老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了１０２名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Ｓｉｎｇｈ指数、股骨颈皮质骨指数和股骨外侧皮质厚度，结果表明两骨折组与正常对照组之间均有非常显著（Ｐ〈０．０１）或显著（Ｐ〈０．０５）之统计学差异，认为骨质疏松是老年人髋部骨折的主要影响因素之一，而采用Ｘ线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值。     

老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了102名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Singh指数、股骨颈皮质骨指数和股骨外侧皮质骨厚度,结果表明两骨折组与正常对照组之间均有非常显著(P<0.01)或显著(P<0.05)之统计学差异,认为骨质疏松是老年人髋部骨折的主要影响因素之一,而采用X线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值.     

老年人骨质疏松与髋部骨折发病关系的分析

目的探讨骨质疏松与老年人髋部骨折的关系。方法采用随机分组设计测量了120名老年人股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Singh指数、股骨颈皮质指数和股骨外侧皮质骨厚度。结果显示两组之间有非常显著（P〈0．01）的统计学差异。结论骨质疏松是老年人髋部骨折的主要致病因素之一。采用X线片评定股骨近端骨量改变对于预测髋部骨折的危险性具有一定价值。     

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.     

骨质疏松性髋部骨折的皮质骨因素

很长一段时间内对老年髋部骨折的骨质疏松研究主要集中于松质骨,但皮质骨才是骨折最终发生的决定因素。股骨颈完全去除松质骨情况下股骨颈强度仅小幅度下降,股骨颈力学测试表明皮质骨承受主要压力负荷,对股骨近端强度起着重要作用。皮质骨在骨质疏松时发生结构和组成改变,随着年龄增大皮质骨内侧面出现皮质骨小梁化,导致皮质骨不断变薄,髓腔不断变大;骨质疏松的老年患者皮质骨骨质量发生一系列变化,包括皮质骨矿化程度过高、骨胶原含量减少和胶原网功能不断退化,皮质骨骨转换率高、微损害过度聚集,皮质骨中孔道直径变大及数量增多等。因此,皮质骨随着年龄不断增大而发生一系列改变,最终造成髋部骨强度下降。     

女性骨质疏松性髋部骨折的骨密度和髋部结构强度变化

目的观察女性骨质疏松性髋部骨折的骨密度和髋部结构强度变化。方法对95例骨质疏松性髋部骨折女性患者进 行双能X线骨密度检测和髋关节结构分析,年龄：76. 60 ±9. 36岁,体重指数：20. 88 ±3. 72 kg/m2 ;将63例年龄>50岁骨密度 正常的女性作为对照组。对照组女性年龄57. 24 ±5. 65岁,体重指数：26. 56 ±4. 82 kg/m2,比较二组股骨颈骨密度和结构强 度参数(包括骨横截面积、皮质厚度和屈曲应力比）。结果髋部骨折患者的股骨颈骨密度、股骨颈和转子间的骨横截面积和 皮质厚度均非常显著低于对照组;屈曲应力比非常显著高于对照组,87. 4%髋部骨折患者的股骨颈和转子间屈曲应力比均> 10;而84. 1%正常骨密度组患者的股骨颈和转子间屈曲应力比均< 10。结论髋部骨折患者的股骨颈骨密度及髋关节结构 强度均发生非常显著改变,骨强度降低,HSA提供的结构强度参数有助于预测髋部骨折风险。     

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。     

转子间骨折

随着人类寿命的延长,骨结构退化性病变与骨质疏松症的发生率逐年增加。骨质疏松症的主要并发症是骨折,此类骨折又被称为脆性骨折,与骨质疏松所致的骨皮质变薄、骨小梁结构脆弱、力学强度下降密切相关。髋部是老年骨质疏松性骨折的好发部位。髋部骨折多见于60岁以上人群,90%发生于65岁以上老人。髋部骨折包括股骨颈囊内骨折及股骨转子间骨折。美国每年发生转子间骨折达25万例,随着年龄增加,骨折发生率也上升。老年人常合并不同程度的内科疾病及脏器功能障碍,增加了骨折治疗的复杂性。转子间以松质骨为主,骨质疏松使骨小梁微结构破坏,轻微暴力…     

