股骨近端骨折后对侧再次骨折

Second Hip Fracture

目的 阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法 对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论 老年性股骨近端骨折后?

Objective To clarify the incidence,predisposing factors and clinical characteristics of bilateral fracture of the proximal femur,and to improve our understanding and prevention of second hip fractures.Methods A total of 476 cases of osteoporotic fractures of the proximal femur were operated in our clinic and were retrospectively investigated.Among them,26 patients sustained fractures of both sides.The incidence,fracture type,age and sex distribution of the second contralateral hip fracture,and the time interval between the two fractures were analyzed.The influence of concomitant disorders which might disqualify the walking ability of the patients was also compared between the unilateral fracture group and bilateral fraacture group.Results The overall incidence of second contralateral fracture of the proximal femur was 5.5%(26/476).There was a significant similarity of fracture patterns between the first and second fracture in the majority of the patients:68.8%(11/16) of the femoral neck and 90 0%(9/10) of the trochanteric fractures were preceded by a contralateral fracture of the same type.The mean interval between fractures was 2 7 years,and the second fracture most often apppeared within 2～3 years after the first one.Either age or gender had no effect on the prevalence of bilateral fractures.The prevalence of concomitant disorders,such as cataract,Parkinsons disease,celebrovascular ailment,sequelae of poliomyelitis and chronic rheumatoid arthritis was higher in the bilateral fracture group than that in the unilateral fracture group.Conclusion The increased risk of a new fracture in those who already sustained one in the contralateral proximal femur stresses the importance of osteoporosis therapy.In the meantime,the awareness of the high possibility of a new fracture within 2～3 years after the first contralateral one ,and treatment of concomitant disorders to control the predisposing factors are crucial to the prevention of second hip fracture.