老年骨质疏松性骨折的外科治疗进展
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摘要
骨质疏松性骨折是老年患者致残、致死的常见病因,严重影响老年人的生活质量。随着骨折内固定理论及技术的发展,骨质疏松性骨折的外科治疗取得了明显进步。本文从治疗理念、内固定材料、特殊部位骨折的治疗及数字医学的应用等方面进行阐述,以供临床参考。
Osteoporotic fracture is a common cause of disability and mortality in elderly patients, which seriously affects the quality of life of the elderly. With the development of fracture internal fixation theory and technology, the surgical treatment of osteoporotic fracture has made remarkable progress.This article elaborates the treatment concept, internal fixation materials, treatment of special site fractures and the application of digital medicine for clinical reference. Osteoporotic fracture is a common cause of disability and mortality in elderly patients, which seriously affects the quality of life of the elderly. With the development of fracture internal fixation theory and technology, the surgical treatment of osteoporotic fracture has made remarkable progress. This article elaborates the treatment concept, internal fixation materials, treatment of special site fractures and the application of digital medicine, which may provide some clinical references.
Osteoporotic fracture is a common cause of disability and mortality in elderly patients, which seriously affects the quality of life of the elderly. With the development of fracture internal fixation theory and technology, the surgical treatment of osteoporotic fracture has made remarkable progress.This article elaborates the treatment concept, internal fixation materials, treatment of special site fractures and the application of digital medicine for clinical reference. Osteoporotic fracture is a common cause of disability and mortality in elderly patients, which seriously affects the quality of life of the elderly. With the development of fracture internal fixation theory and technology, the surgical treatment of osteoporotic fracture has made remarkable progress. This article elaborates the treatment concept, internal fixation materials, treatment of special site fractures and the application of digital medicine, which may provide some clinical references.
引文
[1]张奎,刘洋,马煜,等.骨质疏松性骨折与相关基因多态性研究进展[J].中国骨质疏松杂志,2017,23(7):974-980.Zhang K, Liu Y, Ma Y, et al. Research progress in osteoporotic fractures and the related gene polymorphisms[J]. Chinese Journal of Osteoporosis, 2017, 23(7):974-980.
[2]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南——骨质疏松性骨折诊断及治疗原则[J].黑龙江科学,2018,9(2):85-88,95.Qiu GX, Pei FX, Hu ZM, et al. Guidelines for the diagnosis and treatment of osteoporotic fractures in ChinaPrinciples for the diagnosis and treatment of osteoporotic fractures[J]. Heilongjiang Science, 2018, 9(2):85-88,95.
[3]祁福.老年髋骨骨折的多因素调查分析[J].武汉大学学报(医学版),2017,38(1):128-130,158.Qi F. Multivariate analysis of hip fracture in the elderly[J]. Medical Journal of Wuhan University, 2017,38(1):128-130,158.
[4] Bonaccorsi G, Messina C, Cervellati C,et al. Fracture risk assessment in postmenopausal women with diabetes:comparison between DeFRA and FRAX tools[J].Gynecol Endocrinol,2018,34(5):404-408.
[5]王永强,刘晓光.影响骨质疏松患者椎弓根螺钉固定强度的相关技术进展[J].中国脊柱脊髓杂志,2016,26(5):466-470.Wang YQ, Liu XG. Technological advances in influencing the strength of pedicle screw fixation in osteoporotic patients[J]. Chinese Journal of Spine and Spine,2016,26(5):466-470.
[6] Takura T, Yoshimatsu M, Sugimori H, et al. Cost-effectiveness analysis of percutaneous vertebroplasty for osteoporotic compression fractures[J]. Clin Spine Surg,2017,30(3):E205-E210.
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[9]李淼,史晓,施丹,等.骨质疏松症相关细胞因子研究进展[J].中国骨质疏松杂志,2018,24(12):1 647-1 651.Li M, Shi X, Shi D, et al. Progress in the study of osteoporosis-related cytokines[J]. Chinese Journal of Osteoporosis, 2018,24(12):1 647-1 651.
