高龄患者半髋关节置换后骨折风险的评估方法

Evaluation for fracture risk in elderly patients after hemiarthroplasty

背景:对高龄患者(75岁以上)半髋关节置换后假体周围骨折风险的评估应当从患者术后身体健康情况、生活质量、髋关节功能、骨密度等多种综合性指标来进行动态观察才更准确,而现阶段缺乏相对全面的研究。目的:为临床诊治及预测高龄患者半髋关节置换后假体周围骨折发生风险提供参考。方法:在整理近年来部分国内外学者对髋关节假体周围骨折发生风险因素探究结果的基础上,分析了学者们对相关骨折风险因素的监测方法,同时结合现代检验科学的发展,投入临床加以尝试,总结出更为全面且有一定临床意义的高龄患者半髋关节置换后假体骨折风险因素的评估方法。结果与结论:对于高龄伴有多种内科疾病的股骨颈或转子间骨折患者,半髋关节置换是目前认为最有效的手术方式。高龄患者术后假体周围骨折发生逐渐增多,一旦出现将会给患者精神、经济甚至生命带来极大的打击。因此,早期做出对假体周围骨折风险因素有效的评估,从而选择全面正确的预防策略及治疗方式是预防和挽救这一灾难性后果的必要措施,将会极大改善患者的预后,提高患者的生活质量及存活率。通过当前短期小样本的前瞻性随访研究表明,综合性的动态评估对于高龄老年患者半髋关节置换后骨折风险的评估可能存在一定临床意义,并值得继续探索。

BACKGROUND：For evaluation of risks of periprosthetic fractures in elderly patients aged〉75 years old after hemiarthroplasty, we should perform dynamic observation of postoperative physical health status, quality of life, hip function and bone mineral density. Presently, there is lack of general investigation. OBJECTIVE：To provide references for clinical diagnosis and prediction of periprosthetic fractures after hemiarthroplasty in elderly patients. METHODS：On the basis of arranging the exploration results of recent studies on risk factors for periprosthetic fractures of hip joint, we analyzed the monitoring method of scholars concerning fracture-associated risk factors. Simultaneously, in combination of the development of modern inspection sciences, the method was applied in the clinic. Thus, we summarized general evaluation methods with clinical significance for risk factors of prosthesis fracture in elderly patients after hemiarthroplasty. RESULTS AND CONCLUSION：For elderly patients with femoral neck or intertrochanteric fracture combined with various medical il ness, hemiarthroplasty is an effective manner presently. Fractures surrounding the prosthesis in elderly patients postoperatively gradual y increased. Once fracture appeared, it would bring a great attack on patients’ spirit, economy and even life. Therefore, early evaluation on the risk factors for fractures surrounding the＆amp;nbsp;prosthesis is a necessary measure for preventing and saving this disastrous consequence by selecting general correct prevention and treatment strategies. This wil greatly improve patients’ prognosis and elevated patient’s quality of life and survival rate. Present short-term smal-sample prospective fol ow-up studies suggested that comprehensive dynamic evaluation possibly has a certain clinical significance for the evaluation of risks of fractures after hemiarthroplasty in elderly patients, and deserves further investigations.