老年髋部骨质疏松性骨折的治疗

目的 观察老年髋部骨质疏松性骨折的治疗效果,并分析影响患者预后的相关因素.方法 老年髋部骨质疏松性骨折患者118例,根据自身和骨折情况进行不同的治疗,观察患者的治疗效果,并分析影响疗效的相关因素.结果 12例患者采用非手术治疗,106例采用手术治疗.所有患者均好转,手术患者住院时间为(18.6±7.2)d,术后均无严重并发症;非手术患者治疗时间为3个月,其中肺部感染2例.轻度骨质疏松18例,中度骨质疏松58例,重度骨质疏松42例.多因素Logistic回归分析发现年龄、性别、骨折原因、基础疾病、患者的骨密度疏松情况、治疗方法均为影响疗效的相关因素.结论 治疗老年髋部骨质疏松性骨折不但需要根据患者的自身因素,也应顾及骨质疏松情况,选择适宜的治疗方法,配合合理的康复锻炼,才能取得良好的临床效果.     

骨质疏松性骨折

一、骨质疏松症及骨质疏松性骨折的流行病学我国60岁以上老龄人口已达1.3亿。在华北、华东、华南、西南及东北五大区,对40岁以上汉族人群5602人的调查结果显示,骨质疏松症患病率为12.4%(男8.5%,女15.7%)。Morgan报道,妇女每10年平均骨量丢失10%,男性每10年骨量丢失5～7%。全球大约有2亿人口罹患骨质疏松症。骨质疏松的后果是导致骨折。美国绝经妇女中预期有1/4发生骨质疏松性骨折。60岁以后,妇女每增龄5岁,骨折发生率将增加一倍。欧洲1999年统计资料显示髋部骨折达48万5千余人。美国因骨质疏松性骨折住院治疗者40万人,另有250万人需接受门…     

应用骨形态计量学观察粗聚焦震波对大鼠骨质疏松性骨折愈合的影响

目的应用骨形态计量学观察粗聚焦震波对大鼠骨质疏松性骨折愈合的影响,探讨其作用机制。方法将30只体重为(280±2.5)g的6月龄雌性清洁级SD大鼠双卵巢去势,复制骨质疏松模型后行双侧胫骨近端截骨并予克氏针内固定术。术后左侧胫骨用能量密度0.26mj/mm2,频率60次/min,脉冲2000次的高能震波治疗1次(治疗组),右侧胫骨不予震波治疗(对照组)。随后行组织学观察、骨组织不脱钙切片观察与测定。结果组织学观察结果显示,震波治疗后2周时治疗组与对照组相比炎性反应强,胶原形成相对多,成熟胶原多,形成的骨小梁较多;4周时治疗组成熟骨小梁较多,软骨性骨痂逐渐为骨性骨痂替代,大量类骨质形成。骨组织不脱钙切片观察与测定发现,震波治疗后8周治疗组大鼠骨体积分数(BV/TV)、骨小梁数(Tb.N)、骨小梁厚度(Tb.Th)、活跃成骨细胞表面(Ob.S/BS)、纠正骨矿化沉积率(jMAR)等参数均高于对照组,而骨小梁骨间距(Tb.S)、矿化延迟时间(Mlt)等指标低于对照组,差异均具有统计学意义。结论粗聚焦高能震波能促进骨质疏松性骨折后骨形成,改善骨形态,提高局部骨密度,达到防止骨量丢失的作用。同时可增加骨矿化沉积率,缩短矿化延迟时间,抑制骨转换,可能成为局部治疗和预防人体骨质疏松性骨折的新选择。     

