老年髋部骨折患者术后对侧髋部骨折发生因素的Meta分析

目的通过Meta分析评价影响老年髋部骨折患者术后对侧髋部骨折的相关因素。方法检索Pubmed、Cochrane、中国生物医学文献数据库、CNKI中国期刊全文数据库、万方数据库自2005年1月至2018年4月国内外正式刊物上公开发表的有关老年髋部骨折术后对侧髋部骨折相关因素的文献,严格评价质量及提取相关资料,获取患者的性别、年龄(>65岁)、吸烟、初次髋部骨折类型、骨质疏松症(Singh指数≥4为骨质疏松)、伴有原发性高血压、伴有帕金森病、伴有脑卒中、伴有老年痴呆症、伴有白内障、伴有类风湿关节炎、伴有糖尿病、初次骨折内固定种类、患者治疗配合的依从性。运用RevMan5.0软件进行统计分析,评估各项指标的优势比(OR)和95%可信区间(CI)。结果共纳入17项研究13717例老年髋部骨折患者,发生对侧髋部骨折1504例。影响老年髋部骨折术后对侧髋部骨折的相关因素有患者年龄(OR=-3.55,95%CI:-5.60^-1.50,P<0.001)、骨质疏松症(OR=2.38,95%CI:1.36~4.17,P=0.002)、伴有帕金森病(OR=4.54,95%CI:2.74~7.53,P<0.001)、脑卒中(OR=0.33,95%CI:0.18~0.59,P<0.001)、老年痴呆症(OR=0.43,95%CI:0.29~0.62,P<0.001)、白内障(OR=0.37,95%CI:0.22~0.63,P<0.001)、类风湿关节炎(OR=0.32,95%CI:0.21~0.50,P<0.001)、糖尿病(OR=0.65,95%CI:0.47~0.91,P=0.01)、初次骨折内固定种类(OR=0.51,95%CI:0.30~0.85,P=0.01)、治疗配合依从性(OR=0.36,95%CI:0.21~0.64,P<0.001),而与性别(OR=1.07,95%CI:0.45~2.56,P=0.88)、吸烟(OR=0.86,95%CI:0.40~1.86,P=0.70)、初次髋部骨折类型(OR=0.97,95%CI:0.60~1.57,P=0.90)、伴有原发性高血压(OR=0.70,95%CI:0.41~1.21,P=0.20)无关。结论影响老年髋部骨折患者术后对侧髋部骨折的相关因素有年龄偏大、伴有骨质疏松症、帕金森病、脑卒中、老年痴呆症、白内障、类风湿关节炎、糖尿病、初次骨折内固定种类、治疗配合依从性差。而患者性别、吸烟、骨折类型、伴有原发性高血压目前尚无足够的证据与对侧髋部骨折有关。     

Results of non-operative treatment following hip fracture compared to surgical intervention

We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically.     

Antiresorptive treatment,when initiated after a first hip fracture,may not protect of a second contralateral episode in elderly population: A study with 685 patients

IntroductionOsteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised.Patients and methodsWe reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised.ResultsA 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1–122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p = 0.2).DiscussionWe identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised.     

髋臼骨折手术治疗后髋关节功能恢复的影响因素分析

背景：髋臼骨折多为高能量损伤所致,属于关节内骨折,手术是最佳治疗方式。但骨折类型、手术入路、复位质量、年龄、手术时机等会对治疗效果产生影响。因此,分析影响手术效果的关键因素十分必要。目的：探讨手术治疗髋臼骨折后影响髋关节功能恢复的因素。方法方法：选择2010年1月至2013年10月手术治疗且随访资料完整的髋臼骨折患者42例,18例采用Kocher-Langenbeck入路,14例采用髂腹股沟入路,10例采用前后联合入路。术后采用Matta标准评定骨折复位情况。采用改良的Merled＇Aubigne-Postel评分系统评价患者髋关节功能。对可能影响手术疗效的指标（如性别、年龄、手术时机、骨折类型、手术入路、复位质量等）进行单因素及多因素Logistic回归分析,筛查影响手术疗效的危险因素。结果：术后14例达到解剖复位,20例良好复位,8例一般复位。切口均甲级愈合,未出现感染。全部患者术后随访12-26个月,平均19个月。X线检查示骨折于术后10-18周愈合,平均14周。术后出现坐骨神经损伤4例,创伤性关节炎2例,股骨头缺血坏死2例,异位骨化7例。术后6个月时髋关节功能评定为优13例,良21例,可5例,差3例,优良率为81%。单因素分析结果显示性别、年龄、手术入路、髋关节脱位与手术疗效无明显关系（P〉0.05）,而手术时机、骨折类型、复位质量、异位骨化与手术疗效有关（P〈0.05）。多因素分析显示骨折类型、手术时机、复位质量是影响手术效果的独立因素（P〈0.05）。结论：骨折类型、手术时机和复位质量是影响髋臼骨折手术疗效的独立因素,而后两者是相对可控的因素,治疗时要选择合适时机、尽量达到解剖复位,以期获得良好的临床结局。     

