骨质疏松性骨折手术治疗策略
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摘要
骨质疏松性骨折是老年人中最常见的骨骼系统疾病之一,具有发病率高、致残率高、致死率高和医疗支出大等特点。由于患者的骨质量差,粉碎性骨折多见,内固定治疗稳定性差,卧床时间较长,再骨折发生率高,因而,骨质疏松性骨折的手术治疗亦面临着诸多挑战。本文对近年来骨质疏松性骨折手术治疗的原则和技术进行回顾和总结。
Osteoporotic fracture is one of the most common skeletal system diseases in the elderly, which has the characteristics of high incidence, high disability rate, high mortality, and high medical cost. Because of the poor bone quality, comminuted fractures occur frequently, the stability of internal fixation is poor, bed stay time is long, and incidence of refracture is high. Therefore, the surgical treatment of osteoporotic fractures continues to challenge orthopedic surgeon. This paper reviews and summarizes the principles and techniques of surgical treatment for osteoporotic fractures in recent years.
Osteoporotic fracture is one of the most common skeletal system diseases in the elderly, which has the characteristics of high incidence, high disability rate, high mortality, and high medical cost. Because of the poor bone quality, comminuted fractures occur frequently, the stability of internal fixation is poor, bed stay time is long, and incidence of refracture is high. Therefore, the surgical treatment of osteoporotic fractures continues to challenge orthopedic surgeon. This paper reviews and summarizes the principles and techniques of surgical treatment for osteoporotic fractures in recent years.
引文
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[8] 中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.
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[18] Fitzpatrick DC,Doornink J,Madey SM,et al.Relative stability of conventional and locked plating fixation in a model of the osteoporotic femoral diaphysis[J].Clin Biomech (Bristol,Avon),2009,24(2):203-209.
[19] Gardner MJ,Nork SE,Huber P,et al.Stiffness modulation of locking plate constructs using near cortical slotted holes:a preliminary study[J].J Orthop Trauma,2009,23(4):281-287.
[20] Sellei RM,Garrison RL,Kobbe P,et al.Effects of near cortical slotted holes in locking plate constructs[J].J Orthop Trauma,2011,25(Suppl 1):S35-S40.
[21] Bottlang M,Feist F.Biomechanics of far cortical locking[J].J Orthop Trauma,2011,25(Suppl 1):S21.
[22] Adams Jr JD,Tanner SL,Jeray KJ.Far cortical locking screws in distal femur fractures[J].Orthopedics,2015,38(3):e153-e156.
[23] Kammerlander C,Erhart S,Doshi H,et al.Principles of osteoporotic fracture treatment[J].Best Pract Res Clin Rheumatol,2013,27(6):757-769.
[24] Gardner MJ,Collinge C.Management principles of osteoporotic fractures[J].Injury,2016,47(Suppl 2):S33-S35.
[25] Ito K,Hungerbühler R,Wahl D,et al.Improved intramedullary nail interlocking in osteoporotic bone[J].J Orthop Trauma,2001,15(3):192-196.
[26] Kammerlander C,Erhart S,Doshi H,et al.Principles of osteoporotic fracture treatment[J].Best Pract Res Clin Rheumatol,2013,27(6):757-769.
[27] Osterhoff G,Morgan EF,Shefelbine SJ,et al.Bone mechanical properties and changes with osteoporosis[J].Injury,2016,47(Suppl 2):S11-S20.
[28] Von Rüden C,Augat P.Failure of fracture fixation in osteoporotic bone[J].Injury,2016,47(Suppl 2):S3-S10.
[29] Cornell CN.Internal fracture fixation in patients with osteoporosis[J].J Am Acad Orthop Surg,2003,11(2):109-119.
[30] Ito K,Hungerbühler R,Wahl D,et al.Improved intramedullary nail interlocking in osteoporotic bone[J].J Orthop Trauma,2001,15(3):192-196.
