骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。     

肱骨近端、髋部骨折老年女性骨密度和骨代谢指标对比研究

目的对髋部、肱骨近端骨折老年女性的骨密度和骨代谢指标进行对比分析,进一步揭示上述骨折部位女性患者骨密度和骨代谢指标特征性变化情况。方法经患者及家属同意,共纳入62例老年髋部骨折女性患者(其中股骨颈骨折39例,股骨粗隆间骨折23例)、肱骨近端骨折21例,收集患者年龄、检测患者骨密度、血清骨转换指标(Ⅰ型胶原氨基端延长肽,P1NP;Ⅰ型胶原C端肽β降解产物,β-CTX)。结果肱骨近端骨折女性患者平均年龄为(66.1±8.0)岁,明显小于股骨颈骨折、粗隆间骨折女性患者(P<0.05);肱骨近端骨折女性髋部(T=-1.19±0.66)、腰椎骨密度(T=-1.67±1.00)明显高于粗隆间骨折女性髋部(T=-2.36±1.17)、腰椎骨密度(T=-2.61±1.42)(P<0.05),同时显著高于股骨颈骨折患者髋部骨密度(T=-2.33±0.99)。股骨颈骨折、股骨粗隆间骨折患者髋部、腰椎骨密度相比差异无统计学意义;三组间血清P1NP比较差异没有统计学意义,粗隆间骨折女性血清β-CTX(732.18±334.37μg/L)要明显高于肱骨近端骨折患者(529.66±292.34μg/L)(P<0.05)。结论相对于髋部骨折患者,肱骨近端骨折老年女性患者年龄较低,骨密度相对较高;骨吸收活跃可能是导致粗隆间骨折女性骨密度下降的原因。     

老年髋部骨折类型与股骨近端骨密度的关系

目的探讨老年股骨颈骨折与转子间骨折患者在股骨近端骨密度(BMD)上的不同特点。方法回顾性研究520例60岁及60岁以上初次髋部骨折患者:股骨颈骨折237例,男67例,平均年龄80.0±8.5岁,女170例,平均年龄79.0±8.2岁;转子间骨折283例,男95例,平均年龄80.2±8.4岁,女188例,平均年龄82.4±6.7岁。比较两种髋部骨折患者健侧股骨近端五个区域(股骨颈、大转子、转子间、全髋部、Ward区)的BMD,并采用二分类logistic回归分析探讨股骨近端不同区域BMD与髋部骨折类型之间的关系。结果男性转子间骨折患者只有大转子BMD显著低于同性股骨颈骨折患者,差异有统计学意义(P0.01);而女性转子间骨折患者大转子、转子间、全髋部、Ward区的BMD显著低于同性股骨颈骨折患者,差异均有统计学意义(P0.01)。女性按年龄分层后,60~69岁转子间骨折患者只有Ward区BMD显著低于股骨颈骨折患者,差异有统计学意义(P0.05);70~79岁转子间骨折患者五个区域BMD均显著低于股骨颈骨折患者,差异有统计学意义(P0.05);大于79岁转子间骨折患者只有大转子BMD显著低于股骨颈骨折患者,差异有统计学意义(P0.01)。二分类Logistic回归分析发现:女性中增龄、大转子、转子间、全髋部以及Ward区的BMD与髋部骨折类型存在统计学关联(P0.01),而男性中只有大转子BMD与髋部骨折类型存在统计学关联(P0.01)。结论股骨颈骨折患者和转子间骨折患者存在不同的BMD水平,女性股骨近端BMD与髋部骨折类型的关系随着年龄的变化而变化。     