老年髋部骨折患者术后2年内再发对侧髋部骨折的危险因素研究

目的:探讨老年髋部骨折患者术后2年内再发对侧髋部骨折的相关危险因素。方法:回顾性分析2015年5月至2018年4月期间北京积水潭医院创伤骨科采用手术治疗的1 962例老年髋部骨折患者资料。男573例,女1 389例;首次骨折时的年龄中位数为81（75,86）岁。根据术后2年内是否发生对侧髋部骨折分为两组：对侧髋部骨折组...     

腰大肌面积与股骨转子间骨折后对侧髋部骨折的相关性分析

目的：探讨初次转子间骨折时腰大肌区域面积与再发对侧髋部骨折的关系。方法 ：选取2008年1月至2011年1月股骨转子间骨折患者87例在首次骨折时进行腰椎及髋部CT扫描,根据对侧髋部是否发生骨折分为两组,其中对侧髋部骨折组13例,男5例,女8例,年龄（82.30±5.66）岁;非对侧髋部骨折组74例,男32例,女42例,年龄（79.70±5.84）岁。观察比较两组患者性别,年龄,术前血白蛋白值,骨折侧,体质量指数（body mass index,BMI）,术后1年髋关节Harris评分、术前Barthel指数、术前合并内科疾病,以腰大肌指数（Psoas major index,PMI）比较两组术前CT腰大肌面积,评估初次骨折时腰大肌面积与对侧髋部骨折相关性。结果 ：两组患者术后随访均2年以上,两组的PMI值差异有统计学意义（P<0.05）。患者术前PMI与对侧髋部再次骨折的时间之间存在明显的正相关性（r=0.641,P=0.018）。结论：对侧髋关节骨折患者腰大肌区域面积存在差异,故腰大肌面积可作为对侧髋部骨折的重要危险因素。     

经皮椎体后凸成形术后继发椎体压缩性骨折的危险因素分析及预测模型的建立与验证

目的 ：分析经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）后继发椎体压缩性骨折（subsequent vertebral compression fracture,SVCF）的危险因素,建立预测模型并进行验证。方法：回顾性分析在徐州医科大学附属医院骨科行PKP治疗的415例患者的临床资料,其中有24例（5.8%）患者在术后出现SVCF,所有患者术后随访时间16～30个月,根据术后是否出现SVCF,将患者分为SVCF组与非SVCF组。对两组患者的性别、年龄、体重指数（body mass index,BMI）、骨密度（bone mineral density,BMD）、临床合并症史（高血压病史、糖尿病史）、骨水泥注射量、骨水泥渗漏情况、初始手术节段数及手术前后的Cobb角和椎体前缘高度（anterior vertebral height,AVH）进行单因素分析。根据套索（LASSO）回归,选择与PKP术后SVCF显著相关的危险因素;随后将筛选出来的危险因素纳入多因素Logistic回归分析,最终依据多因素Logistic回归分析结果建立预测模型,并通过绘制列...     

