老年髋部骨折后对侧髋部的再骨折

背景：老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。 目的：阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。 方法：于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。 结果与结论：单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率(P=0.018)。再发对侧骨折组骨质疏松发生率高于单侧骨折组(P=0.032)。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。 关键词：再发对侧髋部骨折;髋部骨折;股骨颈骨折;转子间骨折;骨密度;骨质疏松 doi:10.3969/j.issn.1673-8225.2012.04.042     

基于髋部骨骼属性预测骨折风险研究进展

随着人口寿命不断延长,老年人口所占比例不断增加,老年骨质疏松患者易发生髋部骨折,给家庭和社会带来沉重的经济负担。从股骨近端几何结构、骨密度（bone mineral density, BMD）、骨折风险评估工具（fracture risk assessment tool, FRAX）和基于CT影像的有限元分析（finite element analysis, FEA）等方面阐述髋部骨折风险预测的研究进展,旨在了解骨折风险的影响因素,提高老年人髋部骨折风险预测的准确性,尽量在早期发现易骨折的高危人群,并通过及时干预降低骨折发生概率,同时也为髋部骨折的预防和治疗方法 提供理论参考。     

二次骨折风险评价：老年女性髋部骨折后6-12个月骨密度及骨代谢变化

背景：国内外文献中关于骨折后骨代谢指标及骨密度变化量的前瞻性研究在20世纪60年代就开始有文献报道,但主要集中于胫腓骨和踝关节骨折患者,且样本量较低。 目的：观察老年女性髋部骨折愈合后(伤后6-12个月)骨密度及骨代谢指标的变化情况,并分析其相关性。 方法：选择2011年5月至2013年7月北京航天总医院骨科收治的老年女性髋部骨折患者48例,制定随访标准进行L1-4、患侧、健侧髋部骨密度测量及骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平测定,并行骨折愈合后患侧全髋部骨密度与血清骨代谢指标的多元线性回归分析。 结果与结论：患者骨折愈合后,患髋及腰椎骨密度显著低于基线值,健髋部位骨密度与基线值差异无显著性意义。患者在伤后6个月,即骨折完全愈合时,骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平均显著高于基线值(P < 0.05)。患者在伤后12个月,即骨折完全愈合6个月,骨钙素水平显著高于基线值,其余骨代谢指标与基线值差异无显著性意义。骨折达到临床及影像学愈合后,血清骨钙素水平的改变量与患髋骨密度改变量的偏回归系数最大。提示骨折达到临床愈合后,骨钙素血清水平对于评估骨密度回升速度具有较高价值。骨折愈合后监测相应的骨代谢指标可以提高判断骨密度变化的准确性,以降低罹患二次骨折的风险。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学的关系

目的:探讨髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学的关系。方法:选取82例髋部骨折老年患者（观察组）与41例既往存在闭合性髋部骨折史青壮年者（对照组）的临床资料进行回顾性分析,对比Singh指数分级、股骨近端几何结构指标（股骨颈轴长、颈干角、颈长、内侧偏距）及承重区生物力学指标（骨极限应力、弹性模量）,分析Singh指数与股骨近端几何结构指标、承重区生物力学指标的关系。结果:观察组Singh指数分级中Ⅱ、Ⅲ级占比高于对照组,而Ⅳ、Ⅴ、Ⅵ级占比低于对照组（P<0.05）;观察组Singh指数、颈干角、骨极限应力、弹性模量低于对照组,而股骨颈轴长、内侧偏距、颈长高于对照组（P<0.05）。分层回归显示,颈干角、骨极限应力、弹性模量会对Singh指数产生显著的正向影响关系,而股骨颈轴长会对Singh指数产生显著的负向影响关系（P<0.05）。结论:髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学具有密切关系,Singh指数的降低会严重影响患者的股骨近端几何结构及承重区生物力学。     