我国中老年脆性髋部骨折及桡骨远端骨折骨质疏松诊断标准与WHO诊断标准的比较分析

目的评估我国中老年髋部骨折及桡骨远端骨折骨质疏松诊断标准与世界卫生组织(World Health Organization,WHO)诊断标准的不同所产生的骨质疏松人群的数量差异,更加精确地指导临床对适宜骨质疏松人群的筛查及治疗。方法收集2016年8月至2018年2月我院骨科年龄在60～80岁的脆性髋部骨折女性患者110例及桡骨远端骨折女性患者100例及与年龄相仿的正常人女性312名,使用双能X线骨密度仪测量腰1～4、股骨颈、股骨大粗隆骨密度,分别计算骨质疏松率;再按照我国骨质疏松诊断标准及WHO诊断标准进行比较分析。结果脆性髋部骨折女性患者腰1～4、股骨颈、股骨大粗隆骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。脆性桡骨远端骨折女性患者腰1～4、股骨颈骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。股骨大粗隆骨密度低于对照组,骨质疏松率高于对照组,但差异不具有统计学意义(P0.05)。按照我国骨质疏松诊断标准与WHO诊断标准进行比较,我国脆性髋部骨折及桡骨远端骨折骨质疏松人数多于WHO骨质疏松人数,差异具有统计学意义(P0.05)。结论据本文分析,我国脆性髋部骨折及桡骨远端骨折骨质疏松率明显高于正常人,我国骨质疏松诊断标准扩大了骨质疏松人数。呼吁更多研究评估我国骨质疏松骨折,特别是脆性桡骨远端骨折的诊断及治疗,适时调整我国骨质疏松诊断标准。     

股骨近端骨折类型的影响因素分析

目的探讨影响股骨近端骨折类型的相关因素。方法对2016年1月至2018年9月河南省洛阳正骨医院髋部诊疗中心297例股骨近端骨折病人的临床资料进行回顾性分析,根据入院时第一诊断结果将其分为股骨颈骨折组与股骨转子间骨折组,其中股骨颈骨折病人206例(69.4%),股骨转子间骨折91例(30.6%)。先通过单因素分析比较两组的性别、年龄、身高、体重、身体质量指数(body mass index,BMI)、生活习惯(吸烟、酗酒)、合并内科疾病(高血压、糖尿病、冠心病、卒中病史、恶性肿瘤、既往骨折史)、股骨颈骨密度、转子间骨密度、全髋骨密度、颈干角、所受能量等因素,再采用Logistic回归分析确定其影响因素。结果两组间年龄、股骨颈骨密度、转子间骨密度、全髋骨密度、颈干角、所受能量比较,差异均有统计学意义(P均<0.05)。Logistic回归分析发现,年龄[OR=1.071,95%CI(1.038,1.106),P<0.001]、全髋骨密度[OR=0.004,95%CI(0.000,0.356),P=0.016]、颈干角[OR=0.915,95%CI(0.881,0.951),P<0.001]为股骨近端骨折类型的影响因素。结论年龄越大、全髋骨密度越低、颈干角越大的病人,更容易发生股骨颈骨折。     

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。     

骨密度结合股骨近端几何参数预测老年髋部骨折

目的研究老年人骨密度(Bone mineral density,BMD)值结合股骨近端几何参数是否能提高骨质疏松性髋部骨折危险性的预测。方法将85例绝经后妇女髋部骨折患者按骨折类型分组, 其中52例股骨颈骨折,33例转子间骨折。对照组100例老年女性。在骨盆片上测量股骨近端几何参数,在股骨颈、Ward’s三角和转子处测量BMD值,对结果进行统计学处理分析。结果骨折组的BMD值均低于对照组(P<0．01);股骨干皮质厚度与股骨颈BMD值有相关性(r=0．45,P< 0．01);逐步线性回归分析结果显示股骨距内侧皮质厚度、转子处BMD值、颈干角和Ward’s三角 BMD值相结合是预测髋部骨折最好方法(r=0．74,r2=0．53,P<0．01)。结论骨密度值结合放射学测量股骨近端几何参数能提高对骨质疏松性髋部骨折及骨折类型的预测。     

