More aggravated osteoporosis in lateral trochanter compared to femoral neck with age: Contributing age difference between inter-trochanteric and femoral neck fractures in elderly patients

In the medical literature, elderly patients with inter-trochanteric fractures are considered older than those with femoral neck fractures, but the reason for this age-related difference remains unclear. Inconsistent bone mass re-distribution with age in both regions was hypothesised and the change in bone mineral density (BMD) was studied. This study aims to investigate another possible pathomechanism of reducing bone strength in the proximal femur with increasing age. The findings might help in developing a better method for preventing osteoporotic hip fractures.

Patients and methods

In the BMD study, 400 consecutive female patients were divided into eight groups, comprising 50 individuals each. Except for the first group (16–20 years), all other groups were divided by 10-year age increments up to 90 years. Relative BMD change with age in different regions in each group was compared.

Results

The BMD ratio of the lateral trochanter to the neck gradually reduced with age, whereas that of the medial trochanter to the neck gradually increased. The comparisons were statistically significant (p < 0.001 in both cases).

Conclusion

One important predisposing factor to affect patients with inter-trochanteric fractures older than those with femoral neck fractures may be that the BMD is further lowered in the lateral trochanter compared to the femoral neck with age. It may be caused by lack of compressive loads in the lateral trochanter in daily activity. All devices which may increase bone mass in the lateral trochanter, theoretically, may be helpful in lowering the incidence of hip fractures.     

应用吻合血管的游离腓骨移植治疗陈旧性股骨颈骨折

目的 对股骨颈骨折内固定失败和骨不连采用吻合血管的游离腓骨移植术治疗并进行临床评价。方法 对自2000年11月～2003年10月，采用吻合血管的游离腓骨移植术治疗的9例股骨颈骨折骨不连伴早期股骨头坏死的病例进行随访，平均随访时间22．5月。结果 9例骨折均获愈合，骨折愈合时间4～6月。在X线片上，所有病例的股骨头骨密度都表现明显增高，未见股骨头坏死加重的表现。Harris评分89．2分。结论 吻合血管的游离腓骨移植术是治疗股骨颈骨折内固定失败伴早期股骨头坏死的有效方法。     

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.     

吻合血管游离腓骨移植治疗股骨颈陈旧性骨折及骨不连

目的评价吻合血管的游离腓骨移植术治疗股骨颈陈旧性骨折和骨不连的临床疗效。方法2000年11月至2005年12月采用吻合血管的游离腓骨移植术治疗29例股骨颈陈旧性骨折或骨不连患者,平均随访时间28．5个月,对患者的临床资料进行回顾性分析。结果术后所有患者均未出现严重手术并发症。患者均获得骨折愈合,骨折愈合时间4～6个月,平均5．6个月。除1例患者术后1年并发股骨头坏死,2年后置换人工关节,其余28例患者在随访期间内髋关节功能良好,Harris评分达88．2分,治愈率达96,3％。结论吻合血管的游离腓骨移植术是治疗股骨颈陈旧性骨折和骨不连的有效方法。     

中药对绝经妇女股骨颈骨密度及股骨颈抗骨折能力的影响

目的 观察中药强骨胶囊（QGJN）对绝经妇女股骨颈骨密度（BMD）及股骨颈抗骨折能力（FS）的影响。方法 择自愿参加研究的绝经1年以上，年龄60岁以下的骨量减少或骨质疏松的绝经妇女150例，随机分为3组：中药＋激素组（50例）：采用中药QGJN联合雌激素戊酸雌二醇治疗；中药组（50例）：单纯用中药QGJN治疗；激素组（50例）：单纯用雌激素戊酸雌二醇周期序贯治疗；另50例符合上述条件，目前不愿接受研究用药的绝经妇女作为对照组。各组均于治疗前及治疗后24W采用DEXA骨密度仪测定股骨颈（BMD）。采用肌肉功能分析仪测定股骨颈抗骨折能力（FS）。结果 因各种原因失访18例，182例（包括对照组）完成了总疗程。中药＋激素组（46例）、中药组（48例）、激素组（42例）、股骨颈BMD及FS较治疗前均有明显升高，增幅分别为7．33％、9．04％（P〈0．01）；3．38％，5．87％（P〈0.01）；3．57％，5．91％（P〈0．01），其中中药＋激素组BMD及FS升高幅值均明显高于中药组（P〈0．01）和激素组（P〈0.01）；而激素组上述指标较中药组略高，但差异无显著性（P〉0．05）；对照组（46例）的BMD及FS明显下降。下降幅值分别为3、30％、5．31％。P〈0．01）。结论 中药强骨胶囊能提高绝经妇女股骨颈骨密度及股骨颈抗骨折能力。从而对绝经妇女骨质疏松具有较好的防治作用。其效果与雌激素戊酸雌二醇相仿。两药联用效果更好。     