骨质疏松椎体压缩性骨折治疗现状及展望

随着年龄的增长,人体机能一些退行性病变将逐渐表现出来,从而影响人们的工作与生活。其中最为常见的退行性病变疾病是骨质疏松症(Osteoporosis, OP),除去疾病本身骨吸收增加引起的周身疼痛(腰背部多见)外,最严重的并发症是骨折,其中又以椎体压缩性骨折最为常见。骨质疏松性椎体压缩性骨折(Osteoporotic Vertebral Compression Fracture, OVCF)可给患者的生活带来严重影响,包括腰背部疼痛加剧、驼背畸形等。由于老年患者基础病较多,若本病治疗效果欠佳,患者卧床时间较长,则有可能诱发甚至加重基础病,使患者生活质量严重下降。随着医疗技术的不断发展,目前针对骨质疏松性椎体压缩性骨折的治疗方法十分丰富且均可获得一定的疗效,主要分为非手术治疗和手术治疗,其中非手术治疗包括中药西药内服、物理治疗、手法复位治疗等;手术治疗包括微创手术和开放性手术治疗。笔者通过阅读近年国内外相关文献并整理和分析,骨质疏松性椎体压缩性骨折的治疗方法,对比各治疗方法的优缺点,为临床治疗骨质疏松性椎体压缩性骨折选择较优方案提供参考。     

股骨近端骨质疏松性骨折60例的手术治疗分析

目的 探讨治疗股骨近端骨质疏松性骨折的最佳手术方式.方法 将60例符合诊断标准的股骨近端骨质疏松性骨折患者随机分为两组,内固定组32例,采用动力髋部螺钉(DHS)12例,重建钉8例,伽玛钉7例,股骨近端髓内钉(PFN)5例;假体置换术组28例,全部行骨水泥型双极人工股骨头置换术.术后随访8～24个月.结果　内固定组优良率为62.5%,行骨水泥型双极人工股骨头置换术患肢功能优良率为89.3%,假体置换术组优良率较高.结论 对无手术禁忌证的股骨近端骨质疏松性骨折应尽可能行人工假体置换术,以提高患者生活质量,减少并发症.     

应力刺激促进骨质疏松性骨折愈合研究进展

正骨质疏松导致骨折的概率为69.4%~([1])。临床上对骨质疏松的治疗大多使用药物,虽然获得一定疗效,但同时也带来很多副作用。近年来研究发现生物力学因素如适当的应力刺激可以促进骨形成和骨重建效应,但是不同的强度及频率影响成骨效果~([2])。在国际生物力学领域专家将机械振动用于动物和细胞实验,证实了低载荷机械振动可以促进骨细胞的生长~([3,4])。大量实验研究表明低载荷(频率0~100 Hz,加速度     

骨质疏松性骨折及治疗原则

介绍了骨质疏松症及明质疏松性骨折的流行病学。对中国五大区40岁以上人群5602人次调查，骨质疏松症患病率为12.4%，骨量减少症患病率为为15.8%。北京地区50岁以上女脊椎骨折患病率为15%。骨质疏松性骨折与骨量丢失、微结构破坏导致物理性能降低有关，四肢骨折还与外伤因素有关。骨质疏松性骨折骨痂成熟与新骨形成迟缓，骨的矿化与骨痂质量相对较差。老年骨质疏松性骨折的治疗目的和治疗原则是减少并发症，降低病死率，改善生活质量。另外，不应忽视骨质疏松症的治疗，以防止和降低骨折再发生率等。对常见的髋部转子间骨折、股骨颈囊内骨折、脊椎骨折及肱骨近端骨折等骨质疏松性骨折当今常用治疗方法与适应症也作了简要介绍。     

骨质疏松性骨折外科治疗策略

随着人类寿命的延长，人口老龄化导致骨质疏松症（osteoporosis，OP）及其引起的骨折越来越多，严重威胁着中老年人的健康。根据我国“九五”攻关课题流行病学研究结果表明，我国OP及低骨量的总患病率分别为22．6％和13．3％。同时，〉50岁人群中骨质疏松性骨折总患病率为26．6％，其中，男性24．6％，     

骨质疏松性骨折的流行病学研究进展

骨质疏松可以定义为"以低骨量和骨组织的微结构损伤为特征,并最终导致骨脆性增加及容易发生骨折的一种全身性骨疾病".由于脆性骨折是骨质疏松造成的主要公共健康危害,因此诊断指标应该是那些可以预测骨折的指标.     

