可（恢复部分生活自理能力）２１例，占１９．６％；差（仍有疼痛，不能下地活动，生活不能自理）９例，占８．４％。结论８０岁以上老年人髋部骨折的手术治疗是安全可行的。     

髋部骨折1266例流行病学调查分析

目的探索髋部骨折的流行病学特点,以期对老年髋部骨折的防治提供科学依据。方法回顾性分析上海复旦大学附属华东医院2008年-2012年1266例髋部骨折住院患者的临床资料。统计分析髋部骨折患者年龄、性别、致伤原因、好发季节、骨折类型、主要伴发病等的分布以及治疗方式、转归、住院天数和住院费用等资料。结果髋部骨折患者平均年龄为76．77±12．26岁,女性为78．83土10．20岁,显著高于男性的72．60土14．75岁,P〈0．001;全组老年人占89．42％,发病高峰年龄段为80～89岁,占42．1％,男女比例1：2．01。好发季节为冬季。老年患者的致伤原因以跌倒为主（91．08％）。1266例髋部骨折患者中,股骨颈骨折占48．34％,股骨粗隆间骨折占51．03％,股骨头骨折占0．63％。股骨粗隆间骨折平均年龄为78．69土11．39岁,显着高于股骨颈骨折的74．77±12．83岁,P〈0．001。髋部骨折的基本治疗方式为手术治疗,占86．02％;中青年组手术治疗的有效（痊愈＋好转）率为100％,老年组为98．76％,老年组围手术期死亡率为1．24％（12／966）。老年组的住院天数（20．5±9．5）d较中青年组（16．9±7．7）d长。髋部骨折手术治疗的人均费用：老年组为（5．16±1．82）万元,高于中青年组的（3．98±2．70）万元,从2008年（4．03±2．28万元）到2012年（5．51±1．90万元）逐年增高。结论髋部骨折是以老年人占绝大多数、以跌倒为主要致伤原因的骨质疏松性骨折;老年人髋部骨折手术治疗虽然有较大风险,但仍是其主要有效治疗手段;老年人髋部骨折手术治疗住院时间较长,费用较高,给患者家庭和社会造成沉重的经济负担。     

老年人髋部骨折的相关因素观察

目的　观察老年人髋部骨折的骨密度 (BMD)值 ,探讨老年人股骨颈骨折和转子间骨折与骨密度的相关性。　方法　将 496例老年髋部骨折住院患者按年龄、性别及骨折类型分组 ,选择性行骨密度检查。对检查结果进行统计学处理 ,并对临床髋部骨折患者分布情况进行分析。　结果　骨折组的骨密度值均低于同性别正常人骨峰值的 2 5s;同性别、同年龄组股骨颈骨折和转子间骨折患者的骨密度间差异无显著性 (P <0 0 1) ;老年人髋部骨折主要集中在 6 0～ 79岁之间 ,占同期髋部骨折的 73 %。　结论　老年人骨量低于同性别骨峰值应视为髋部骨折的危险人群。骨量降低是老年人髋部骨折的前提条件 ,但老年骨质疏松患者发生股骨颈骨折或发生转子间骨折 ,主要决定于受伤时的暴力大小和方向。     

老年人骨质疏松性髋部骨折100例治疗探讨

目的探讨老年人骨质疏松性髋部骨折的临床诊治方法及疗效。方法对70～96岁的骨质疏松性髋部骨折100例实施不同的方法治疗的(其中股骨粗隆间骨折29例中,DHS内固定20例,保守治疗8例,人工股骨头置换1例;股骨颈骨折71例中,人工股骨头置换33例,全髋置换38例)的同时,配合抗骨质疏松药物治疗。结果 100例均获得随访。随访时间6～28个月,平均14.2个月。术后股骨头缺血坏死4例;内固定物松动滑脱5例,断裂2例;人工股骨头下沉致疼痛5例;84例恢复行走功能。结论老年骨质疏松性髋部骨折需要采取积极的以手术为主的综合治疗。     