股骨颈骨折术后股骨头坏死率及相关危险因素的Meta分析

目的: 研究2000年以后的成人股骨颈骨折患者内固定术后股骨头坏死发生率及相关危险因素以识别股骨头坏死高危人群。方法: 检索PubMed、Medline、The Cochrane Library、中国知网、万方和维普数据库,收集2000年1月1日至2020年7月1日期间有关股骨颈骨折术后股骨头坏死及其危险因素的全部研究,根据入选和排除标准剔除不符合要求的研究。使用Endnote X9和Excel 2019进行文献提取、管理以及数据录入,利用R Studio 3.6.5软件进行Meta分析。通过亚组分析、敏感性分析和发表偏倚检测来研究异质性来源及评估结果的可靠性。结果: 共纳入16篇文献,包括5 521例股骨颈骨折患者。Meta分析结果显示成人股骨颈骨折内固定术后股骨头坏死发生率为14.5%[95%CI(0.126-0.165)]。骨折移位情况[OR=0.27,95%CI(0.21-0.35)]和复位质量[OR=0.15,95%CI(0.09-0.27)]是股骨头坏死相关危险因素。亚组率分析结果显示:非移位型骨折坏死率为6.2%[95%CI(0.051-0.077)],移位型骨折坏死率为20.4%[95%CI(0.166-0.249)];骨折复位良好坏死率为8.3%[95%CI(0.072-0.095)],骨折复位不良坏死率为35.5%[95%CI(0.233-0.500)]。纳入的文献一致性较好,不存在发表偏倚。结论: 2000年以后的成人股骨颈骨折内固定术后股骨头总坏死率有所下降,而移位型骨折和复位质量不良的患者坏死率仍处于较高水平。由于各原始文献对受伤至手术时间间隔的划分不一致,没有对该指标进行分析。     

老年髋部骨折术后健侧骨折的危险因素分析

目的: 探讨老年髋部骨折术后健侧骨折的发生率及其相关危险因素为预防再次骨折提供依据。方法: 回顾分析2012年6月至2017年6月接受髋关节置换术或股骨近端髓内钉固定术治疗的65岁以上股骨颈骨折或转子间骨折452例患者的临床资料,男168例,女284例;年龄65~97(75.5±7.5)岁;股骨颈骨折191例,股骨转子间骨折261例;按照术后健侧髋部是否存在骨折,分为骨折组和无骨折组,记录两组患者性别、年龄、体质量指数、骨折类型、初次治疗方式、骨密度、医疗依从性、术后是否短期谵妄、伤前是否并存内科疾病及末次随访髋关节Harris评分。应用单因素Logostic回归分析筛选出术后健侧骨折的危险因素,再将有统计学意义的危险因素纳入多因素Logostic回归分析,筛选出老年髋部骨折术后健侧骨折的独立危险因素。结果: 452例患者中42例发生健侧髋部骨折,发生率为9.3%,两次骨折发生相隔时间平均(2.9±2.1)年。单因素Logistic回归分析结果示年龄、骨密度、医疗依从性、术后短期谵妄、伤前合并内科疾病及末次随访髋关节Harris评分差异均有统计学意义(P<0.05)。多因素Logistic分析显示年龄(OR=4.227)、骨密度(OR=4.313)、合并内科疾病(OR=5.616),以及末次随访髋关节Harris评分分级低(OR=3.891),是老年髋部骨折术后健侧骨折的独立危险因素(P<0.05)。结论: 年龄、骨密度、合并内科疾病以及末次随访髋关节Harris评分分级低是老年髋部骨折术后健侧骨折的主要危险因素,术后3年内要加强内科疾病的治疗,抗骨质疏松,改善髋关节功能,以预防健侧髋部骨折的发生。     

高龄髋部骨折后二次骨折的危险因素分析

目的 分析高龄髋部骨折后二次骨折的相关因素,为预防再次骨折提供依据.方法 对2003年5月-2011年3月在保定市第二中心医院手术治疗的高龄髋部骨折患者327例进行随访,19例患者发生二次骨折,分析比较再骨折组与未骨折组的年龄、性别、卧床时间、Singh指数、抗骨质疏松治疗情况、生活环境(城市/农村)和合并症.结果 再发同侧股骨骨折5例,对侧髋部骨折14例,再骨折组与未骨折组比较年龄及性别均无明显差异,但再骨折组卧床时间长、Singh指数≤Ⅲ级患者比例高、农村患者比例高、抗骨质疏松药物应用率低、脑卒中及呼吸系统疾病所占比例较高,两组存在统计学差(P＜0.05).结论 农村患者髋部骨折术后二次骨折风险较高,术后卧床时间长、未规律应用抗骨质疏松药物、低Singh指数、合并脑卒中及呼吸系统疾病均为二次骨折的高危因素.     