[31] Horn J,Linke B,H?ntzsch D,et al.Angle stable interlocking screws improve construct stability of intramedullary nailing of distal tibia fractures:a biomechanical study[J].Injury,2009,40(7):767-771.
[32] Heini PF,Franz T,Fankhauser C,et al.Femoroplasty-augmentation of mechanical properties in the osteoporotic proximal femur:a biomechanical investigation of PMMA reinforcement in cadaver bones[J].Clin Biomech (Bristol,Avon),2004,19(5):506-512.
[33] Unger S,Erhart S,Kralinger F,et al.The effect of in situ augmentation on implant anchorage in proximal humeral head fractures[J].Injury,2012,43(10):1759-1763.
[34] Biyani A,Reddy NS,Chaudhury J,et al.The results of surgical management of displaced tibial plateau fractures in the elderly[J].Injury,1995,26(5):291-297.
[35] Makridis KG,Obakponovwe O,Bobak P,et al.Total hip arthroplasty after acetabular fracture:incidence of complications,reoperation rates and functional outcomes:evidence today[J].J Arthroplasty,2014,29(10):1983-1990.
[36] Gigis I,Nenopoulos A,Giannekas D,et al.Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly[J].Open Orthop J,2017,11:108-118.
[37] Yoo JI,Ha YC,Lim J,et al.Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur:systematic review and meta-analysis[J].J Korean Med Sci,2017,32(5):858-867.
[2] 中国健康促进基金会骨质疏松防治中国白皮书编委会.骨质疏松症中国白皮书[J].中华健康管理学杂志,2009,3(3):148-154.
[3] Akesson K,Marsh D,Mitchell PJ,et al.Capture the fracture:a best practice framework and global campaign to break the fragility fracture cycle[J].Osteoporos Int,2013,24(8):2135-2152.
[4] Si L,Winzenberg TM,Jiang Q,et al.Projection of osteoporosis-related fractures and costs in China:2010-2050 [J].Osteoporos Int,2015,26(7):1929-1937.
[5] Konstantinidis L,Helwig P,Hirschmüller A,et al.When is the stability of a fracture fixation limited by osteoporotic bone?[J].Injury,2016,47(Suppl 2):S27-S32.
[6] Simpson AH,Murray IR.Main differences in osteoporotic fracture models:which should I use?[J].Injury,2016,47(Suppl 2):S15-S20.
[7] Cheung WH,Miclau T,Chow SKH,et al.Fracture healing in osteoporotic bone[J].Injury,2016,47(Suppl 2):S21-S26.
[8] 中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.
[9] Cornell CN,Ayalon O.Evidence for success with locking plates for fragility fractures[J].HSS journal,2011,7(2):164-169.
[10] Goldhahn J,Suhm N,Goldhahn S,et al.Influence of osteoporosis on fracture fixation-a systematic literature review[J].(Suppl 2),2008,19(6):761-772.
[11] Seebeck J,Goldhahn J,Morlock M M,et al.Mechanical behavior of screws in normal and osteoporotic bone[J].Osteoporos Int,2005,16(2):107-111.
[12] Miranda MA.Locking plate technology and its role in osteoporotic fractures[J].Injury,2007,38(3):35-39.
[13] MacLeod AR,Simpson AHRW,Pankaj P.Reasons why dynamic compression plates are inferior to locking plates in osteoporotic bone:a finite element explanation[J].Comput Methods Biomech Biomed Engin,2015,18(16):1818-1825.
[14] Schandelmaier P,Partenheimer A,Koenemann B,et al.Distal femoral fractures and LISS stabilization[J].Injury,2001,32:55-63.
[15] Schütz M,Südkamp NP.Revolution in plate osteosynthesis:new internal fixator systems[J].J Orthop Sci,2003,8(2):252-258.
[16] Cornell,Charles N.Fixation considerations in osteoporotic bone fractures[J].Current Opinion in Orthopaedics,2005,16(5):376-381.
