Hemiarthroplasty is an effective surgical method to manage unstable trochanteric fractures in elderly people

Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full weight bearing was achieved during the short period of hospitalization (9-14 days). Given that the affected population is predominantly the elderly, who are less mobile and demanding and thus put less strain on the endoprosthesis, we believe that this kind of treatment is the treatment of choice for unstable trochanteric femoral fractures in these patients. This assumption is corroborated by the fact that we did not have any endoprosthesis luxation, apparent acetabular protrusion or instability during the mean follow up period of 15 months (range 12-18 months).     

微创经皮LCP 接骨术治疗老年股骨近端粉碎骨折

目的:本研究通过观察微创锁定钢板接骨术治疗老年股骨近端粉碎骨折临床效果,旨在找出最佳治疗方式。方法:自2007年12月～2010年03月,应用股骨近端锁定加压钢板治疗老年股骨近端粉碎骨折23例。记录术中出血量、手术时间,术后并发症、骨折愈合时间及最后一次随访时功能恢复情况。结果:骨折临床愈合时间为12～28周,平均16周。除1例患者髋内翻畸形,1例锁定加压钢板断裂外,其他患者均达到骨性愈合。结论:股骨近端锁定钢板具有创伤小、固定可靠、骨折愈合快、功能恢复满意的特点,尤其适用于老年股骨近端粉碎骨折。     

动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效比较

目的:比较动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效和安全性。方法:收集我院收治的老年股骨近端骨折患者64例,随机分为DHS组和PFN组,每组各32例。DHS组患者给予动力髋螺钉的固定方式,PFN组给予股骨近端髓内钉的固定方式。手术后对患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症以及患者临床疗效进行检测并比较。结果:与治疗前相比,两组患者治疗后的Harris评分均显著下降(P0.05);与DHS组相比,PFN组患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症的发生率以及Harris评分均较低(P0.05)。结论:股骨近端髓内钉的固定治疗老年股骨近端骨折的临床疗效较好,安全性更高。     

近端膨胀髓内钉与抗旋髓内钉治疗老年股骨转子间骨折的临床疗效分析

目的:探究近端膨胀髓内钉与近端螺旋刀片抗旋髓内钉治疗老年股骨转子间骨折疗效及躁动发生率比较。方法:病例来源为2012年5月至2013年10月收入我院的老年股骨转子间骨折患者60例,采用随机数字表随机分为两组,膨胀钉组30例,采用近端膨胀髓内钉的手术方法,PFNA组30例,采用近端螺旋刀片抗旋髓内钉的手术方法。手术结束后,对两组患者进行X射线片、手术时间及出血量、髋关节功能的比较,同时对比躁动发生率。结果:X线检查结果显示两组患者经手术后骨折处均复位良好,无并发症及内固定物的脱落及松动,两组比较无显著差异(P0.05);与PFNA组相比,膨胀组患者的手术时间及出血量明显降低,差异具有统计学意义(P0.05);两组患者术后3个月、6个月的Harris评分显示,与PFNA组相比,膨胀钉组的优良率明显升高,髋关节优于PFNA组,差异具有统计学意义(P0.05);膨胀钉组患者躁动率为10.00%低于PFNA组患者躁动率为33.33%,具有统计学意义(P0.05)。结论:可膨胀髓内钉具有手术时间较短、出血量少,更利于骨折的愈合,且躁动发生率较低,对股骨转子间骨折的疗效优于较近端螺旋刀片抗旋髓内钉,对临床有指导意义,值得临床推广。     

Osteoporosis Treatment After Osteoporotic Fractures: Data From a Single Medical Center

ObjectiveMost patients do not receive osteoporosis treatment after osteoporotic fracture. This study reviewed osteoporosis treatment after osteoporotic fractures in a center without a Fracture Liaison Service.MethodsWe identified all patients with hip, vertebral, humeral or radial fractures, evaluated in Meir Medical Center, in 2017. The exclusion criteria were not a Clalit Health Services member, high-energy fracture or 30-day postoperative mortality. The primary endpoint was osteoporosis drugs issued within 12 months of fracture. Secondary endpoints included bone densitometry and 1-year mortality.ResultsFive-hundred-eighty-two patients (average age 78.6 ± 11.1 years, 75.8% women) were included. There were 321 (55.5%) hip, 84 (14.1%) humeral, 33 (5.6%) vertebral, and 144 (24.7%) radial fractures. Osteoporosis drugs were issued to 26.5% of the patients; those with humeral fractures received the least (21.4%) and vertebral, the most (30.3%; P = .51). Bone densitometry was performed in 23.2% of patients. One-year mortality after hip fracture was 12.1%, followed by humeral (3.6%; P < .05). Logistic regression showed that previous treatment (odds ratio [OR] = 7.4; 95% confidence interval [CI] 3.6–15.2), bone densitometry (OR = 4.4; 95% CI 2.6–7.4) and endocrinology visit (OR = 2.6; 95% CI, 1.4–4.6) were the most important factors associated with treatment.ConclusionFewer than one third of patients received pharmacotherapy within 1 year after fracture. Because pharmacotherapy reduces future fractures and mortality, we recommend that medical staff who care for patients with fracture adopt practical and effective strategies to increase treatment rates among patients with osteoporotic fractures.     