老年人髋部骨折的流行病学研究现状

髋部骨折是老年人的常见病、多发病。目前国内关于此病的流行病学研究报道少见,关于其发病率、人群分布特点、疾病危险因素及其带来的社会问题的较为完整的流行病学研究资料更是缺乏。本文根据国外近年来关于髋部骨折流行病学研究的文献,对髋部骨折流行病学研究现状作一概述。     

80岁以上患者股骨转子间骨折手术治疗(附85例分析)

目的探讨８０岁以上患者股骨转子间骨折的手术方式及疗效。方法回顾性分析８５例８０岁以上患者股骨转子间骨折的临床资料。其中采用滑动加压鹅头钉固定２６例，麦氏鹅头钉２５例，Ｅｎｄｅｒ钉８例，双加压螺丝钉９例，单加压螺丝钉１７例。结果术中无死亡病例，随访平均２８个月，功能恢复优良者５９例，占６９％；功能尚可者１４例；活动受限、疼痛、不能下床者１２例。结论手术治疗８０岁以上患者的股骨转子间骨折是延长患者寿命、改善其生活质量的有效方法。     

我国七城市社区老年人高血压患病调查

目的抽样调查我国部分城市社区老年人高血压的流行现状及主要相关因素，以制订合理的防治对策。方法选择７个脑卒中高发城市（北京、上海、哈尔滨、长春、郑州、长沙、银川），按统一标准，测量社区人群中９５９７名老年人的血压，并对一些相关危险因素进行问卷调查。结果７个城市合计确诊高血压患病率为２６．４％，临界高血压患病率１４．１％。其中北京确诊高血压患病率高达３２．２％。女性确诊高血压高于男性，纯收缩期高血压亦明显高于男性（Ｐ值＜０．０１）。分析相关因素显示，体重指数与高血压密切相关。结论高血压是危害老年人健康的主要疾病之一，需进一步加强宣传教育力度     

老年骨质疏松髋部骨折患者住院费用影响因素的分析

目的 分析60岁及以上骨质疏松髋部骨折患者住院费用的影响因素,为老年人该病治疗提供依据. 方法 应用单因素方差分析及多因素回归分析方法,分析北京积水潭医院2009年7月至2010年12月骨质疏松髋部骨折手术治疗后出院患者住院费用的影响因素. 结果 手术治疗患者中,股骨颈骨折住院费平均为(42 127±20 821)元,其中治疗费为(27 283±14 959)元,其他费用(14 844±8717)元;粗隆间骨折则分别为(52 965±15 901)元、(36 872±11 763)元和(16 093±7793)元,治疗费占住院费的65％.多元回归分析显示:股骨颈骨折行关节置换术、粗隆间骨折、围术期下肢静脉血栓形成、输注蛋白与住院费及治疗费增加密切相关(P＜0.001);骨折前并存糖尿病、贫血、围术期谵妄、新发心脏病、肺栓塞、肺部感染增加其他费用(P＜0.05);住院时间越长,住院费用越高(P＜0.001). 结论 并存疾病、围术期并发症增加其他类费用.骨质疏松髋部骨折患者住院费用高、住院经济负担沉重,有效控制治疗费是减少髋部骨折住院费用、减轻患者与社会经济负担的有效途径;应从经济学角度重视老年人骨质疏松以及慢性疾病防治.     