老年股骨颈骨折围手术期的治疗分析

目的探讨老年人股骨颈骨折的治疗及围手术期的处理。方法回顾性分析2003年1月～2006年12月手术治疗的201例老年股骨颈骨折患者资料，其中男51例，女150例，年龄60～98岁，平均78．2岁。按Garden分型，Ⅱ型20例，Ⅲ型86例，Ⅳ型95例。采用多枚中空螺钉固定、Morre型人工股骨头置换术或双极人工股骨头置换手术进行治疗。结果本组患者平均住院10～14d，5～7d即能早期下床活动，住院期间及术后1年内无一例死亡。85％患者获得8个月～4年（平均2年）的随访，功能恢复按Harris评分，优良率为85％。结论老年人各脏器机能衰退，多同时合并各种内科疾病，手术治疗存在风险，但老年人股骨颈骨折的手术治疗仍能取得满意疗效。     

经皮双头空心加压螺钉治疗股骨颈骨折

股骨颈骨折是老年人常见的损伤，股骨颈骨折的不愈合率及股骨头坏死率分别为10％～30％和20％～40％，骨折的部位和移位程度是影响股骨颈骨折预后的根本因素。目前，国内外对多针固定的优点已产生共识，空心加压螺钉已成为治疗股骨颈骨折的首选方法。1998年6月-2001年6月，我们采用3枚双头加压空心螺钉治疗股骨颈骨折，取得了较满意疗效，现总结如下。     

骨密度与股骨颈抗骨折能力对骨质疏松诊断价值的比较研究

目的 探索骨密度及股骨颈抗骨折能力两种骨质疏松的诊断方法在临床上应用中各自的特点。方法 用双能X线骨密度仪(DEXA)及神经-肌肉-关节-骨骼综合测量分析系统(MES)分别对118例绝经后妇女进行测量，比较两者的结果，探讨两者的差异的原因。结果 118例绝经后妇女中被DEXA诊断为骨质疏松者48人，患病率为40．67％。有24例被MES诊断为骨质疏松，患病率为20．34％。结论 研究提示DXEA测定骨密度(BMD)的方法更容易发现在正常体重者中的骨质疏松患者，而MES测定股骨颈抗骨折能力指标(FS)的方法在超体重和肥胖者中的骨质疏松诊断中占有优势。FS和BMD结合应用于骨质疏松诊断克服了骨密度(BMD)由于体重影响造成的漏诊和误诊现象。即在正常体重的患者进行诊断时选择BMD，而对于超体重和肥胖者使用FS指标则更为合理。     

Structural and biomechanical basis of racial and sex differences in vertebral fragility in Chinese and Caucasians

We conducted a cross-sectional study in 1868 healthy Chinese and Caucasian women and men aged 18 to 93 years to define the structural and biomechanical basis for racial and sex differences in vertebral body (VB) fragility. VB bone mineral content (BMC), cross-sectional area (CSA), and volumetric bone mineral density (vBMD) of the third lumbar vertebrae were measured using dual-energy X-ray absorptiometry. Using engineering principles, we calculated the load per unit CSA (stress), VB strength estimated from vBMD and the ratio of stress to strength (fracture risk index, FRI). Young adult Chinese women and men had a smaller VB with a higher vBMD than their Caucasian counterparts. In each race, women had a smaller VB than men but similar vBMD. From young adulthood (30 years) to old age (70 years), VB CSA increased more in Chinese than Caucasian women (8.6% vs. 5.8%) and increased less in Chinese than Caucasian men (8.7% vs. 11.8%). Estimated periosteal bone deposited was similar in Chinese and Caucasian women (2.64 vs. 2.63 g, 46% vs. 40% of peak BMC). Estimated endosteal bone lost was similar (3.94 vs. 4.05 g or 68% vs. 62% of peak BMC). As endosteal bone loss exceeded periosteal bone gain, net bone was lost from the VB, but this was similar in Chinese and Caucasian women (1.30 vs. 1.42 g or both lost 22% of peak BMC). For men, Chinese gained less periosteal bone than Caucasians (2.73 vs. 5.05 g or 34% vs. 56% of peak BMC) and lost less endosteal bone (3.07 vs. 5.49 g or 38% vs. 61% of peak BMC), so net bone loss was similar in Chinese and Caucasian men (0.34 vs. 0.44 g, both lost 5% of peak BMC). Comparing sexes, in Chinese, net bone loss was greater in women than in men because of greater endosteal bone loss in women (68% of peak BMC) than men (38% of peak BMC); periosteal bone gain was similar in women and men. In Caucasians, net bone loss was greater in women than men because periosteal bone gain was less in women (40%) than men (56%), endosteal bone loss was similar. The age-related increase in VB CSA reduced VB stress but vBMD decreased so the FRI increased; 25% of elderly Chinese and Caucasian women and 5% of elderly Chinese and Caucasian men had an FRI above unity. The structural basis of bone fragility differs by race and sex. Periosteal apposition plays a pivotal role in determining racial and sex differences in net bone loss, geometry, and strength.     