髓内钉InterTan 治疗股骨近端骨折的早期疗效分析

目的:分析应用新一代股骨近端髓内钉( InterTan)治疗股骨近端骨折的早期临床疗效.方法:回顾性分析2009年9月至201 1年8月我科共收治股骨近端骨折患者共107例,均采用InterTan髓内钉系统进行治疗,其中男45例,女62例;年龄34-93岁,平均73.05岁.受伤肢体左侧63例,右侧44例.按AO分型,31-A1型32例,31 -A2型59例,31-A3型16例.记录患者手术持续时间、并发症、死亡率、骨折愈合时间、末次复查Harris评分,并对比患者健侧及患侧术前、术中及术后1周的颈干角变化.所有数据采用SPSS 13.0进行统计分析.结果:平均手术持续时间为66.69分钟.颈干角:术前健侧:140.66±9.08度,术前患侧:118.00± 15.49度,术中患侧:135.16± 7.08度,术后1周患侧:137.51±15.21度.术前患侧颈干角与其他三组相比均有显著性差异(P＜0.05),术前健侧、术中复位后患侧、术后1周患侧颈干角之间相比均无显著性差异.3例患者于随访过程中死亡,6例患者失访.98例患者获得随访,随访时间3 -22个月,平均8.6个月.2例患者发生头钉切出,3例患者术后练习后出现股骨疼痛症状,未发生股骨干骨折.96例患者均获得骨性愈合,骨折愈合时间12～18周.临床疗效按Harris评分标准:41-92分,平均78.5分,优良率80.6％.结论:髓内钉InterTan是治疗股骨近端骨折的良好选择.     

Femoral neck fracture after removal of the standard gamma interlocking nail: a cadaveric study to determine factors influencing the biomechanical properties of the proximal femur

We retrospectively analyzed 1334 patients who were implanted standard gamma interlocking nails^® (SGN) to stabilize trochanteric femoral fractures over the years 1992–1998. Reoperation to remove the nails was performed in 37 patients, in 9 of them purely because of pain. Three out of these 9 patients with removed SGN suffered femoral neck fractures in the early postoperative course after having been mobilized to full weight-bearing capacity. This complication was not observed with other implant systems and, considering the notoriously high complication rate of femoral neck fractures, severely reduces the value of the SGN concept per se. These findings in combination with other known shortcomings of SGNs prompted us to conduct an experimental study on the fracture force of excavated femurs addressing the hypothesis that the specific design of the SGN is responsible for the occurrence of fatigue fractures of the femoral neck. Eighteen matched pairs of fresh human cadaveric proximal femurs, which were treated by insertion and removal of (i) SGNs or (ii) dynamic hip screws^® (DHS) or (iii) by excavation in the absence of an implant, were subjected to incremental loading cycles and compared to the untreated contralateral femurs. Overall, the fracture force was found to be significantly lower among the treated than among the untreated bones. However, the fracture force required after removal of the DHS system was still significantly higher than for SGN or excavation alone. In this way, our findings demonstrate that removing relatively big implants such as SGN can cause serious complications such as femoral neck fractures. We therefore recommend to leave this type of device in place even after fracture healing except in cases of deep and chronic infection.     

尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折中的应用

目的:探讨尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折临床效果中的作用和意义,为骨外科手术疗效的评价提供可借鉴的方法。方法:对2006年8月-2007年10月期间在我院接受PFNA治疗的32例股骨近端骨折患者的临床资料进行回顾性分析。根据AO/ASIF国际内固定研究学会标准对骨折进行分类,应用术中和术后即刻X光射线照片对骨折复位情况、远端锁定类型和股骨头内刀片位置进行记录。患者术后常规X光照片观察切出情况,用Oxford髋关节评分系统评价临床疗效。结果:研究期间共有37例PFNA植入,纳入本研究的共32例,27例获得随访。其中,3例切出(2例内侧穿孔和1例内侧塌陷)TAD小于20mm。4例植入相关股骨骨折,2例不愈合,1例复位失败。结论:PFNA是治疗股骨近端不稳定型骨折的有效装置。我们认为TAD应尽量20 mm或30 mm以避免股骨头穿透。     