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[11]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.Guidelines for the Prevention of Venous. Thromboembolism in major orthopaedic surgery of China[J]. Chinese Journal of Orthopaedics, 2016,36(2):65-71.
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[15] Asif N, Ahmad S, Qureshi OA, et al. Unstable intertrochanteric fracture fixation-Is proximal femoral locked compression plate better than dynamic hip screw[J]? J Clin Diagn Res, 2016,10(1):RC09-RC13.
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[17] Kiriakopoulos E, McCormick F, Nwachukwu BU, et al. In-hospital mortality risk of intertrochanteric hip fractures:a comprehensive review of the US Medicare database from 2005 to 2010[J]. Musculoskelet Surg, 2017,101(3):213-218.
[18]熊文,陈明,郑琼.加长Gamma 3钉结合钛缆固定治疗SeinsheimerⅢ型老年股骨转子下骨折[J].中华创伤骨科杂志,2018,20(1):33-37.Xiong W, Chen M, Zheng Q. Treatment of Seinsheimer typeⅢsubtrochanteric femoral fractures with prolonged Gamma3 nails and titanium wire fixation in the aged patients[J]. Chinese Journal of Orthopaedic Trauma, 2018,20(1):33-37.
[19]郭小龙.股骨粗隆间骨折手术治疗研究进展[J].医学理论与实践,2016,29(20):3 465-3 466,3 469.Guo XL. Progress in surgical treatment of intertrochanteric fracture of femur[J]. Medical Theory and Practice,2016,29(20):3 465-3 466,3 469.
[20]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015,35(1):266-268.Zhang WQ, Qi BC, Deng PF, et al. Clinical progress in the treatment of intertrochanteric fracture of femur in the elderly[J]. Chinese Journal of Gerontology, 2015,35(1):266-268.
[21]袁琦,李强,郝彦明,等. Inter TAN与PFNA治疗老年骨质疏松AO/OT A31-A2型股骨转子间骨折临床疗效的比较[J].中国骨与关节杂志,2018,7(11):828-831.Yuan Q, Li Q, Hao YM, et al. Comparison of InterTAN nail and PFNA in managing AO/OT A31-A2 intertrochanteric hip fracture in older osteoporotic patients[J]. Chinese Journal of Bone and Joint, 2018,7(11):828-831.
[22]中国老年医学学会骨与关节分会创伤骨科学术工作委员会.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.Chinese Geriatrics Society Bone and Joint Association Orthopaedic Trauma Committee Corresponding. Experts'concensus on diagnosis and management of geriatric hip fractures(2017)[J]. Chin J OrthopTrauma, 2017,19(11):921-927.
[23] Jettoo P, James P. Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture[J].J Orthop Surg(Hong Kong), 2016,24(2):146-149.
[24] Chen C, Yu L, Tang X, et al. Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures:A retrospective study[J]. Acta Orthop Traumatol Turc,2017,51(5):381-387.
[25]刘砥彬,付玉,战丽丽.人工股骨头置换术治疗老年股骨颈骨折疗效观察[J].中华灾害救援医学,2018,6(8):441-444.Liu DB, Fu Y, Zhan LL. Observation of the curative effect of artificial femoral head replacement in the treatment of femoral neck fracture in the elderly[J]. Chinese Disaster Relief Medicine, 2018,6(8):441-444.
[26]中华医学会骨科学分会创伤骨科学组,中国医师协会骨科医师分会创伤专家工作委员会.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志, 2018, 20(11):921-928.Traumatic Orthopedics Group, Society of Orthopedics,Chinese Medical Association; Trauma Experts Working Committee, Society of Orthopaedists, Association of Chinese Doctors. Guidelines for the diagnosis and treatment of femoral neck fractures in adults[J]. Chinese Journal of Traumatic Orthopaedics, 2018, 20(11):921-928.