比较不同类型骨质疏松性髋部骨折的特点

目的 比较骨质疏松性股骨颈骨折和转子间骨折患者在髋部骨密度及几何结构上的不同特点。方法 将137例50岁以上髋部骨折的患者分为两组:股骨颈骨折组69例,男20例,女49例,年龄50 -97岁（75.1 ±9.6),体重指数（BMI) ：21.6±4. 1 kg/m2 ;股骨转子间骨折组48例,男16例,女32例,年龄50-91岁（78. 1 ± 9. 1),体重指数（BMI )：21. 5 ± 4. 3 kg/m2。对所有患者的健侧股骨近端行双能X线骨密度仪（Dual energy X-ray absorptiometry,DXA)测定,并利用该仪器的HSA软件分析髋部几何结构参数。结果两组患者在男女构成比例、年龄、身高、体重、体重指数的比较上没有统计学差异（P <0. 05);两组 患者的骨密度在股骨颈区（Neck)、大转子区(Troch)、Ward区、转子间区（Inter)、全髋(Total hip)的比较上没有统计学差异(P <0. 05)。两组患者在股骨颈区及转子间区的横截面积(CSA)、横截面转动惯量(CSMI)、屈曲应力比（BR)的比较上均没有统计学差异(P <0. 05);两组患者在股骨颈区域的皮质骨厚度的比较上没有统计学差异(P <0. 05);两组患者在转子间区域的皮质骨厚度的比较上有统计学差异(P =0. 013)。结论 在脆性髋部骨折的不同骨折类型的发生机制上,皮质骨变薄是引起不同髋部骨折类型的一个主要因素,尤其是对于高龄的髋部骨折患者。     

老年人髋部骨折股骨近端骨质CT测量的意义

[目的]探讨老年人股骨近端松质骨CT值和皮质骨厚度值评估髋部骨折的意义。[方法]回顾性分析146例髋部CT检查患者,其中,73例髋部骨折,73例非髋部骨折。测量健侧股骨近端冠状位股骨头、股骨颈、转子间的松质骨CT值,以及股骨颈和转子间的皮质骨厚度值。[结果]骨折组股骨颈和转子间的CT值均显著低于非骨折组(P0.05),骨折组在股骨近端4个部位的皮质骨厚度值均显著低于非骨折组(P0.05)。ROC曲线下面积(area under curve, AUC)由大至小依次为:股骨颈外侧皮质厚度值转子间外侧皮质厚度值转子间CT值转子间内侧皮质厚度值股骨颈CT值股骨颈内侧皮质厚度值,P值均0.05。其中,股骨颈外侧皮质厚度及转子间外侧皮质骨厚度值的AUC分别为0.893及0.844。[结论]股骨颈和转子间的皮质骨厚度值及松质骨CT值可能具有预测骨质疏松髋部骨折的价值。     

Bone Strength and Structural Deficits in Children and Adolescents With a Distal Forearm Fracture Resulting From Mild Trauma

Although distal forearm fractures (DFFs) are common during childhood and adolescence, it is unclear whether they reflect underlying skeletal deficits or are simply a consequence of the usual physical activities, and associated trauma, during growth. Therefore, we examined whether a recent DFF, resulting from mild or moderate trauma, is related to deficits in bone strength and cortical and trabecular bone macro‐ and microstructure compared with nonfracture controls. High‐resolution peripheral quantitative computed tomography was used to assess micro‐finite element‐derived bone strength (ie, failure load) and to measure cortical and trabecular bone parameters at the distal radius and tibia in 115 boys and girls with a recent (<1 year) DFF and 108 nonfracture controls aged 8 to 15 years. Trauma levels (mild versus moderate) were assigned based on a validated classification scheme. Compared with sex‐matched controls, boys and girls with a mild‐trauma DFF (eg, fall from standing height) showed significant deficits at the distal radius in failure load (–13% and –11%, respectively; p < 0.05) and had higher (“worse”) fall load‐to‐strength ratios (both +10%; p < 0.05 for boys and p = 0.06 for girls). In addition, boys and girls with a mild‐trauma DFF had significant reductions in cortical area (–26% and –23%, respectively; p < 0.01) and cortical thickness (–14% and –13%, respectively; p < 0.01) compared with controls. The skeletal deficits in the mild‐trauma DFF patients were generalized, as similar changes were present at the distal tibia. By contrast, both boys and girls with a moderate‐trauma DFF (eg, fall from a bicycle) had virtually identical values for all of the measured bone parameters compared with controls. In conclusion, DFFs during growth have two distinct etiologies: those owing to underlying skeletal deficits leading to fractures with mild trauma versus those owing to more significant trauma in the setting of normal bone strength. © 2014 American Society for Bone and Mineral Research.     

Diminished Bone Strength Is Observed in Adult Women and Men Who Sustained a Mild Trauma Distal Forearm Fracture During Childhood

Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age <18 years) DFF and 150 sex‐matched controls with no history of fracture using high‐resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro–finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex‐matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual‐energy X‐ray absorptiometry (DXA)‐derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health. © 2014 American Society for Bone and Mineral Research.     