老年人急性脑血管意外并发心肌梗死22例临床分析

目的探讨老年人急性脑血管意外并发心肌梗死的临床特征，为临床治疗提供指导。方法回顾性分析了２２例急性脑血管意外并发心肌梗死的老年患者的临床资料。结果２２例患者心肌梗死均发生于脑血管意外后６小时～８天。其中下壁７例，前壁５例，前壁＋下壁４例，前间壁３例，下壁＋侧壁２例，无Ｑ波型１例。入院前，１５例患者有各种基础疾病。住院期间１６例患者出现各种并发症，死亡９例（４０．９％）。结论此类患者心肌梗死症状不典型、并发症多，且治疗存在矛盾。     

Institutionalized patients with hip fractures

The authors sought to identify patient- and nursing home-specific characteristics associated with a return to community living among patients with hip fractures discharged initially to nursing homes. One hundred eighty-nine free-living elderly patients were admitted for hip fractures to a 1,120-bed community hospital during 1984–1986. At hospital discharge, 114 (60%) of these patients were institutionalized. One year later, 49/114 (43%) had returned to the community. Three factors independently correlated with patients’ return to community living: being discharged to a nursing home with a large ratio of annual admissions to number of beds (RR=2.51, 95% CI 1.65, 3.94), achieving any in-hospital ambulation (RR=4.24, 95% CI 1.77, 8.14), and receiving conventional Medicare insurance (RR = 0.37, 95% CI 0.05, 0.53). These data suggest the existence of patient and nursing home features that identify those institutionalized patients with hip fractures who are more likely to return to community dwelling. Received from the Regenstrief Institute for Health Care, the Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, and the Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana Supported in part by grant 1D28PE55009 from the Bureau of Health Professions, Health Resources and Services Administration. The conclusions presented herein do not necessarily represent those of the federal government.     

Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures

OBJECTIVES: To identify independent risk factors for first hip fracture over 10 years of follow-up. DESIGN: Prospective cohort study. SETTING: Four U.S. clinical centers. PARTICIPANTS: A total of 6,787 women aged 66 and older in the Study of Osteoporotic Fractures. MEASUREMENTS: Total hip bone mineral density (BMD) using dual-energy x-ray absorptiometry and a comprehensive set of potential risk factors were collected. Incident hip fractures were identified prospectively and confirmed using radiographic report. RESULTS: Six hundred two women (8.9%) had a hip fracture during a mean +/- standard deviation (SD) follow-up of 10.1 +/- 3.2 years. Older age, previous self-reported fracture after age 50, maternal history of hip fracture after age 50, greater height at age 25, impaired cognition, slower walking speed, nulliparity, type II diabetes mellitus, Parkinson's disease, and depth perception each independently predicted a 1.17- to 1.83-fold increase in hip fracture risk, whereas each SD (0.13 g/cm2) decrease in hip BMD was independently associated with a 1.84-fold increase in risk. Lower body mass index also was associated with an increased risk of hip fracture, although lower hip BMD largely explained this association. CONCLUSION: Although hip BMD is strongly related to hip fracture risk in elderly white women, other clinical risk factors also are independent predictors of long-term risk and provide additional insight into the prevention of fracture in high-risk women. Clinicians should be alert to factors other than BMD that place older women at a high risk of hip fracture.     

Second hip fracture and patients’ medication after the first hip fracture: A follow-up of 221 hip fracture patients in Finland

The national Finnish guidelines for medical treatment of hip fracture patients are: anti-osteoporotic drugs and the daily concomitant use of calcium plus vitamin D supplements. We investigated the incidence, the fracture type and the side of all second hip fractures among 221 consecutive hip fracture patients who were followed up for 5 years. The medication of the patients and the time interval between the first and second hip fracture were analyzed. Of the patients 12% (26/221) sustained a second hip fracture. The type of fracture was in most cases (76%) the same as in the first case, more often in trochanteric and subtrochanteric fractures than in cervical fractures. The mean interval between the fractures was 4 ± 4.2 years (±S.D.); 3.2 ± 3.5 years in men and 4.4 ± 4.4 years in women. The number of patients using polypharmacy (5 or more drugs daily) was 9/25 (36%) at the time of the first hip fracture and 17/25 (68%) at the time of the second hip fracture. The use of at least one psychotropic drug regularly rose from 9/25 (36%) to 16 (64%) between the two fractures. Concomitant use of calcium plus vitamin D and anti-osteoporotic drugs was insufficient among the patients. More effort should be focused on the secondary prevention following the first hip fracture.     