老年骨质疏松症股骨颈骨折术后抗骨质疏松治疗的初步观察

目的探讨老年人骨质疏松症股骨颈骨折术后应用（密盖息＋钙＋维生素D3）方案抗骨质疏松治疗的效果。方法随机选择诊断为“原发性骨质疏松症＋股骨颈病理性骨折”的老年患者56例,人工关节置换术后除髋关节康复锻炼外,应用（密盖息＋钙＋维生素D3）方案治疗3个月,比较治疗前后临床症状和空腹血钙、磷、甲状旁腺激素、碱性磷酸酶、24h尿钙、磷以及定量CT腰椎骨密度值变化。结果周身疼痛症状改善有效率为50％;治疗3个月前、后空腹血钙、磷、甲状旁腺激素、碱性磷酸酶、24h尿钙、磷变化间的差异无统计学意义（P〉0．05）;腰椎骨密度值间的差异有统计学意义（P〈0．01）。结论老年人股骨颈骨折术后应用（密盖息＋钙＋维生素D3）方案抗骨质疏松治疗能有效增加骨密度,改善疼痛,从而预防再次骨折。     

球囊扩张骨水泥加强内固定术治疗老年骨质疏松性股骨颈骨折的临床初步报告

目的 探讨一种治疗老年骨质疏松性股骨颈骨折的简单、微创、安全、有效的方法。方法 自2001年7月-2003年9月，采用球囊扩张骨水泥加强内固定术治疗23例骨质疏松性股骨颈骨折，男9例，女14例，平均85岁。结果 所有患者术后1-10d疼痛减轻，均下地免负重活动，无严重并发症发生。结论 球囊扩张骨水泥加强内固定术是一种治疗骨质疏松性股骨颈骨折简单、有效、安全的新方法，能早期去除疼痛，尽快使患者下床，减少卧床所致并发症，尤其适用于严重骨质疏松不能耐受人工髋关节置换术的病人。     

Sex differences in geometry of the femoral neck with aging: A structural analysis of bone mineral data

Summary The greater hip fracture rate among elderly women is generally ascribed to differences in femoral neck strength between the sexes. Strength of a given bone is a function of both its material properties and the magnitudes of mechanical stresses within it. This study examined the hypothesis that these apparent strength differences between the sexes are due to dissimilarities in the restructuring of the femoral neck with age, which result in higher stresses in elderly women. Using Hip Strength Analysis, a computer program developed by the authors, femoral neck cross-sectional geometric properties for stress analyses were derived from bone mineral image data of 409 community living, white subjects ranging from 19 to 93 years of age. Though both sexes show declines in femoral neck bone mineral density (BMD) and cross-sectional area with age, only females show a decline in the cross-sectional moment of inertia (CSMI, a geometric index of bone rigidity). The lack of decline in male CSMI appears to be a result of a small but significant increase in femoral neck girth. Similar age-related changes have been observed in the femoral shaft by others. The net effect of these observed changes is that mechanical stresses in the femoral neck of females appear to increase at three times the rate per decade of those of males. These results lend support to the hypothesis that the higher fracture rate in elderly women is due, at least in part, to elevated levels of mechanical stress, resulting from a combination of greater bone loss and less compensatory geometric restructuring with age.     

Treatment of femoral neck fractures in patients 45–64 years of age

Introduction

Young patients with femoral neck fractures are optimally treated with reduction and stable fixation, while patients over the age of sixty-five are often treated with arthroplasty. This study analyzes in-hospital outcomes associated with total hip arthroplasty, hip hemiarthroplasty and internal fixation for treatment of femoral neck fractures in patients aged 45–64.

骨水泥型人工股骨头假体治疗高龄股骨颈骨折

目的报告骨水泥型人工股骨头假体治疗高龄股骨颈骨折的疗效。方法131例患者(新鲜骨折101例,陈旧性骨折30例按Garden分型:Ⅱ型23例,Ⅲ型62例,Ⅳ型46例),取后外侧切口安置骨水泥型人工股骨头,术后药物预防静脉血栓。结果随访0.5～8年,优良率96.4%。结论骨水泥型人工股骨头假体置换术具有手术简单,术后恢复快等优点,适用于高龄股骨颈骨折患者。     