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[2]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南——骨质疏松性骨折诊断及治疗原则[J].黑龙江科学,2018,9(2):85-88,95.Qiu GX, Pei FX, Hu ZM, et al. Guidelines for the diagnosis and treatment of osteoporotic fractures in ChinaPrinciples for the diagnosis and treatment of osteoporotic fractures[J]. Heilongjiang Science, 2018, 9(2):85-88,95.
[3]祁福.老年髋骨骨折的多因素调查分析[J].武汉大学学报(医学版),2017,38(1):128-130,158.Qi F. Multivariate analysis of hip fracture in the elderly[J]. Medical Journal of Wuhan University, 2017,38(1):128-130,158.
[4] Bonaccorsi G, Messina C, Cervellati C,et al. Fracture risk assessment in postmenopausal women with diabetes:comparison between DeFRA and FRAX tools[J].Gynecol Endocrinol,2018,34(5):404-408.
[5]王永强,刘晓光.影响骨质疏松患者椎弓根螺钉固定强度的相关技术进展[J].中国脊柱脊髓杂志,2016,26(5):466-470.Wang YQ, Liu XG. Technological advances in influencing the strength of pedicle screw fixation in osteoporotic patients[J]. Chinese Journal of Spine and Spine,2016,26(5):466-470.
[6] Takura T, Yoshimatsu M, Sugimori H, et al. Cost-effectiveness analysis of percutaneous vertebroplasty for osteoporotic compression fractures[J]. Clin Spine Surg,2017,30(3):E205-E210.
[7]冯博,郝定均,郭浩.经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的研究进展[J].中华老年骨科与康复电子杂志,2016,2(3):185-188.Feng B, Hao DJ, Guo H. Progress in percutaneous kyphoplasty for osteoporotic vertebral compression fractures in the elderly[J]. Chinese Journal of Geriatric Orthopedics and Rehabilitation, 2016,2(3):185-188.
[8]王兵站,王利民,谭洪宇,等.骨质疏松性胸腰椎体陈旧压缩骨折并发裂隙征患者的PKP手术效果[J].武汉大学学报(医学版),2016,37(2):309-312.Wang BZ, Wang LM, Tan HY, et al. PKP effect of patients with osteoporotic thoracolumbar vertebral body old compression fracture complicated with fissure sign[J]. Medical Journal of Wuhan University, 2016,37(2):309-312.
[9]李淼,史晓,施丹,等.骨质疏松症相关细胞因子研究进展[J].中国骨质疏松杂志,2018,24(12):1 647-1 651.Li M, Shi X, Shi D, et al. Progress in the study of osteoporosis-related cytokines[J]. Chinese Journal of Osteoporosis, 2018,24(12):1 647-1 651.
[10]季祥,文良元.老年人髋部骨折治疗进展[J].中华老年医学杂志,2018,37(12):1 418-1 422.Ji X, Wen LY. The latest progression for treatment of hip fracture in the elderly[J]. Chinese Journal of Geriatrics, 2018,37(12):1 418-1 422.
[11]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.Guidelines for the Prevention of Venous. Thromboembolism in major orthopaedic surgery of China[J]. Chinese Journal of Orthopaedics, 2016,36(2):65-71.
[12]王军,高明,危杰,等.老年髋部骨折围手术期隐性失血量的相关影响因素分析[J].中华创伤骨科杂志,2015,17(2):143-146.Wang J, Gao M, Wei J, et al. Analysis of the influencing factors of occult blood loss in perioperative period of elderly hip fracture[J]. Chinese Journal of Traumatic Orthopaedics, 2015,17(2):143-146.
[13]安志军,吕松岑,史立强.老年人股骨粗隆间骨折的治疗进展[J].中国伤残医学,2016,24(6):207-210.An ZJ, LV SC, Shi LQ. Progress in the treatment of femoral intertrochanteric fractures in the elderly[J].China Disability Medicine, 2016,24(6):207-210.
[14] Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw:a comparative study[J]. Rev Bras Ortop, 2018,53(4):477-481.