[17] Perren SM,Linke B,Schwieger K,et al.Aspects of internal fixation of fractures in porotic bone.Principles,technologies and procedures using locked plate screws[J].Acta Chir Orthop Traumatol Cech,2005,72(2):89-97.
[18] Fitzpatrick DC,Doornink J,Madey SM,et al.Relative stability of conventional and locked plating fixation in a model of the osteoporotic femoral diaphysis[J].Clin Biomech (Bristol,Avon),2009,24(2):203-209.
[19] Gardner MJ,Nork SE,Huber P,et al.Stiffness modulation of locking plate constructs using near cortical slotted holes:a preliminary study[J].J Orthop Trauma,2009,23(4):281-287.
[20] Sellei RM,Garrison RL,Kobbe P,et al.Effects of near cortical slotted holes in locking plate constructs[J].J Orthop Trauma,2011,25(Suppl 1):S35-S40.
[21] Bottlang M,Feist F.Biomechanics of far cortical locking[J].J Orthop Trauma,2011,25(Suppl 1):S21.
[22] Adams Jr JD,Tanner SL,Jeray KJ.Far cortical locking screws in distal femur fractures[J].Orthopedics,2015,38(3):e153-e156.
[23] Kammerlander C,Erhart S,Doshi H,et al.Principles of osteoporotic fracture treatment[J].Best Pract Res Clin Rheumatol,2013,27(6):757-769.
[24] Gardner MJ,Collinge C.Management principles of osteoporotic fractures[J].Injury,2016,47(Suppl 2):S33-S35.
[25] Ito K,Hungerbühler R,Wahl D,et al.Improved intramedullary nail interlocking in osteoporotic bone[J].J Orthop Trauma,2001,15(3):192-196.
[26] Kammerlander C,Erhart S,Doshi H,et al.Principles of osteoporotic fracture treatment[J].Best Pract Res Clin Rheumatol,2013,27(6):757-769.
[27] Osterhoff G,Morgan EF,Shefelbine SJ,et al.Bone mechanical properties and changes with osteoporosis[J].Injury,2016,47(Suppl 2):S11-S20.
[28] Von Rüden C,Augat P.Failure of fracture fixation in osteoporotic bone[J].Injury,2016,47(Suppl 2):S3-S10.
[29] Cornell CN.Internal fracture fixation in patients with osteoporosis[J].J Am Acad Orthop Surg,2003,11(2):109-119.
[30] Ito K,Hungerbühler R,Wahl D,et al.Improved intramedullary nail interlocking in osteoporotic bone[J].J Orthop Trauma,2001,15(3):192-196.
[31] Horn J,Linke B,H?ntzsch D,et al.Angle stable interlocking screws improve construct stability of intramedullary nailing of distal tibia fractures:a biomechanical study[J].Injury,2009,40(7):767-771.
[32] Heini PF,Franz T,Fankhauser C,et al.Femoroplasty-augmentation of mechanical properties in the osteoporotic proximal femur:a biomechanical investigation of PMMA reinforcement in cadaver bones[J].Clin Biomech (Bristol,Avon),2004,19(5):506-512.
[33] Unger S,Erhart S,Kralinger F,et al.The effect of in situ augmentation on implant anchorage in proximal humeral head fractures[J].Injury,2012,43(10):1759-1763.
[34] Biyani A,Reddy NS,Chaudhury J,et al.The results of surgical management of displaced tibial plateau fractures in the elderly[J].Injury,1995,26(5):291-297.
[35] Makridis KG,Obakponovwe O,Bobak P,et al.Total hip arthroplasty after acetabular fracture:incidence of complications,reoperation rates and functional outcomes:evidence today[J].J Arthroplasty,2014,29(10):1983-1990.
[36] Gigis I,Nenopoulos A,Giannekas D,et al.Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly[J].Open Orthop J,2017,11:108-118.
[37] Yoo JI,Ha YC,Lim J,et al.Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur:systematic review and meta-analysis[J].J Korean Med Sci,2017,32(5):858-867.