���������Թ��ۼ���Ӱ����������

骨质疏松是一种进行性的骨骼系统疾病,最终将导致骨骼脆性增加,骨折发生。骨质疏松性骨折发生受到骨密度、骨强度、脆性骨折史、骨折家族史、年龄及衰老、皮质激素应用、低体重、跌倒、饮食异常和某些疾病等多种危险因素的影响。骨质疏松性骨折愈合则受到生物学,机械和药物等因素的影响。     

Nonpharmacological prevention of osteoporotic fractures

Osteoporosis is a systemic, metabolic disease that can result in debilitating fractures. The lasting effects of vertebral and hip fractures can cause acute and chronic pain, deformity, and emotional distress. Research evidence and clinical experience have determined that weight bearing and strength training exercise, fall prevention efforts, hip protectors, and some alternative therapies may assist patients in avoiding the pervasive and lasting effects of osteoporotic fractures. Clinicians should consider the recommendations of nonpharmacological measures to assist patients at risk for experiencing the culminating event of this destructive disease.     

经皮椎体后凸成形术治疗老年骨质疏松性椎体骨折: 单球囊与双球囊对比研究

目的 探讨单球囊与双球囊椎体后凸成形术治疗骨质疏松性椎体骨折的疗效。方法2008年4月～2010年2月,收治骨质疏松性椎体压缩骨折患者26例,累及椎体35个。随机分为单球囊组,15例,21个椎体,平均72（53～79）岁;双球囊组,11例,14个椎体。平均70．8（51～80）岁。手术于x线透视下完成,双球囊组应用双球囊在椎体内双侧同时扩张;单球囊组应用单球囊双侧穿刺在椎体内交替扩张。术后观察症状改善、椎体高度复位及后凸畸形矫正、并发症发生等情况。结果单球囊组平均每个椎体手术时间37．5（33～85）min;双球囊组平均每个椎体手术时间33．9（30～75）min;随访时间12～18个月,平均14．8个月。术后患者腰背痛症状均较术前明显缓解。VAS疼痛评分：单球囊组术前平均为7．6±2．2,术后为2．5±1．8,末次随访为3．1±2．0,手术前后差异有统计学意义（P〈O．05）;双球囊组术前平均为7．9±2．3,术后为2．4±2．0,末次随为2．9±2．1,手术前后差异有统计学意义（P〈0．05）;两组术后椎体前缘、中央高度均比术前有显著增加,且维持至末次随访,差异均有统计学意义（P〈0．05）。椎体后凸角单球囊组平均矫正（7．0°±4．5°）,双球囊组平均矫正（7．7°±3．9°）,各组手术前后比较,差异有统计学意义（P〈0．05）。而两组间上述各指标对应比较,差异无统计学意义。结论单球囊与双球囊椎体后凸成形术治疗老年骨质疏松性压缩骨折均可获得满意的治疗效果。     

Effect of ipriflavone on pain due to recent osteoporotic vertebral crush fracture

Aim: Ipriflavone conserves bone mass in postmenopausal osteoporosis. Salmon calcitonin and alendronate, two other anti‐resorptive drugs, have been found to have analgesic effects in osteoporotic acute vertebral fracture. This study aimed to determine if ipriflavone also possesses such an effect. Methods: Thirty‐two women with recent osteoporotic vertebral fractures were randomly assigned to ipriflavone treatment or placebo groups. Ipriflavone was given at the dose of 200 mg three times a day. Non‐steroidal anti‐inflammatory drugs were given ad libitum in both groups. Calcium carbonate (1 g daily) was administered to all subjects. Intensity of pain at rest, on movement and on pressure, pain rating on a 10‐point visual analogue scale, degree of mobility impairment, and supplementary analgesic were assessed at the end of a 3‐month period in both groups to assess the analgesic effect of ipriflavone. Results: Fourteen subjects in the ipriflavone group and 12 in the placebo group completed the trial. After 3 months, all pain variables had decreased significantly in both groups. Intensity of pain at rest and on pressure and supplementary analgesic use were significantly lower in the ipriflavone group compared to the placebo group. Conclusion: The study shows that ipriflavone has an analgesic adjuvant effect in acute osteoporotic vertebral fracture.     