吻合血管腓骨联合髂骨移植治疗陈旧性股骨颈骨折

目的 对治疗失败和骨不连的股骨颈骨折病例进行吻合血管联合髂骨移植治疗并观察临床效果。方法通过对1994至1997年76例应用吻合血管联合髂骨移植治疗陈旧性股骨颈骨折患者进行长期随访，了解骨折愈合、髋关节功能和股骨头坏死情况。结果76例中68例获得随访，平均随访时间10．5年，骨折均在4-6个月内愈合。63例髋关节活动恢复接近正常，平均Harris评分87．5分。股骨头结构正常，植入腓骨和髂骨与股骨头颈部完全融合。4例发现骨坏死，1例合并髋关节脱位。结论对选择保留股骨颈的陈旧性股骨颈骨折患者，吻合血管腓骨联合髂骨移植是一种较好的方法。     

老年性股骨颈骨折178例分析

股骨颈骨折是一种治疗较困难的损伤。现将我院近20年来收治的股骨颈骨折178例治疗结果分析如下。1 临床资料 178例中男113例,女65例;年龄54～87岁,平均64.8岁。骨折类型:头下型71例,头颈型51例,经颈型37例,基底型19例。骨折移位:GardenⅠ型4例,Ⅱ型37例,Ⅲ型86例,Ⅳ型51例。接受非手术治疗43例,手术治疗135例,其中三翼钉固定术36例,多枚斯氏针固定4例,3根加压折断螺纹钉固定术45例,3根空心加压螺纹钉固定术15例,人工股骨头置换术35例。2 结果 股骨颈骨折愈合较慢,本组病例观察愈合时间12～48周,平均26周,因此判定愈合与否不得少于1     

带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折

目的 应用带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折，探讨其早中期随访结果。方法 1997年1月至2003年12月，收治31例陈旧性股骨颈骨折患者，其中有完整随访资料者26例。男19例，女7例；年龄15-38岁，平均25岁。致伤原因：交通伤17例，高处坠落伤9例。Garden骨折分型：Ⅲ型11例，Ⅳ型15例。保守治疗骨折不愈合11例，术后骨折不愈合15例（闭合复位骨圆针固定6例、切开复位螺纹钉或骨圆针固定9例）。受伤时间6-17个月，平均8．5个月。多数患者存在不同程度的肢体短缩及髋关节活动功能受限。X线片显示股骨颈骨折移位17例．股骨颈不同程度吸收9例。手术采用切开复位。带旋髂深血管蒂髂骨瓣植骨及螺纹钉、空心螺钉或骨圆针固定。术后6-8个月开始部分负重．术后11个月开始完全负重。结果 26例随访28-69个月，平均41个月。骨折全部愈合，愈合时间11-15个月，平均12．5个月。随访期间2例发生股骨头坏死。5例患肢短缩超过3cm的患者术后无进一步短缩。Harris髋关节功能评分平均为82．8分。结论 带旋髂深血管蒂髂骨瓣植骨可以改善骨折端的血运，促进青壮年陈旧性股骨颈骨折的愈合。     

吻合血管腓骨移植治疗陈旧性股骨颈骨折

目的 应用吻合血管腓骨移植和加压螺丝钉内固定治疗陈旧性股骨颈骨折,观察股骨颈骨折的愈合和股骨头缺血坏死的修复和预防状况。方法 在加压螺丝钉内固定的基础上,取自体带血管腓骨,移植在股骨头颈部的前外侧,腓骨动静脉与旋股外动静脉吻合。结果 １８６例患者经３￣１５年的系统Ｘ线片和功能随访观察,骨折愈合率为９３．０％,优良率达８６．５％。结论 带血管腓骨和加压螺丝钉对陈旧性股骨颈骨折形成协同固定作用,腓骨坚     

带阔筋膜张肌髂骨瓣移植治疗儿童股骨颈骨折

目的：探讨儿童股骨颈骨折的治疗方法，并对其疗效进行评定。方法：本组儿童股骨颈骨折12例，男7例，女5例；年龄7～15岁，平均10．5岁。损伤按Delbet分型：Ⅰ型1例，Ⅱ型6例，Ⅲ型4型，Ⅳ型1例。全部病例均行切开复位、多枚克氏针固定，并应用带阔筋膜张肌髂骨瓣移植，以促进骨折愈合。结果：经平均4．5年随访，所有骨折均解剖复位，无切口感染及断针情况发生，除Ⅰ型1例发生股骨颈变短、骺板早闭，Ⅱ型2例发生股骨头缺血眭坏死外，其余病例骨折均愈合。按赵东升等功能评定标准：优6例，良3例，差3例，优良率达75％。结论：多枚克氏针呈三角锥形固定具有较强的抗水平剪力及旋转应力，固定可靠，阔筋膜张肌的营养血管行走恒定，血供丰富，髂骨块切取后对患儿的肢体功能和形态无影响，是治疗儿童股骨颈骨折比较理想的一种方法。     

Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate

Purpose

Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.