应用形状环抱内固定器治疗髋关节置换术后股骨干骨折

自2001年1月-2004年11月对4例人工髋关节置换术后假体远端股骨干骨折使用形状记忆环抱内固定器治疗,取得满意的疗效,现报告如下。     

髋部骨折患者的肌少症相关危险因素分析

目的:探讨肌少症在髋部骨折患者中的发生率及相关风险因素。方法:自2013年5月至2017年1月收治髋部骨折患者187例,男99例,女88例;年龄50～95(77.40±10.58)岁。观察分析患者的一般情况、四肢骨骼肌质量指数(ASMI)、脂肪总量、骨矿含量(BMC)、身体质量指数(BMI),握力、术前血维生素D、血白蛋白、美国麻醉医师协会分级评分(ASA)及NMS运动评分。根据握力和ASMI,将患者并分为肌少症组与非肌少症组,采用单因素及多因素分析统计分析。结果:符合肌少症诊断的患者99例(52.9%),与非肌少症组相比,肌少症的发生与高龄、高ASA、低脂肪总量、低骨矿含量、低BMI,低白蛋白、低NMS评分相关,随后进行的二元Logistic回归分析提示高龄(OR=1.804,P=0.048),高ASA评分(OR=3.052,P=0.001),低脂肪总量(OR=0.843,P=0.006),低骨矿含量(OR=0.203,P=0.026)是髋部骨折患者肌少症发生的相关因素。结论:高龄、高ASA评分、低脂肪总量、低骨矿含量可能是髋部骨折患者肌少症的相关危险因素     

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Background: Hip fracture surgery is associated with high post‐operative mortality and poor functional results: the excess mortality is 20% in the first year; of those patients who survive, only 50% recover their previous ability to walk. The purpose of this study was to assess the predictive value of six functional status and/or surgical risk scoring systems with regard to serious complications after hip fracture surgery in the elderly. Methods: We performed a prospective study of a consecutive series of 232 patients (aged 65 years or older) undergoing hip fracture surgery. We pre‐operatively applied: The American Society of Anesthesiologists classification, the Barthel index, the Goldman index, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system, the Charlson index and the Visual Analogue Scale for Risk (RISK‐VAS) scale. These scales were evaluated with respect to three variables: incidence of serious complications, the ability to walk after a 3‐month period and 90‐day survival. The predictive value of the different scales was assessed by the calculated area under a receiver operating characteristic curve. Results: The RISK‐VAS scale, the POSSUM scoring system and the Charlson index reached a sufficient predictive value with regard to serious post‐operative complications. The Barthel index and the RISK‐VAS scale were those most useful for predicting ambulation at 3 months. None of the scales proved to be capable of predicting 90‐day mortality. Conclusions: A simple index such as the RISK‐VAS scale was the best predictor of serious post‐operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.     

人工全髋关节置换术后早期手术部位感染的危险因素分析

目的探讨人工全髋关节置换术（THA）后早期手术部位感染的危险因素。方法回顾分析2000年1月至2010年10月本组所行153例单侧THA的患者,其中男46例,女107例,年龄29～79岁,平均（61．0±8．9）岁。回顾性分析多项临床因素与手术部位感染的相关性。连续变量包括：年龄、手术时间、手术出血量、术前白蛋白血清浓度、伤口引流管停留时间;分类变量包括：性别、有无长期使用激素病史、是否合并糖尿病、有无前次手术史、是否使用骨水泥、预防性抗生素使用方案。153例患者按照是否发生手术部位感染分成两组,对连续变量采用f检验、分类变量采用√检验进行比较。结果153例患者中8例出现手术部位感染,发生率为5．23％。单因素分析发现术前白蛋白血清浓度因素差异有统计学意义（t=2．752,P〈0．05）;白蛋白〈35g／L与白蛋白〉35g／L比较差异有统计学意义（岔=7．23,P〈0．05）。有无长期口服激素、有无前次手术比较差异有统计学意义（其Х^2值分别为3．93与12．38,P〈0．05）。年龄、性别、手术时间、术中出血量、抗生素使用时间、引流管停留时间、是否合并糖尿病、是否使用骨水泥等因素对手术部位感染发生无影响,均无统计学差异。结论THA术前低蛋白血症、前次手术史、长期口服激素史是手术部位感染的高危因素。     