近端防旋髓内钉与近端锁定钢板治疗老年股骨转子间不稳定骨折的疗效对比分析

目的:分析对比股骨近端防旋髓内钉(PFNA)与股骨近端锁定钢板(PFLP)治疗老年股骨转子间不稳定骨折的临床疗效。方法:回顾性分析我院骨外科2009年4月至2013年4月收治的老年股骨转子间不稳定骨折患者90例,根据患者手术方式的不同,将其分为PFNA组及PFLP组,各45例。对比分析两组患者术中出血量、手术持续时间及骨折愈合时间术后髋关节功能及内固定并发症情况。结果:PFNA组髋关节功能Harris评分优良率91.11%明显高于PFLP组的71.11%(P0.05);PFNA组比PFLP组骨折愈合时间短、内固定并发症少,比较差异有统计学意义(P0.05)。结论:应用PFNA治疗老年股骨转子间不稳定骨折患者具有骨折愈合时间短、髋关节功能恢复好、术后内固定并发症少的特点,治疗效果较PFLP更满意。     

Malnutrition is Common and Increases the Risk of Adverse Medical Events in Older Adults With Femoral Fragility Fractures

BackgroundFemoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population. Our purpose was to assess the annual trends of malnutrition diagnosis and determine risk factors for malnutrition and complications in patients 65 years and older presenting with femoral fragility fractures. We hypothesized that malnutrition would increase the risk of postoperative wound infection, wound dehiscence, non-union, and mortality.MethodsThe PearlDiver database was reviewed from 2010 to 2020. Patients ≥ 65-years-old with femur fractures treated with operative fixation were identified by CPT code. A preoperative diagnosis of malnourished state was defined by ICD-9 and ICD-10 codes and patients were divided into malnourished and non-malnourished cohorts. Patients were tracked for one year following operative fixation of a femoral fragility fracture for the occurrence of infection, wound dehiscence, nonunion and mortality. The rates of these complications were compared between malnourished and nonmalnourished cohorts.ResultsThere were 178,283 total femoral fragility fractures identified in patients aged 65-years or older. The overall prevalence of malnutrition diagnosis in this geriatric population was 12.8%. Documented malnutrition in femoral fragility fractures increased from 1.6% to 32.9% from 2010-2020 (P<0.0001). Compared to patients without malnutrition, patients with malnutrition are at increased risk of mortality (OR 1.31, 95% CI 1.2558 – 1.3752, p < 0.0001), are more likely to develop a wound infection (OR 1.49; 95% CI 1.252 – 1.7626; p < 0.0001), more likely to have a wound dehiscence (OR 1.55; 95% CI 1.3416 – 1.7949; p < 0.0001), and more likely to develop non-union (1.89; 95% CI 1.6946 – 2.1095; p < 0.0001). Multiple demographic variables were associated with malnutrition diagnosis including higher age, higher Charlson Comorbidity Index, female sex, dementia, and institutionalization. Parkinson’s disease, feeding difficulty and institutionalization demographic variables had the highest risk of malnutrition.ConclusionThe current study found that malnutrition diagnosis significantly increases the risk of adverse medical events in elderly adults with femoral fragility fractures. The rates of malnutrition increased steadily from 2010-2020. This trend is likely a result of increased awareness and testing for malnutrition, not reflecting an actual increased prevalence of malnutrition. Multiple expected demographic variables are associated with diagnosis of malnutrition. Level of Evidence: III     

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

PurposeTo experimentally validate a non-linear finite element analysis (FEA) modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT) data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD) measurements as gold standard.MethodsOne fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.ResultsIn-vitro simulations showed good correlation with the experimentally measured strains both in stance (R² = 0.963) and fall configuration (R² = 0.976). The simulated maximum stress overestimated the experimental failure load (4743 N) by 14.7% (5440 N) while the simulated maximum strain overestimated by 4.7% (4968 N). The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366), but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028).ConclusionFEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT derived FEA models may assess bone strength more accurately than BMD measurements alone, providing a valuable in-vivo fracture risk assessment tool.     