抗骨质疏松药物治疗老年股骨转子间骨折疗效分析

目的观察老年骨质疏松性股骨转子间骨折内固定术后应用有效抗骨质疏松药物治疗的疗效。方法选取2013年7月至2014年6月在我院60岁以上诊断为骨质疏松的老年股骨转子间骨折患者57例,分为A组(使用抗骨质疏松药物组30例)和B组(未使用抗骨质疏松药物组27例),骨折术后第5天后行口服维生素D钙咀嚼片、阿伦膦酸钠片治疗,观测骨折愈合时间、骨折并发症、髋关节Harris评分、骨密度。结果完成随访病例A组26例,B组24例,2组骨折愈合时间、骨折并发症无统计学差异(P0.05),术后12个月髋关节Harris评分A组高于B组,有统计学意义(P0.05),A组、B组术后3天血清钙及维生素D较术前降低,有统计学意义(P0.05),A组术后6个月血清钙及维生素D较术前、术后3天增加,有统计学意义(P0.05),术后6个月A组、B组骨密度较术前无统计学差异(P0.05),术后12个月A组骨密度较术前增加,有统计学意义(P0.05),术后12个月B组骨密度较术前无统计学差异(P0.05)。结论老年骨质疏松性股骨转子间骨折患者术后使用抗骨质疏松治疗能增加骨密度,能获得更好疗效。     

精神病患者髋部骨折手术疗效分析

[目的]总结分析17例精神病患者髋部骨折的手术疗效.[方法]回顾性分析本院2004年5月～2010年6月收治17例精神病患者髋部骨折的手术方法,随机抽取本院同期收治正常人群髋部骨折患者20例,分别比较精神病患者与正常人群髋部骨折术前准备时间、手术时间、并发症发生率及术后1年Harris评分.[结果]患者随访16～47个月,平均(30.5±3.6)个月.精神病患者股骨转子间骨折组与正常人群股骨转子间骨折组术前准备时间分别平均为(5.28±2.56)d、(3.3±1.16)d(t=2.174,P=0.0231),精神病患者股骨颈骨折组与正常人群股骨颈骨折组术前准备时间平均(4.8±1.75)d、(2.8±1.31)d(t=2.887,P=0.0049),精神病患者股骨转子间骨折组与正常人群股骨转子间骨折组术后1年Harris评分分别平均为(71.85±7.31)分、(79.3±6.70)分(t=2.173,P=0.0231),精神病患者股骨颈骨折组与正常人群股骨颈骨折组术后1年Harris评分分别平均(79.0±6.44)分、(80.9±7.30)分(t=0.6165,P=0.2726),两组患者手术时间、并发症发生率无显著性差异.[结论]对于精神病患者髋部骨折要给予充分的围手术期处理,股骨转子间骨折患者要选择坚强、有效地内固定器材,股骨颈骨折患者建议选择骨水泥型双极股骨头置换手术治疗.     

老年患者不同部位的髋部骨折对预后的影响

目的:研究骨折部位对老年髋部骨折预后的影响。方法:自2012年1月至2014年12月,共收治髋部骨折患者667例,根据骨折部位将髋部骨折分为股骨转子间骨折组和股骨颈骨折组,其中股骨转子间骨折组304例,男96例,女208例,平均年龄(80.33±7.94)岁;股骨颈骨折组217例,男74例,女143例,平均年龄(79.82±9.33)岁。比较两组患者入院资料、术后死亡率及独立生活能力的差异。结果:两组年龄、性别、合并症、ASA分级、麻醉方式差异不明显,但入院至手术等待时间、手术时间、术中出血量、术后引流量以及输血量差异有统计学意义。股骨转子间骨折术前、术后1、3、5 d白细胞计数较高,血红蛋白、白蛋白较低。股骨转子间骨折住院期间、术后1、3、6、12个月内死亡率较股骨颈骨折高,但差异无统计学意义。在存活患者中,出院时、术后1、3个月股骨颈骨折患者日常生活能力较股骨转子间骨折患者恢复更为满意,术后6、12个月,两组患者相比,日常独立生活能力差异无统计学意义。结论:尽管股骨转子间骨折对机体应激较大,但排除年龄、性别、合并症等因素的影响后,股骨转子间骨折和股骨颈骨折术后1年内死亡率差异不明显。和股骨转子间骨折患者相比,股骨颈骨折关节置换后早期功能恢复良好,但手术后1年,两者功能恢复差异不明显。     