高龄髋部骨折行人工髋关节置换术后患者再入院危险因素分析

目的:探讨高龄髋部骨折行人工髋关节置换术后患者再入院的发生率及危险因素分析。方法:回顾性分析2015年2月至2020年10月接受人工髋关节置换的高龄髋部骨折患者237例,根据患者术后3个月再入院情况分为两组,其中再入院组39例,男7例,女32例,年龄(84.59±4.34)岁;未再入院组198例,男34例,女164例,年龄(84.65±4.17)岁。将两组患者的一般资料、手术情况、髋关节Harris评分和并发症纳入单因素分析,并采用多因素Logistic回归分析患者再入院的独立危险因素。结果:再入院组中合并症(脑梗死和冠心病)的比例明显高于未再入院组(P<0.05),再入院组中术中出血量明显高于未再入院组(P<0.05),髋关节Harris评分明显低于未再入院组(P<0.05)。在并发症方面,再入院组发生感染、谵妄、关节脱位、贫血和静脉血栓形成的比例明显高于未再入院组(P<0.05)。多因素Logistic回归分析显示,高龄髋部骨折行人工髋关节置换术后患者再入院危险因素包括脑梗死、感染、谵妄、关节脱位、贫血和静脉血栓形成(P<0.05)。结论:高龄髋部骨折行人工髋关节置换术后再入院的患者并发症明显高于未再入院患者,脑梗死、感染、谵妄、关节脱位、贫血和静脉血栓形成是导致患者再入院的危险因素,临床可根据这些危险因素采取相应的干预措施,以此减低患者再入院的发生率。     

Evaluation of estimation of physiologic ability and surgical stress (E-PASS) to predict the postoperative risk for hip fracture in elder patients

Introduction  The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts the postoperative risk by quantifying the patient’s reserve and surgical stress in general surgery. This study aims to evaluate the usefulness of this scoring system for the hospitalization outcomes in hip fracture. Patients and methods  A consecutive series of 419 elderly patients who underwent surgery with osteosynthesis or arthroplasty for hip fracture were prospectively assessed for the E-PASS scoring system, which was compared with their postoperative course. Results  The postoperative morbidity and mortality rates in hospital increased linearly as the PRS and CRS increased, with significant correlation (ρ = 0.2, P < 0.01) in both operations. The cost of hospital stay also related significantly to the SSS (r = 0.6, P < 0.0001) and CRS (r = 0.4, P < 0.0001). Conclusion  These results suggest that E-PASS may be useful for predicting postoperative risk and estimating medical expense for surgical cases with hip fracture.     

髋、膝关节矫形术和髋部骨折内固定术后病人下肢深静脉血栓形成的危险因素

目的 分析髋、膝关节矫形术和髋部骨折内固定术后病人下肢深静脉血栓形成(DVT)的危险因素.方法 2004年至2005年接受髋、膝关节矫形术和髋部骨折内固定术的病人147例,年龄33～92岁.术后2周行双侧下肢静脉Duplex彩色超声检查,观察DVT形成的情况,根据是否形成DVT,分为非DVT组和DVT组.记录围术期有关病人、手术和麻醉方面的临床资料.结果 术后下肢DVT发生率42.2%,而近端DVT发生率2.7%.与非DVT组相比,DVT组麻黄碱使用率及其用量增加,麻醉时间延长,术后1 d白细胞计数及术后最高白细胞计数明显升高(P＜0.05);logistic回归分析结果显示,上述因素与下肢DVT有关(P＜0.05).结论 髋、膝关节矫形和髋部骨折内固定术后病人下肢DVT的危险因素为麻醉时间＞3 h、使用麻黄碱及术后白细胞计数明显升高.     

Femoral neck geometry and hip fracture risk: the Geelong osteoporosis study

To determine the relationship between femoral neck geometry and the risk of hip fracture in post-menopausal Caucasian women, we conducted a retrospective study comparing the femoral neck dimensions of 62 hip fracture cases to those of 608 randomly selected controls. Measurements were made from dual-energy X-ray absorptiometry scans (Lunar DPX-L), using the manufacturers ruler function, and included: hip axis length (HAL), femoral neck axis length (FNAL), femoral neck width (FNW), femoral shaft width (FSW), medial femoral shaft cortical thickness (FSCT_med), and lateral femoral shaft cortical thickness (FSCT_lat). The fracture group was older (median age 78.3 years vs 73.8 years), lighter (median weight 59.9 kg vs 64.5 kg), and, after adjustment for age, taller (mean height 158.7±0.8 cm vs 156.7±0.2 cm) than the controls. Furthermore, bone mineral density was lower in this group (0.682±0.016 g/cm² vs 0.791±0.006 g/cm²). After adjustment for age, bone mineral content (BMC) or height, hip fracture patients had greater FNW (up to 6.6%) and FSW (up to 6.3%) than did the controls. Each standard deviation increase in FNW and FSW was associated with a 1.7-fold (95% CI 1.3–2.3) and a 2.4-fold (95% CI 1.8–3.2) increase in the fracture risk, respectively. BMC-adjusted FNAL was greater in the fracture group (+2.1%) than in the controls, while the age-adjusted FSCT_med was reduced (–7.2%). There was a trend towards longer HAL (up to 2.1%) after adjustment for age or BMC, and thinner age-adjusted FSCT_lat (–1.7%) in fracture patients that did not reach statistical significance. In multivariate analysis, the risk of hip fracture was predicted by the combination of age, FNW, FSW, BMC and FSCT_med. HAL was not analyzed because of the small number of HAL measurements among fracture cases. We conclude that post-menopausal women with hip fractures have wider femoral necks and shafts, thinner femoral cortices and longer femoral neck axis lengths than do women with no fractures. Alteration in hip geometry is associated with the risk of hip fracture.The authors declare no conflicts of interest with regard to this article     