Indomethacin and bone trauma. Effects on remodeling of rabbit bone

The influence of indomethacin on remodeling activity in normal trabecular and cortical bone and its influence on cortical bone close to a midtibial drill hole, 2 mm in diameter were histomorphometrically evaluated. Eight rabbits were treated with indomethacin (12.5 mg/kg/day), and another 8 rabbits served as controls. After 3 days, the mean plasma indomethacin level was 542 ng/mL, resulting in an almost complete inhibition of prostaglandin synthesis as reflected by the serum levels. In the control rabbits the remodeling activity after 6 weeks was increased 1 mm away from the drill hole but not at 3 and 8 mm. In conclusion, indomethacin had no effect on the activated remodeling process in cortical bone neighboring a small drill hole or on remodeling in nontraumatized cortical and cancellous bone. This suggests that the inhibitory effect of indomethacin on the remodeling process following local trauma to bone depends on the extent of the trauma.     

Indomethacin and bone trauma: Effects on remodeling of rabbit bone

The influence of indomethacin on remodeling activity in normal trabecular and cortical bone and its influence on cortical bone close to a mid-tibial drill hole, 2 mm in diameter were histomorphometrically evaluated. Eight rabbits were treated with indomethacin (12.5 mg/kg/day), and another 8 rabbits served as controls. After 3 days, the mean plasma indomethacin level was 542 ng/mL, resulting in an almost complete inhibition of prostaglandin synthesis as reflected by the serum levels. In the control rabbits the remodeling activity after 6 weeks was increased 1 mm away from the drill hole but not at 3 and 8 mm.

In conclusion, indomethacin had no effect on the activated remodeling process in cortical bone neighboring a small drill hole or on remodeling in nontraumatized cortical and cancellous bone. This suggests that the inhibitory effect of indomethacin on the remodeling process following local trauma to bone depends on the extent of the trauma.     

Secular trends in the incidence of postmenopausal vertebral fractures

Summary Several studies suggest secular increases in hip fracture incidence through this century, but little is known about such trends for vertebral fracture. We have examined changes in the incidence of clinically ascertained vertebral fractures among Rochester, Minnesota residents aged 35–69 years, that were first diagnosed between 1950 and 1989. Our results indicate no overall increase in incidence over the 40-year period. Categorization of fractures according to the level of preceding trauma, however, revealed a significant increase in the incidence of fractures following moderate trauma among women aged 60–69 years. This increase occurred between 1950 and 1964, and leveled off thereafter. Rates for severe trauma fractures among postmenopausal women, and for vertebral fractures from any cause among younger men and women, remained stable. The rise in moderate trauma fractures in postmenopausal women paralleled that for hip fractures in Rochester and began to plateau at around the same time. It might have resulted from increased diagnosis of vertebral fractures, but the increase in hip fracture incidence is inconsistent with this explanation. An increase in the prevalence of osteoporosis, however, might account for the trend in both types of fractures.     

Femoral Head Fracture without Dislocation by Low-Energy Trauma in a Young Adult

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidence of hip dislocation. While plain radiographs showed no definite fracture or dislocation, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspect of the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probably represented subluxation with spontaneous relocation. The characteristic findings and possible mechanisms of this fracture were postulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were better than those of previously reported indentation fractures.     

老年股骨颈骨折骨密度、Singh指数的研究

目的研究骨密度和Singh指数在衡量股骨近端骨强度和预测股骨颈骨折中的意义.方法对21名60岁以上、因轻度创伤所致新鲜股骨颈骨折老年人进行股骨近端骨密度、Singh指数及Ward三角矿化骨体积进行测量.结果本组患者股骨近端骨密度减少规律,Ward三角>股骨颈>股骨粗隆,骨密度减少的下限(±s)是股骨颈1.14SD、粗隆部0.35SD、Ward三角2.04SD;Singh指数4级以下(含4级)20名(95.2%);Singh指数与MBV呈正相关(r=0.517P<0.05),与粗隆部骨密度及减少的标准差呈正相关(r=0.457,0.474P<0.05).结论骨密度较峰值骨量减少的标准差数在股骨颈大于1.14、粗隆部大于0.35、Ward三角大于2.04,加上Singh指数低于4级(含4级)提示股骨颈骨折的危险性明显增高.     

Avulsion Fracture of the Calcaneal Tuberosity: Case Report and Literature Review

Avulsion fractures of the calcaneal tuberosity are predominantly seen in patients with poor bone quality, the commonly used lag screw fixation might not be strong enough even with bony fragments of sufficient size. We present a case of a closed displaced avulsion fracture of the calcaneal tuberosity due to blunt trauma to the calf in a 74-year-old female. Open reduction and internal fixation with two 3.5-mm cannulated cortical screws with washers was performed, and anatomic reduction was achieved. Without further trauma, secondary displacement of the fracture occurred on day 3. Revision was performed with a single 3.5-mm cortical screw and transosseous fixation with 2 suture anchors, followed by partial weightbearing for 6 weeks. At 12 weeks postoperative, the fracture had completely healed, and she was doing well at 16 months after the revision surgery. Transosseous suture anchor fixation of an osteoporotic avulsion fracture of the calcaneal tuberosity seems to provide better and stronger fixation than that using lag screws.