老年髋部骨折术后无抗骨质疏松药物治疗患者骨质变化的初步分析

The primary analysis of bone character changes in the elders without anti-osteoporosic medicine treatment after hip fracture

目的探讨老年髋部骨折术后无应用抗骨质疏松药物治疗患者的骨质变化。方法入选本研究的患者共12例,平均年龄77.6岁,髋部骨折术后平均8.6年。全部患者接受对骨质疏松症认知水平询问;双能X线吸收骨密度仪(DXA)测定5例股骨近端和7例腰椎骨密度,并与在门诊经规范骨质疏松治疗1年以上随机选取的骨质疏松症患者(男3例,女9例,平均年龄74岁)骨密度比较,两组相应部位数值进行t检验;影像学检查包括拍摄骨盆正位片和腰椎X线片,部分患者作腕部X线片或腰椎MR I检查。结果患者对骨质疏松症认知水平低(16%)。腰2、3椎体和股骨近端骨密度均降低,以股骨近端更为明显(P<0.05)。6例人工髋关节假体柄松动,3例髋臼磨损,2例动力髋钢板螺钉和1例股骨近端髓内钉松动伴移位,所有患者腰椎椎体骨小梁稀疏,共有9例椎体呈压缩性骨折,16例椎体呈明显"双凹"征,3例桡骨远端骨小梁稀疏。结论老年髋部骨折术后如无进行抗骨质疏松药物治疗,骨质可能会变得更加脆弱。

Objective To study the bone character changes in the elders without anti-osteoporosic medicine treatment after hip fracture operations. Methods 12 cases of elder in/out-patients with average age of 77.6 years were selected, who never took any anti-osteoporosic medicines after their hip fractures operations for average 8.6 years. All patients were investigated in general knowledge about osteoporosis. The Dual energy X-ray absorptiometry （DXA） bone density was measured in proximal femurs for 5 cases and lumbar vertebrae for 7 cases, and compared by t-test to control group （osteoporosis out-patients randomly selected who have been treated normatively for more than one year）. Results The degree of patients＇ general knowledge on osteoporosis was poor （16%）. The DXA bone density of proximal femurs and second, third lumbar vertebrae was decreased, especially in the proximal femurs （ P 〈 0. 05 ）. 6 stems of artificial hip joints were loosening, 3 acetabulums were worn out, 2 DHS and 1 PFN were loosening with displacement. Condusions The bone characters may become more frangible in the elders without anti-osteoporosic medicine treatment after hip fracture.