Principles of osteoporotic fracture treatment

The number of osteoporotic fractures is still increasing and the overall management of these multimorbid patients is demanding. Surgical management of these fractures is challenging due to often comminuted fractures and poor purchase of implants. New implants and some with add-on possibilities such as standardized cement augmentation have been developed to address these problems. With these technical innovations the overall patient outcome can be improved. This review describes general considerations in operative treatment of osteoporotic fractures and gives recommendations for a selection of frequent fracture types.     

Prescribing by general practitioners after an osteoporotic fracture

OBJECTIVES—Osteoporosis is a major cause of morbidity and cost. Patients sustaining one osteoporotic fracture are at increased risk of having another fracture. The objective of this study was to examine the use of "bone drugs" for the prevention of further osteoporotic fractures among patients who have had a "typical" osteoporotic fracture.
METHODS—This study took a random sample of 300 women aged 50 and over who had sustained either a vertebral, hip or Colles fracture in 1995 from the General Practice Research Database (GPRD) and compared their use of bone drugs with 300 age and practice matched controls.
RESULTS—Compared with age and practice matched control patients only vertebral fracture patients showed a statistically significant increase in the use of bone drugs in the year after fracture (39% and 2% for cases and controls respectively; 95% CI of difference 27% to 47%). Etidronate was the most commonly used compound.
CONCLUSION—The majority of patients sustaining an osteoporotic fracture are not prescribed any pharmaceutical agents for the secondary prevention of fracture one year after a primary fracture.

Keywords: osteoporosis; fracture     

骨水泥在骨质疏松性脊柱压缩骨折的应用与研究现状

骨水泥已广泛应用在脊柱外科领域。在椎体成形术和后凸成形术中应用的主要是三种骨水泥：聚甲基丙烯酸甲酯骨水泥（PMMA）;磷酸钙骨水泥（CPC）,硫酸钙骨水泥（CSC）;掺骨生长因子的其他可注射物。它们各有优缺点。随着骨水泥材料学、生物力学研究的进展,骨水泥的性能不断改进,在此基础上研究的新的骨水泥将能更好的用于脊柱骨折。     

The association of OPG polymorphisms with risk of osteoporotic fractures: A systematic review and meta-analysis

Background:Subjects with low bone mineral density and osteoporosis are more likely to suffer osteoporotic fractures during their lifetime. Polymorphisms in osteoprotegerin (OPG) gene are found to be associated with low bone mineral density and osteoporosis risk but their association with fracture risk is inconclusive. Here, we performed a meta-analysis to investigate the relationship between OPG polymorphisms with susceptibility to osteoporotic fractures.Methods:Eligible studies investigating the association between common OPG polymorphisms (A164G, T245G, T950C, and G1181C) and risk of osteoporotic fracture were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Odds ratio (OR) and the 95% confidence interval (CI) were calculated in the allelic, dominant, recessive, and homozygous model. Subgroup analyses of vertebral fractures, Caucasians, and postmenopausal women were also performed.Results:A total of 14 studies comprising 5459 fracture cases and 9860 non-fracture controls were included. A163G was associated with fracture risk in dominant (OR = 1.29, 95%CI 1.11–1.50), recessive (OR = 1.64, 95%CI 1.10–2.44), and homozygous model (OR = 1.73, 95%CI 1.16–2.59). T245G was significantly correlated with susceptibility to fractures in all genetic models. Subjects with CC genotype of T950C had a reduced risk of fracture compared to those with CT or TT genotypes (OR = 0.81, 95%CI 0.70–0.94, P = .004). Subgroup analysis showed that A163G and T245G but not T950C and G1181C were associated with vertebral fracture risk.Conclusion:OPG A163G and T245G polymorphisms were risk factors of osteoporotic fractures while T950C had a protective role. These polymorphisms can be used as predictive markers of fractures.     