老年人髋部骨折的临床护理

目的：探讨老年人髋部骨折的临床护理。方法回顾性分析38例老年人髋部骨折患者的临床资料,总结临床护理方法,并对护理结果进行分析。结果38例患者经过实施有效的临床护理,均未发生并发症,治愈或好转出院。结论老年患者手术风险大,根据老年患者的生理特点及各种老年患者易出现的异常心理特点,有针对地采取护理措施,预防和控制术后并发症,可有效降低手术风险,减少并发症和病死率,促进患者的早日康复。     

老年脑卒中患者髋部骨折危险因素预测模型的建立和验证

背景:脑卒中后骨折的预防非常重要,目前尚无预测脑卒中后发生髋部骨折的模型。目的:探讨导致脑卒中患者发生髋部骨折的危险因素,并建立风险预测模型将风险可视化。方法:选择2014年6月至2017年6月徐州医科大学附属医院收治的脑卒中患者439例,男107例,女332例,平均(71.38±9.74)岁,根据脑卒中后有无髋部骨折分为骨折组(n=35)和非骨折组(n=404)。采用单因素和多因素分析确定脑卒中后发生髋部骨折的危险因素。将数据随机分为训练集(70%)和测试集(30%),基于多因素分析结果,建立预测髋部骨折发生风险列线图,并使用受试者工作特征曲线、校准曲线和决策曲线对其性能进行评价。开发一个网络计算器用于给临床医生提供更方便的交互体验。结果与结论:①单因素分析显示,两组间跌倒次数、吸烟、高血压、糖皮质激素、脑卒中次数、简易智能精神状态检查量表、视力水平、美国国立卫生研究院卒中量表、Berg平衡量表、交谈时停止步行测试比较差异均有显著性意义(P<0.05);②多因素分析显示,跌倒次数[OR=17.104,95%CI(3.727-78.489),P=0.000]、美国国立卫生研究院卒中量表[OR=1.565,95%CI(1.193-2.052),P=0.001]、交谈时停止步行测试[OR=12.080,95%CI(2.398-60.851),P=0.003]是与脑卒中后髋部骨折呈正相关的独立危险因素,骨密度[OR=0.155,95%CI(0.044-0.546),P=0.012]和Berg平衡量表[OR=0.840,95%CI(0.739-0.954),P=0.007]与脑卒中后髋部骨折呈负相关;③在训练集和测试集中,列线图的曲线下面积AUC值分别为0.956和0.907,校准曲线显示预测值与实际状态吻合度较高,决策曲线下面积分别为0.038和0.030;④结果显示,跌倒次数多、骨密度低、Berg平衡量表评分低、美国国立卫生研究院卒中量表评分高、交谈时停止步行测试阳性是脑卒中后髋部骨折的危险因素。在此基础上建立列线图预测模型,并开发了一个网络计算器(https://stroke.shinyapps.io/DynNomapp/)。     

髋部骨折的发生与股骨近端三维几何解剖形态的相关性研究

目的运用计算机辅助设计(computer aided design,CAD)及三维重建技术测量髋部几何解剖形态学参数,探究骨折人群股骨近端解剖形态与正常组人群(未骨折人群)的差异,分析其对髋部骨折发生率和发生类型的影响。方法通过髋部骨折患者正常侧下肢CT扫描图像,运用Mimics 10.01软件建立三维解剖形态模型,并测量股骨颈前倾角(femoral neck anteversion angle,FNAA)、颈干角(neck-shaft angle,NSA)、股骨头直径(femoral head diam-eter,FHD)及股骨颈轴长(length of femoral neck axis,LFNA)等正常股骨近端三维几何解剖形态学参数。结果股骨颈骨折组中FNAA、NSA、FHD、LFNA平均值为分别为(7.9±4.6)°、(128.6±4.6)°、(46.0±4.6)mm、(47.1±5.1)mm。股骨粗隆间骨折组中FNAA、NSA、FHD、LFNA平均值分别为(15.5±6.8)°、(134.7±6.9)°、(45.3±3.6)mm、(46.7±3.4)mm。股骨粗隆间骨折组FNAA及NSA无论男性还是女性都显著大于股骨颈骨折组(P<0.01),股骨颈骨折组、股骨粗隆间骨折组FNAA和NSA均与正常对照组有非常显著的差异性。结论中国人群FNAA较正常值大越容易发生股骨粗隆间骨折,较正常值小越容易发生股骨颈骨折。髋部骨折患者NSA较正常值大,其中NSA越大越容易发生股骨粗隆间骨折。骨折组人群的股骨近端解剖结构与正常人存在一定的差异,以角度解剖学参数影响为主。年龄越大越容易发生股骨粗隆间骨折,年龄越小越容易发生股骨颈骨折。     