强骨胶囊对老年股骨头近段骨折延迟愈合患者血清BMP-2 及IGF-1水平的影响

目的:探究强骨胶囊对老年股骨头近段骨折延迟愈合患者血清骨形态发生蛋白-2(BMP-2)及胰岛素生长因子-1(IGF-1)水平的影响。方法:选择我院收治的股骨近端骨折延迟愈合的老年患者41例,随机分为实验组及对照组。对照组19例予钙片;实验组22例予强骨胶囊。对比两组的临床疗效及治疗前后血清BMP-2及IGF-1水平的改变。结果:实验组总有效率(95.5%)高于对照组(78.9%),差异具备统计学意义(P0.05)。两组血清BMP-2及IGF-1水平均较治疗前显著升高(P0.05),且实验组血清BMP-2和IGF-1水平较对照组高(P0.05)。治疗后,两组血浆粘度均下降、骨密度值(BMD)均升高(P0.05);与对照组相较,实验组血浆粘度降低、BMD较高(P0.05)。结论:强骨胶囊能够有效改善老年股骨头近段骨折延迟愈合,促进骨折断端的愈合,推测其机制与增加患者血清BMP-2及IGF-1水平有关。     

Cemented versus Uncemented Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients: A Meta-Analysis

Objective

Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old.

Methods

We searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.

Results

7 RCTs involving 1,125 patients (1,125 hips) were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; P = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; P<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; P<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; P<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.

Conclusions

Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.     

人工髋关节置换术发生股骨假体周围骨折的影响因素分析

目的:探讨人工髋关节置换术患者发生股骨假体周围骨折的相关危险因素,为临床预防和治疗提供参考资料。方法:回顾性分析2012年5月~2015年5月在我院接受人工髋关节置换术的92例患者的临床资料。根据是否发生股骨假体周围骨折将所选患者分为研究组和对照组,每组46例,比较两组患者的性别分布、年龄、骨折类型及假体固定方式等,分析影响患者发生股骨假体周围骨折的危险因素。结果:研究组患者骨折类型多为A2型,患者平均年龄、女性患者数及使用生物假体的比例均高于对照组,差异具有统计学意义(P0.05)。患者性别、年龄、骨折类型及假体固定方式是人工髋关节置换术患者发生股骨假体周围骨折的危险因素(OR=1.993、2.012和2.363,P0.05)。结论:高龄女性患者是发生股骨周围假体骨折的高危人群,骨质疏松及骨量减少是引发该并发症的主要危险因素。     

Trabecular bone modeling and subcapital femoral fracture

Fragility fractures, including neck of femur fractures, result from reductions in the amount, quality and architecture of bone. The aim of this study was to compare the cancellous bone structure, and static indices of bone turnover, in female patients who had sustained fragility fracture at the femoral neck, with age-matched females without fragility fracture. Bone samples were taken from the intertrochanteric region of the proximal femur of female patients undergoing hip arthroplasty surgery for a subcapital fragility fracture of the femoral neck (#NOF) or from age-matched female control individuals at routine autopsy. The histomorphometric data, which were normally distributed, indicated no difference between the mean values for any of the structural parameters in control and fracture samples. In particular, the BV/TV values were not different and did not change significantly with age in these cohorts of individuals aged >65 years. The static indices of bone turnover, eroded surface (ES/BS) and osteoid surface (OS/BS), were positively correlated with age in the >65-year-old control group (p<0.05 and p<0.03, respectively). The median values for these indices were not different between the fracture and control groups. However, both the median and the range of OS/BS values were increased for >65-year-old controls compared with a group of younger females aged <65 years, suggesting an increase in bone formation in older females in the proximal femur after 65 years of age. When the data were further interrogated, a reduction in the percentage osteoid surface to eroded surface quotient (OS/ES) was found for the fracture group compared with the age-matched control group. These data indicate that perturbations in bone formation and/or resorption surface are potentially important in producing bone in the proximal femur with increased propensity to fracture. These data also support the concept that trabecular bone modeling may be a factor influencing bone strength in addition to bone mass.     

人工髋关节置换术治疗高龄患者股骨粗隆间骨折的临床疗效研究

目的:探究人工髋关节置换术治疗高龄患者股骨粗隆间骨折的临床疗效。方法:选择40例高龄股骨粗隆间骨折患者并将其随机分为两组,观察组给予人工髋关节置换术治疗,对照组经股骨近端髓内钉内固定术治疗。观察比较两组L2-4椎体骨密度、疼痛程度、髋关节功能恢复情况及Harris评分。结果:治疗后,两组L2-4椎体骨密度均显著高于治疗前(P0.05),且观察组显著高于对照组(P0.05);观察组疼痛比例较治疗前明显降低(P0.05),且显著低于对照组(P0.05);观察组髋关节恢复优良率为95.0%,显著高于对照组(70.0%,P0.05);两组Harris评分均显著高于治疗前(P0.05),且观察组显著高于对照组(P0.05)。结论:采用人工髋关节置换术治疗高龄股骨粗隆间骨折的疗效明显优于经股骨近端髓内钉内固定术治疗,其可有效促进髋关节功能恢复,减轻患者疼痛。     

