老年髋部骨折术后发生再骨折的风险研究

Risk Assessment of Re-fracture after Osteoporotic Hip Fracture Surgery

目的 使用双能X线骨密度仪（DEXA）监测老年髋部骨折术后健侧髋部骨密度变化情况,并通过FRAX系统预测对应时间点健侧髋部及骨质疏松性再骨折风险,以指导临床积极干预.方法 2009年3月～ 2012年2月共收治132例老年髋部骨折患者作为实验组,术后患者拒绝服用抗骨质疏松药物.术后5天、2个月、6个月、9个月、12个月分别用双能X线骨密度仪（DEXA）测量健侧髋部骨密度,再通过FRAX系统预测健侧髋部及全身再骨折风险,同时设未骨折老年群体81例行骨密度检查作为对照组.结果 实验组健侧髋部骨折风险、全身骨质疏松性骨折再发风险于术后9个月最高,相对于其他时间点具有统计学差异（P＜0.05）;实验组健侧髋、全身骨质疏松性骨折再发风险在术后各个时间点均高于对照组（P＜0.05）.结论 患者术后健侧髋部骨折风险及全身骨质疏松性骨折再发风险均高于未骨折老年群体,健侧髋部骨折及全身骨质疏松性骨折再发风险于术后9个月最高,患者术后应当及时预防骨折再发.

Objective To observe the change of bone density in old patients after hip surgery using the dual-energy X-ray absorptiometry （DEXA）.The second fracture risk in the different time was determined by FRAX system,which could be used to guide the active intervention.Methods 132 cases with hip fracture were collected.All patients were operated with hip surgery,and rehabilitation exercises was did after surgery.Was detected and followed-up use the dual-energy X-ray absorptiometry （DEXA）.The change of bone density in old patients 5days,2months,6months,9months and 12 months after the operation.The risk was determined by FRAX which could predicted the hip fracture and osteoporotic fracture.In this study,81 persons without fracture were as the control group.Results After surgery the risk factors of femoral neck,femur,and the upper femoral were higher than control group（P ＜ 0.05）.The significant difference of risk factors could be observed between hip fracture patients and control group.The risk factors were different after 5days,2months,6months,9months and 12months of surgery,and the risk factors of femoral neck at 9months were higher than other time （P ＜ 0.05）.The risk factors in femur,or the upper femoral at 12months were higher than other time （P ＜ 0.05）.Conclusion The risk of hip,osteoporotic fracture at 9months were higher than other time.