肌少症和骨质疏松对类风湿关节炎患者脊柱骨质疏松性骨折的协同影响

目的探讨肌少症和骨质疏松(OP)对RA患者脊柱骨质疏松性骨折(OPF)发生的协同影响.方法选择389例住院的RA患者和同期156例年龄、性别相匹配的健康人,采用双能X线吸收测量(DEXA)法测定腰椎和髋部的骨密度(BMD),采用生物电阻抗法测定四肢骨骼肌质量,摄脊柱X线正侧位片并以半定量法进行脊柱骨折的判定.统计学方法:2组间计量资料比较采用t检验,组间率的比较采用x2检验,2项分类资料的多元回归分析采用Logistic回紧(backward LR法)分析.结果RA患者各测定部位BMD均低于对照组(P<0.01),RA组骨质疏松发生率(128/389,32.9%)高于对照组[(20/156,12.8%),χ^2=22.706,P<0.01];RA患者脊柱OPF发生率为21.6%(84/389),高于对照组中[(3.8%,6/156),χ^2=25.439,P<0.01].RA患者中肌少症的发生率为54.8%,高于对照组[(9.6%,15/156),χ^2=93.241,P<0.01];RA组肌少症合并骨质疏松的发生率(28.5%)高于对照组[(5.8%),χ^2=118.110,P<0.01 ].不同骨量(骨量正常、骨量减少、骨质疏松)分组间RA患者脊柱OPF发生率的差异有统计学意义(χ^2=43.373,P<0.01),且呈现出随着骨量逐渐降低,脊柱OPF发生率逐渐升高的趋势(χ^2=43.003,P<0.01).伴肌少症的RA患者脊柱OPF发生率(27.2%,58/213)高于无肌少症的RA患者[(14.8%,26/176),χ^2=8.833,P=0.003].根据骨质疏松和肌少症分组的3组间(1=无肌少症和骨质疏松;2=单纯肌少症或骨质疏松;3=肌少症合并骨质疏松)RA患者脊柱OPF发生率的差异有统计学意义(χ^2=33.832,P<0.01),且从第1组到第3组脊柱OPF的发生率有逐渐增高的趋势(χ^2=37.164,P<0.01).与未服用糖皮质激素(GC)组相比,服用GC组的RA患者具有更高的肌少症发生率(χ^2=7.136,P=0.008)、OP发生率(CI=10.900,P=0.004)和脊柱OPF发生率(χ^2=20.673,P<0.01).Logistic回归分析显示:高龄[OR(95%CI)=1.069(1.038,1.101),P<0.01]、服用GC[OR(95%CI)=3.169(1.679,5.984),P<0.01]、肌少症和骨质疏松[OR(95%CI)=2.113(1.430,3.124),P<0.01]的同时存在为RA患者发生脊柱OPF的危险因素.结论RA患者肌少症、骨质疏松和脊柱OPF的发生率均明显增高,且肌少症和骨质疏松对RA患者脊柱OPF的发生具有协同作用.     

绝经后骨质疏松性髋部骨折住院患者心理状况分析

目的调查分析绝经后女性骨质疏松性髋部骨折住院患者的心理状况。方法采用一般资料问卷和非精神科住院患者心理状态评定量表(MSSNS),对45例绝经后女性骨质疏松性髋部骨折住院患者进行问卷评估,采用SPSS11.5统计软件进行数据分析。结果绝经后骨质疏松性髋部骨折住院患者的抑郁、孤独和总分分值均高于常模的相应项目分值,差异有统计学意义;与同龄常模相比,本组患者的抑郁、焦虑、愤怒、孤独和总分分值都高于同龄常模,差异有统计学意义;组内分析显示,绝经后女性骨质疏松性髋部骨折住院患者的文化程度、年龄分段和婚姻状况的差异无统计学意义。结论绝经后女性骨质疏松性髋部骨折住院患者属于身心均处于应激状态的特殊群体,需要给予特别的关注。