Talar body fracture combined with bimalleolar fracture

The incidence of talar fractures is relatively low affecting usually young patients, while recent epidemiological studies have shown that talar body fractures represent a significant proportion of the total number of talar fractures. Talar body fractures are usually high-energy injuries and often a combined talar neck and body fracture is noted. An association between talar body fractures and ankle fractures has also been recorded involving the medial or lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture that was found in the literature is referred to a talar neck fracture. In this report, a combination of a talar body fracture and bimalleolar ankle fracture in a polytraumatised young patient is presented. This combined injury pattern seems to be very rare, since a similar case was not found in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. Minimal osteoarthritic changes of the tibiotalar joint were noted at 3 years follow-up with satisfactory functional results.     

三踝骨折的手术治疗

2001年1月~2005年3月,笔者收治31例三踝骨折患者,均进行了手术治疗,疗效满意。1材料与方法1.1病例资料本组31例,男21例,女10例,年龄18~40岁。右侧18例,左侧13例。所有病例均为新鲜骨折且骨折移位明显。按Weber的AO分型,B型19例,C型12例。1.2治疗方法硬膜外麻醉。如骨折片位于胫     

Old nutcracker fracture of cuboid

Nutcracker fractures of the cuboid (compressed) are rare and often missed at an initial visit. We report a 21-year-old patient presented with a 9 months old cuboid fracture. He presented with a localized pain around his left foot. Radiograph revealed the shortening of the lateral column with old cuboid fracture. The lateral column of foot was reconstructed. The patient remained symptom-free and no radiographic evidence of recurrence was observed 1 year postsurgery.     

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia

INTRODUCTION

Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral.

PRESENTATION OF CASE

This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia.

DISCUSSION

Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia.

CONCLUSION

Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen.     

Segmental fracture of the scaphoid: report of a rare fracture pattern

Introduction:To the best of our knowledge, there are no reports in the orthopaedic and trauma literature of true segmental fracture of the scaphoid bone. We present such a case with a brief discussion of the morphology and mechanisms of injury of scaphoid fractures and the problems they present, particularly in diagnosis. Case history: A 43-year-old male with polytrauma sustained in a motorcycle road traffic accident was treated at our hospital. His injuries included a fracture initially thought to involve the waist of the scaphoid. Because he had bilateral upper limb injuries, we elected to treat the fracture surgically to facilitate rehabilitation. At the time of surgery, the fracture was noted to be truly segmental, an unsuspected and rare finding. The fracture was internally fixed, with a satisfactory result. Discussion: Scaphoid fracture patterns are generally consistent and predictable, occurring most commonly through the waist of the bone. Mechanism for injury is thought to be hyperextension of the wrist. Comminution, with or without a butterfly fragment, is occasionally seen, as are simultaneous tuberosity fractures. We suggest that the mechanism in this case may have been multiple or secondary trauma, or an effect of loaded rotation. We highlight the need for careful imaging of the scaphoid bone prior to choosing treatment.     