老年髋部骨折患者术后并发下肢深静脉血栓的危险因素分析及风险预测

背景:针对老年髋部骨折患者,提高下肢深静脉血栓的筛查能力并实行个性化预防方案,是改善患者预后、降低患者家庭及社会经济负担的重要措施.目的:探讨老年髋部骨折患者术后并发下肢深静脉血栓的危险因素,建立预测其导致下肢深静脉血栓发生的风险模型.方法:回顾分析2017年1月至2019年12月无锡市中医医院收住入院的325例髋部骨...     

老年髋部骨折围手术期失血量的临床观察

目的通过观察髋部骨折围手术期血红蛋白水平改变,总结髋部骨折患者围手术期隐形失血量、总失血情况,探讨围手术期失血量的危险因素。方法选择北京市顺义区医院骨科2011年12月至2013年12月老年髋部骨折患者,记录患者一般情况,包括性别、年龄、并发症、骨折类型,手术方式（分别按照空心钉、关节置换、动力性髋螺钉和髓内钉的标准流程操作）、抗凝药物使用情况、出血量、手术时间等,根据患者血红蛋白水平波动、输血量计算患者隐形失血量、总失血量,通过方差分析及多因素线性分析计算围手术期间总失血量的独立危险因素。结果 2011年12月至2013年12月共有161例老年髋部骨折患者入选,经单因素方差分析及多因素线性回归分析,发现服用抗凝药物（均P=0.000）、手术方式（P=0.000,P=0.004）是围手术期出血量较多的独立危险因素。结论老年髋部骨折围手术期隐形失血量远远大于术中出血量,髓内钉术中出血量较关节置换、动力性髋螺钉（DHS）系统少,但隐形失血量、总失血量较其他三种手术方式明显增多,此外,服用阿司匹林等抗凝药物可增加术中出血量、隐形失血量及总失血量。     

The association of proximal femur geometry with hip fracture risk

We aimed to discuss the risk assessments of patients with hip fractures due to the fall-related moderate or minimal trauma and compare them with non-fractured control patients by bone mineral density (BMD) and proximal femur geometric measurements to assess whether geometric measurements of femoral dimensions were associated with femoral strength and hip fracture risk. Forty-two osteoporotic patients with proximal femur fracture and 40 osteoporotic non-fractured age and gender-matched controls were included in the study. Lunar DXA was used for BMD measurements and proximal femur geometric measurements were performed manually on direct X-rays as hip axial length (HAL), femoral length (FL), and femoral neck width (FW). The trochanteric and total BMD values of the fracture group were significantly lower than the control group. There was a significant increase in FW/FL ratio in the fracture group that would be of specific importance for guidance: if FL values did not increase as did FW, it would point out a risk for fracture. The trochanteric BMD values were correlated with all increased measurements in the control group. There are genetically determined adaptive differences among individuals concerning bone morphology and bone mineral distribution. These different adaptations result in different bone strengths and fracture formation risk.     

Subsequent hip fracture in osteoporotic hip fracture patients

Purpose: A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs. Materials and Methods: We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively. Results: The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05). Conclusion: Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.     

Association of body composition and muscle function with hip geometry and BMD in premenopausal women

Abstract

Background: Muscle mass and function are related to bone mineral density (BMD) but associations with bone geometry and BMD at differently loaded hip regions are less well-known.

Aim: To examine associations of muscle strength, maximal impact forces and body composition with hip bone density and geometry.