[15] Asif N, Ahmad S, Qureshi OA, et al. Unstable intertrochanteric fracture fixation-Is proximal femoral locked compression plate better than dynamic hip screw[J]? J Clin Diagn Res, 2016,10(1):RC09-RC13.
[16]熊蠡茗,胡益强,邵增务.股骨近端锁定板固定治疗老年不稳定型股骨转子间骨折[J].中华创伤骨科杂志,2017,19(2):115-119.Xiong LM, Hu YQ, Shao ZW. Treatment of unstable intertrochanteric fracture of femur in the elderly with proximal femoral locking plate fixation[J]. Chinese Journal of Traumatic Orthopaedics, 2017, 19(2):115-119.
[17] Kiriakopoulos E, McCormick F, Nwachukwu BU, et al. In-hospital mortality risk of intertrochanteric hip fractures:a comprehensive review of the US Medicare database from 2005 to 2010[J]. Musculoskelet Surg, 2017,101(3):213-218.
[18]熊文,陈明,郑琼.加长Gamma 3钉结合钛缆固定治疗SeinsheimerⅢ型老年股骨转子下骨折[J].中华创伤骨科杂志,2018,20(1):33-37.Xiong W, Chen M, Zheng Q. Treatment of Seinsheimer typeⅢsubtrochanteric femoral fractures with prolonged Gamma3 nails and titanium wire fixation in the aged patients[J]. Chinese Journal of Orthopaedic Trauma, 2018,20(1):33-37.
[19]郭小龙.股骨粗隆间骨折手术治疗研究进展[J].医学理论与实践,2016,29(20):3 465-3 466,3 469.Guo XL. Progress in surgical treatment of intertrochanteric fracture of femur[J]. Medical Theory and Practice,2016,29(20):3 465-3 466,3 469.
[20]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015,35(1):266-268.Zhang WQ, Qi BC, Deng PF, et al. Clinical progress in the treatment of intertrochanteric fracture of femur in the elderly[J]. Chinese Journal of Gerontology, 2015,35(1):266-268.
[21]袁琦,李强,郝彦明,等. Inter TAN与PFNA治疗老年骨质疏松AO/OT A31-A2型股骨转子间骨折临床疗效的比较[J].中国骨与关节杂志,2018,7(11):828-831.Yuan Q, Li Q, Hao YM, et al. Comparison of InterTAN nail and PFNA in managing AO/OT A31-A2 intertrochanteric hip fracture in older osteoporotic patients[J]. Chinese Journal of Bone and Joint, 2018,7(11):828-831.
[22]中国老年医学学会骨与关节分会创伤骨科学术工作委员会.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.Chinese Geriatrics Society Bone and Joint Association Orthopaedic Trauma Committee Corresponding. Experts'concensus on diagnosis and management of geriatric hip fractures(2017)[J]. Chin J OrthopTrauma, 2017,19(11):921-927.
[23] Jettoo P, James P. Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture[J].J Orthop Surg(Hong Kong), 2016,24(2):146-149.
[24] Chen C, Yu L, Tang X, et al. Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures:A retrospective study[J]. Acta Orthop Traumatol Turc,2017,51(5):381-387.
[25]刘砥彬,付玉,战丽丽.人工股骨头置换术治疗老年股骨颈骨折疗效观察[J].中华灾害救援医学,2018,6(8):441-444.Liu DB, Fu Y, Zhan LL. Observation of the curative effect of artificial femoral head replacement in the treatment of femoral neck fracture in the elderly[J]. Chinese Disaster Relief Medicine, 2018,6(8):441-444.
[26]中华医学会骨科学分会创伤骨科学组,中国医师协会骨科医师分会创伤专家工作委员会.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志, 2018, 20(11):921-928.Traumatic Orthopedics Group, Society of Orthopedics,Chinese Medical Association; Trauma Experts Working Committee, Society of Orthopaedists, Association of Chinese Doctors. Guidelines for the diagnosis and treatment of femoral neck fractures in adults[J]. Chinese Journal of Traumatic Orthopaedics, 2018, 20(11):921-928.
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