髋部骨折24小时内及延迟入院的下肢深静脉血栓发生情况分析

目的 探讨髋部骨折病人骨折后24 h内下肢深静脉血栓形成（deep vein thrombosis, DVT）的发生率及危险因素,并对超过24 h住院病人血栓发生率的变化进行分析。方法 回顾性分析西安交通大学医学院附属红会医院2014年10月至2018年3月收治的1 183例髋部骨折病人资料,根据受伤时间至入院时间进行分组。分析24 h内住院的374例髋部骨折病人资料,根据入院时下肢静脉彩超结果分为DVT组和非DVT组,对两组病人的年龄、性别、身体质量指数（body mass index, BMI）、骨折类型、美国麻醉医师协会（America Society of Anesthesiologists, ASA）分级、入院时的实验室检查、是否多发伤、是否合并内科疾病等可能危险因素进行单因素分析;采用多因素Logistic回归分析确定其独立危险因素;对超过24 h住院的病人进行DVT发生率的变化情况分析。结果 在髋部骨折后24 h内入院的374例髋部骨折病人中,未发生DVT有292例,发生DVT有82例,血栓发生率为21.93%（82/374）。分析DVT组和非DVT组之间的数据,年龄（P=0.005）、骨折部位（P＜0.001）、入院时血红蛋白（P=0.002）、入院时红细胞压积（P=0.004）之间的差异有统计学意义;多因素Logistic回归分析结果显示：年龄、骨折部位是髋部骨折24 h内形成DVT的独立危险因素。粗隆间骨折［P=0.002,OR=2.510,95%CI：（1.397,4.510）］和粗隆下骨折［P=0.023,OR=4.798,95%CI：（1.237,18.605）］发生DVT的风险分别是股骨颈骨折发生DVT风险的2.51倍、4.80倍。45~59岁、60~75岁、≥75岁年龄段病人分别是＜45岁病人发生DVT风险的3.12、3.20、6.45倍。24 h内入院的病人DVT发生率最低,延迟住院后DVT发生率逐渐升高,在受伤后8~14 d入院的病人DVT发生率最高,达到48.86%。结论 髋部骨折后24 h内就会发生DVT,DVT的类型以远端血栓为主,也会发生近端血栓,年龄≥75岁、股骨粗隆下骨折的病人发生DVT的风险最高。髋部骨折后,随着入院时间的推迟,DVT的发生率逐渐升高。入院后应当第一时间对DVT进行诊断和预防,防止发生致命性肺栓塞。     

半髋关节置换术改善老年股骨颈骨折患者髋关节功能的效果观察

目的：观察半髋关节置换术改善老年（年龄≥60岁）股骨颈骨折患者髋关节功能的效果。方法随机将105例老年股骨颈骨折患者进行分组,半髋组行半髋关节置换术,全髋组行全髋关节置换术,观察手术指标和改善髋关节功能效果。结果半髋组手术时间、术中出血量和术后引流量少于全髋组（P＜0.01）;髋臼外展角和髋臼前倾角优于全髋组（P＜0.01）;髋关节功能优良率94.23%高于对照组77.36%（P＜0.05）;并发症发生率5.77%略低于全髋组15.09%（P＞0.05）。结论半髋关节置换术改善老年股骨颈骨折患者髋关节功能效果确切,能够缩短手术时间、降低术中出血量以降低手术风险,维持股骨颈假体位置,促进髋关节功能恢复和降低手术并发症。