Pilon骨折合并同侧跟骨骨折1例

患者,男,69岁,2 d前从约2 m高处坠落,左足着地后出现左下肢畸形、肿胀,于2019年4月26日入我院治疗。判断患者生命体征平稳后,摄左胫腓骨DR片显示左Pilon骨折及左跟骨骨折(图1A);CT检查显示骨折类型为左Pilon骨折,AO分型C2型,左跟骨骨折SandersⅣ型(图1B)。入院后给予左距骨骨牵引以保持左下肢稳定及力线,同时积极给予脱水消肿。13 d后肿胀消退及左下肢力线、皮肤软组织条件等均良好,行左Pilon骨折及左跟骨骨折切开复位内固定术。术后摄左踝关节DR片复查显示骨折对位对线良好,内固定在位(图1C)。出院后患者定期门诊复查,行临床及影像学评估。术后2个月,患者左下肢无负重、后部分负重到完全负重。术后3个月骨折愈合尚可,AOFAS踝-后足功能评分85分,患者的踝关节运动功能基本正常。     

Epidemiology of dancers fracture

BackgroundDancer’s fracture is a spiral, oblique fracture of the diaphysis of the fifth metatarsal. Although it is a well-known fracture in high performance athletes, it is less studied in a general population. The article investigates the epidemiology within an adult population consulting a regional trauma and orthopedic center in the United Kingdom.MethodsStudy population included all patients older than 16 years presenting with a dancer’s fracture. Recorded data were age, sex, side and energy of trauma mechanism, applied treatment and time of healing.ResultsOf all fifth metatarsal fractures, 25% was found to have a dancer’s fracture. About 80% were women, and about 80% was older than 40 years. In the +40 y age group, all patients had a low energy trauma mechanism, where in the −40y age group this was only 27%. All patients were treated conservatively and no correlation was found between type of treatment (walker boot, stiff soled shoe) and time of healing. The time of healing was similar in both age groups and in general 1 out of 3 patients needed longer than 6 weeks to heal.ConclusionThere is an increased incidence of dancer’s fracture observed in the female general population +40y age. A strong correlation was found between the +40y age group and low-energy trauma mechanism. This shows the importance of treating dancer’s fracture as a fragility fracture.Level of evidenceRetrospective cohort study: level 3.     

伴有Tillaux-Chaput骨折块的成人踝关节骨折的手术治疗

目的 :探讨手术治疗伴有Tillaux-Chaput骨折块的成人踝关节骨折的临床疗效。方法:2014年1月至2018年12月采用手术治疗15例伴有Tillaux-Chaput骨折块的成人踝关节骨折患者,其中男9例,女6例;年龄27～67(45.6±14.3)岁;左侧8例,右侧7例。观察患者骨折愈合及并发症情况,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价踝关节功能恢复情况。结果:15例患者均获随访,时间18～70(38.1±9.9)个月。所有切口Ⅰ期愈合。X线片复查示骨折愈合良好,无内固定物松动、断裂等并发症发生。2例患者有腓浅神经损伤症状,经营养神经治疗后逐步恢复;3例患者踝关节屈伸活动轻度受限。末次随访AOFAS评分(85.6±7.9)分,其中优9例,良4例,可2例。结论 :齿状钢板固定Tillaux-Chaput骨折块,操作方便,固定牢靠,有利于踝关节功能恢复。下胫腓联合无须常规使用螺钉固定。     

Hoffa骨折的临床特点及治疗

目的探讨Hoffa骨折的临床特点及治疗方法。方法对5例Hoffa骨折患者1例保守治疗、4例切开复位内固定治疗。结果5例均获随访，时间13—31个月。功能恢复参照Letenneur方法进行评估：优良3例，可2例。结论Hoffa骨折的临床特点以膝关节屈曲外翻位损伤多见，外髁发生率较高。X线对诊断价值有限，多借助CT检查。治疗原则是解剖复位，坚强内固定，早期功能康复锻炼。     

手术治疗胫骨中下段骨折合并后踝骨折

正2011年1月~2014年1月,我科手术治疗20例胫骨中下段骨折合并后踝骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组20例,男14例,女6例,年龄20~65岁。左下肢8例,右下肢12例。致伤原因:摔伤10例,扭伤4例,车祸伤6例。螺旋形骨折15