老年骨质疏松性股骨粗隆间骨折的治疗经验

目的 回顾性分析应用人工股骨头置换及动力髋螺钉系统（dynamic hip screw,DHS）治疗老年骨质疏松性粗隆间骨折,总结该类患者治疗经验。方法选取第四军医大学西京医院骨科2007年1月至2009年12月老年骨质疏松性粗隆间骨折病例103例,其中采用DHS术式71例;采用人工关节置换32例;记录手术时间、术中出血量,术后并发症,骨折愈合情况,术后髋关节Harris功能评分。结果DHS组平均手术时间（96．7±8．6）min,平均出血量（317．7±26．5）ml,术后Harris髋关节功能评分,优32例,良26例,可6例,差7例,优良率81．7％;人工股骨头置换组手术时间平均（107．0±12．8）min,手术出血量平均（335．34-28．1）m1,术后Harris髋关节功能评分：优10例,良14例,可2例,差1例,优良率88．9％。结论结合抗骨质疏松治疗,只要适应证选择恰当,DHS及人工股骨头置换均为老年骨质疏松性粗隆间骨折的有效治疗手段,中短期疗效满意。     

Beyond hip: importance of other nonspinal fractures

It is widely accepted that hip and spine fractures are associated with substantial morbidity, but there is growing awareness that other fractures are under-recognized. The incidence of nonspinal, nonhip fractures is higher than for hip fractures because they occur at an earlier age. Furthermore, the incidence of nonspinal, nonhip fractures exceeds that of hip fractures in men and women >80 years old. Nonspinal, nonhip fractures are associated with considerable morbidity. On average, women with humeral, ankle, distal forearm, and foot fractures experience substantial numbers of limited activity days, and nonspinal, nonhip fractures account for almost a third of health care expenditures attributable to osteoporotic fractures. Nonspinal, nonhip fractures are associated with low bone mineral density, thus it may be possible to identify those at risk. Because these fractures also are indicative of increased risk at other sites, those susceptible might benefit from assessments including these other fracture types. It is the clinician’s responsibility to attend to and recognize that nonspinal, nonhip fractures are usually associated with osteoporosis and should be treated.     

Visual risk factors for hip fracture in older people

OBJECTIVES: To determine the association between poor vision and risk of hip fracture in the Blue Mountains Eye Study. DESIGN: Prospective population-based cohort study. SETTING: Two post code areas in the Blue Mountains, west of Sydney, Australia. PARTICIPANTS: Three thousand six hundred fifty-four community-dwelling Australians aged 49 and older. MEASUREMENTS: At baseline, subjects had an extensive eye examination, including refraction, contrast sensitivity and visual field testing, photographs of the lens and retina, and an interview. Hip fractures during the 5-year follow-up were identified by self-report and review of medical records and were radiologically confirmed. RESULTS: For 2-year follow-up (17 hip fractures), the adjusted hazard ratio (HR) for risk of hip fracture in those with corrected visual acuity worse than 20/60 was 8.4 (95% confidence interval (CI) = 1.5-48.5, population attributable risk (PAR) = 27%); for presence of posterior subcapsular cataract, the adjusted HR was 5.0 (95% CI = 1.1-23.0, PAR = 24%); and for visual field loss, the adjusted HR was 5.5 (95% CI = 1.0-29.8, PAR = 55%). In those aged 75 and older, visual acuity worse than 20/60 gave an adjusted HR of 40.6 (95% CI = 5.6-292.5, PAR = 49%). Visual impairment of any type did not predict risk of hip fracture after a 2-year follow-up. CONCLUSION: Visual impairment is strongly associated with risk of hip fracture in the next 2 years but not over a longer period of time.