摘要
目的探讨老年髋关节置换术后对侧再发骨折的危险因素并加以预防。方法对2008年1月-2011年1月行髋关节置换术的180例老年患者进行随访,其中24例3年内对侧髋部发生再次骨折。通过比较骨折组与未骨折组患者的性别、年龄、居住环境（农村/城市）、术后健侧髋部骨密度值、健侧股骨近端骨小梁类型（Singh）指数等一般情况以及髋关节置换术后总住院时间、出院后日均卧床时间、有无合并内科疾病和抗骨质疏松治疗情况,归纳再发骨折的危险因素。结果两组患者在性别、年龄方面差异无统计学意义（P年龄=0.084,P性别=0.068）,但骨折组患者中农村户口所占比例明显高于未骨折组,差异有统计学意义（P=0.012）。骨折组平均住院时间与出院后日均卧床时间明显长于未骨折组,差异有统计学意义（P平均住院时间=0.024,P出院后日均卧床时间=0.028）。骨折组患者健侧Singh指数低于Ⅲ级的比例以及出院后未规律进行抗骨质疏松治疗的比例明显高于未骨折组,差异有统计学意义（PSingh指数=0.010,P抗骨质疏松治疗=0.015）;经Logistic单因素回归分析,农村患者、住院时间及出院后日均卧床时间长、骨密度低、Singh指数低、未规律行抗骨质疏松治疗以及合并内科疾病的患者对侧髋部再发骨折的风险较高。结论对于髋关节置换术后的老年患者,健侧髋部骨密度值偏低、Singh指数低于Ⅲ级、卧床时间长、合并内科疾病以及抗骨质疏松治疗不佳均为对侧再发骨折的危险因素,因此应于第一次术后积极治疗合并内科疾病,行抗骨质疏松治疗并及早进行功能训练,以避免健侧再发骨折。
Objective To explore the risk factors and prevention of recurrent fracture in elderly patients after hip replacement surgery. Methods Totally 180 elderly patients with hip replacement in our hospital from Jan. 2008 to Jan. 2011 were followed up,including 24 patients who had recurrent hip fracture within 3 years. The indexes including gender,age,living environment（ rural / urban）,postoperative BMD value of the healthy contralateral hip,healthy femoral proximal trabecular type（ Singh index）,total length of hospital stay,days for lying in bed,combined diseases and osteoporosis treatment were compared between the fracture and non-fracture group,so as to explore the risk factors for recurrent fractures. Results Age and gender of the two groups had no statistically significant difference（ P〈0. 05）,but the proportion of fracture patients from rural areas was significantly higher than that of the non-fracture group,and the differences were statistically significant（ P〈0. 05）. The average hospitalization time and the days for lying in bed after discharge in the fracture group were significantly longer than those of the nonfracture group,and the differences were statistically significant（ P〈0. 05）. The proportion of healthy side Singh index lower than grade Ⅲ in the fracture group and the proportion of non-regular anti-osteoporosis treatment were significantly higher than those in the non-fracture group,and the differences were statistically significant（ P〈0. 05）.Through the single factor logistic regression analysis,rural area,long duration of hospitalization,long time for lying in bed after discharge,low bone density,low Singh index,non-regular anti-osteoporosis treatment and the presence of combined chronic medical diseases were the risk factors of recurrent fractures in the contralateral hip. Conclusion In elderly patients with hip arthroplasty,low hip bone density value,Singh index lower than grade Ⅲ,long time for lying in bed,combined chronic medical diseases and poor anti-osteoporosis therapy are risk factors for contralateral recurrent fracture. Therefore,we should initially actively treat the complicated medical diseases,take anti-osteoporosis therapy and early functional training so as to avoid the recurrent fractures of contralateral hip.
出处
《创伤外科杂志》
2016年第9期530-533,共4页
Journal of Traumatic Surgery
关键词
髋关节
置换术
再骨折
老年
hip joint
replacement
recurrent fracture
elderly