Subjects and methods: In 88 sedentary, premenopausal women (32.6 ± 8.5 years), fat-free mass (FFM), isometric knee extension strength (IKES), and peak landing ground reaction force (GRF) were measured. BMD at the proximal femur and sub-regions, section modulus (Z), and cross-sectional area (CSA) were estimated using dual X-ray absorptiometry.

Results: BMD at hip sites was significantly associated with body mass, IKES, GRF and FFM (r = 0.31–0.50) whilst Z and CSA were correlated with FFM (r = 0.67 and 0.62, respectively). In multivariate models, variables explaining most variance were body mass for lower neck and shaft BMD (25% and 17%, respectively), IKES for upper neck BMD (21%), GRF for trochanter (19%) and total hip BMD (18%) and FFM for femoral neck Z, CSA and BMD (54%, 38% and 20%, respectively).

Conclusion: BMD at superolateral hip sites was most strongly related to muscle function and maximal impact forces, BMD at inferiomedial hip sites to body mass, and hip geometry to FFM.     

广西瑶族中老年人骨密度与体成分的相关性分析

目的:分析探讨广西瑶族中老年人身高、体质量、脂肪率、脂肪、体质量指数与骨密度的规律及其相关性。方法:随机抽取343名(男性123名,女性220名)广西瑶族健康中老年人作为研究对象,检测受试者的体质量、脂肪率、脂肪量、体质量指数、身高和右足跟骨密度。结果:广西瑶族中老年人身高、体质量、脂肪率、脂肪量、体质量指数与骨密度均随着年龄的增长逐渐降低,不同性别间身高、脂肪率和骨密度差异明显。男性的身高、脂肪率和骨密度均大于同龄段女性,男性骨密度减少的幅度小于女性。男、女性的身高、体质量、体质量指数与骨密度均显著相关。结论:广西瑶族中老年人身高、体质量、体质量指数和骨密度随年龄的增长逐渐降低,且身高、体质量、体质量指数对骨密度起决定性作用。     

Reasons for discrepancies in hip fracture risk estimates using FRAX and Garvan calculators

ObjectivesBoth the FRAX and Garvan calculators are used to estimate absolute risk of fracture, but they sometimes produce different estimates. We sought to determine which patient characteristics contribute to these discrepancies.Study designTen-year hip fracture risk was estimated for 122 women, using both FRAX and Garvan with bone mineral density (BMD).Main outcome measuresDifferences in estimates of hip fracture were assessed, both in absolute terms and with respect to a treatment threshold of 3%.ResultsGarvan estimates were higher than FRAX estimates across the range of ages and BMDs studied. A history of falls or of multiple fractures increased risk calculated by Garvan 3–6-fold, but did not account for all differences between calculators. Discrepancies around a 3% treatment threshold occurred in 31/122 (25%). Women aged 70–74 years, and women with osteopenia were most likely to have discordant estimates. Most discordant estimates (29/31) had a Garvan estimate ≥3% and FRAX <3%. Falls, multiple fractures, ethnicity and a history of parental hip fracture contributed to some discordant estimates.ConclusionsHip fracture risk estimates are usually higher with Garvan than FRAX, and these differences could impact on treatment decisions in about a quarter of patients. Falls and multiple fractures have a strong influence on Garvan risk estimates, when present. Clinically important discrepancies tend to occur in patients who are at borderline fracture risk. In patients with hip fracture risks near the treatment threshold with one calculator, use of the other calculator should be considered to help guide treatment decisions.     

Comparison of effect of treatment with etidronate and alendronate on lumbar bone mineral density in elderly women with osteoporosis

The purpose of this open-labeled prospective study was to compare the treatment effects of cyclical etidronate and alendronate on the lumbar bone mineral density (BMD), bone resorption, and back pain in elderly women with osteoporosis. Fifty postmenopausal women with osteoporosis, age ranging from 55 to 86 years (mean: 70.7 years), were randomly divided into two groups with 25 patients in each group: the cyclical etidronate group (etidronate 200 mg daily for 2 weeks every 3 months) and the alendronate group (5 mg daily). The BMD of the lumbar spine (L1-L4) measured by DXA, the urinary cross-linked N-terminal telopeptides of type I collagen (NTX) level measured by the enzyme-linked immunosorbent assay, and back pain evaluated by the face scale score were assessed at baseline, 6 months, and 12 months. There were no significant differences in baseline characteristics including age, body mass index, years since menopause, lumbar BMD, urinary NTX level, and face scale score between the two treatment groups. Etidronate treatment sustained the lumbar BMD following a reduction in the urinary NTX level and improved back pain, while alendronate treatment reduced the urinary NTX level more significantly, resulting in an increase in the lumbar BMD, and similarly improved back pain. No serious adverse events were observed in either group. This study confirmed that alendronate treatment had a greater efficacy than etidronate treatment in increasing the lumbar BMD through the reduction of bone resorption in elderly women with osteoporosis.     

中国中老年人骨质疏松症患病率的Meta分析

背景：中国很多学者对不同地方做过骨质疏松症的流行病学调查,但大样本多中心的随机抽样调查仍相对缺乏,目前的文献仍不能很好地全面描述国内骨质疏松症的总体流行病学趋势。 目的：对中国中老年人骨质疏松流行病学的资料进行汇总,综合分析骨质疏松症流行状况。 方法：采用Meta分析对中国2000至2013年发表的有关中老年人骨质疏松流行病学的文献进行归纳和统计学分析。提取资料中40岁以上人群骨质疏松症的患病率,并以10岁为一个年龄组段分别进行汇总,采用stata12.0软件进行分析。 结果与结论：共对32篇文献进行分析,提取40岁以上人群样本总量58 254例,其中男26 844例,女31 410例。中国40岁以上人群骨质疏松症总体患病率13.2%,其中男性11.8%,女性14.2%,差异有显著性意义     (P < 0.05)。随年龄增加,男性及女性的骨质疏松症患病率均逐渐增加,男性增长则相对平缓,女性进入50岁后,患病率明显增高。从Lumbar,Neck,Troch,Ward's 4个检测部位来看骨质疏松症患病率在北方地区以Lumbar检出率最高,可能与北方地区重体力活动相对南方地区多,加速了腰椎的退变有关。南方地区以Ward's检出率最高,有待进一步研究。男性人群中近5年的患病率较5年前明显增加,女性人群中近5年的患病率较5年前明显减小。提示中国为骨质疏松高发地区,开展骨质疏松宣传和相关疾病的防治意义重大。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Multifactorial analysis of risk factors for reduced bone mineral density among postmenopausal women

Introduction

The study aimed to determine the risk factors for reduced bone mineral density (BMD) among postmenopausal women.

Material and methods

Two hundred and fifty-three postmenopausal women were included to the study. The study group consisted of 85 women with osteoporosis (mean age: 59.9 years) and 168 with osteopenia (mean age: 57.8 years). Patients were assigned to groups according to their BMD measured in the lumbar spine, hip and femoral neck by dual X-ray absorptiometry. Bone formation was assessed by measuring serum osteocalcin and bone resorption by measuring serum C-terminal type I α-collagen chain telopeptide.

Results

Multiple regression analysis for lumbar spine showed association of age (p = 0.001), parental history of fracture (p = 0.05), use of hormone replacement therapy (p = 0.034), bisphosphonates therapy (p < 0.001), calcium and vitamin D supplements therapy (p = 0.001), oestradiol level (p = 0.007) and body mass index (p < 0.001). Multiple regression analysis for femoral neck and hip total showed association of age (p = 0.001), parental history of fracture (p = 0.049), use of bisphosphonates (p < 0.03)) use of calcium and vitamin D supplements (p = 0.039), oestradiol level (p = 0.047). All the variables together explain 40.4% of variance in BMD for the lumbar spine and 25.6% of variance in BMD for femoral neck and hip total.

Conclusions

The present study demonstrated correlations between the variables and BMD, which are known and widely described in the literature. Osteoporosis and osteopenia in Polish subjects appear to be associated with several known risk factors that are well described in the literature.