The immune response after fracture trauma is different in old compared to young patients

Background

Despite significant medical progress and improved treatment, surgical procedures of proximal femur fractures in older patients are still associated with a high postoperative complication and mortality rate. Recently, several authors investigated the phenomenon of immunoageing, indicating differences in the ageing immune system.The aim of the present multi-center prospective clinical trial was to analyze differences in the posttraumatic immune response of old patients compared to young patients.

Methods

Blood was collected from young patients (<50 y, n?=?20) with long bone fractures (YF), old patients (>70 y, n?=?21) with proximal femur fractures (OF) upon clinical admission and within 6 hours after surgery, and two healthy age matched control groups (YH & OH). Serum TRAIL- and cytokine concentrations were analyzed via cytometric bead array, Fas-Ligand and TNF-Receptor-I via ELISA. CD15⁺ magnetic bead-isolated neutrophils (PMN) were TUNEL stained.

Results

IL-6 was significantly increased only in OF after trauma and surgery whereas YF patient exhibited a marked decrease of TNF after trauma. Interestingly, a significant increase of GM-CSF serum levels was observed in YF only, whereas OF exhibited a decrease of systemic IFN-γ concentrations after trauma and after surgery. The healthy controls, old and young, had more or less similar inflammation levels.Moreover, TRAIL serum levels were diminished in OF after trauma and even further after surgery whereas in YF this was only observed after the surgical procedure. Fas-L concentrations were reduced only in YF after surgery or trauma. PMN apoptosis was significantly reduced only in YF, indicating activation of the innate immune system.

Discussion

In summary, our data suggest that the posttraumatic immune response is differently regulated in old and young trauma patients. The operative procedure further impacts these differences after trauma. Whether the decreased activation of PMNs and phagocytes along with the observed dysregulation of the posttraumatic inflammatory response contributes to the high perioperative mortality rate of the elderly suffering from a proximal femoral fracture requires further investigation.

     

股骨近端三维有限元模型评价髋部骨折患者骨密度

目的：探究骨密度与老年髋部骨折股骨近端三维有限元模型密度的关系。方法：选取8 例老年髋部骨折,其中4 例股骨颈骨 折,4 例股骨转子间骨折;左侧肢体3 例,右侧肢体5 例。分别测定腰椎骨密度和双侧髋关节CT 资料,运用Mimics软件和abaqus 软件对健侧股骨近端进行重建和计算出该模型的密度。结果：股骨转子间骨折组腰椎骨密度为(-4.05± 0.24) g/cm2,三维有限元模 型密度为[(1.15± 0.02)× 106],均低于股骨颈骨折组的(-3.15± 0.54) g/cm2,[(1.34± 0.06)× 106],两组比较差异均有统计学意义（均 P<0.05）。腰椎的骨密度与三维有限元模型密度成线性正相关（r=0.881,P=0.004）。结论：骨密度与老年髋部骨折股骨近端三维有限 元模型密度成线性正相关的关系,可为进一步用有限元分析法探讨老年髋部骨折部位与骨密度的关系提供理论依据。     

动力加压髋螺钉对股骨上段生物力学特征性的影响

目的：探讨股骨上端骨折,以动力加压髋螺钉进行骨固定治疗,骨折愈合后,取出动力加压髋螺钉以后的股骨上段与完整的股骨上段的生物力学特性相比较,为临床内固定取出术后功能锻炼的强度提供量化依据。方法：收集8具新鲜尸体股骨标本进行实验应力分析,分别测定完整股骨上段和动力加压髋螺钉取出后股骨上段的力学特性改变。结果：动力加压髋螺钉取出术后股骨上段的力学特性与完整股骨上段的力学特性相比有显著的差异（P＜0．01）。结论：股骨上端骨折如果以动力加压髋螺钉为治疗手段,在骨折愈合取出内固定后,功能锻炼只能控制在慢速步行水平,不能进行奔跑、跳跃等活动,以防止再骨折等并发症的发生。     

Orthopedic-Metabolic Collaborative Management for Osteoporotic Hip Fracture

Objective: Osteoporotic hip fractures are associated with increased morbidity, mortality, and secondary fractures. Although osteoporosis treatment can reduce future fracture risk, patients often do not receive it. We report results of a coordinator-less fracture liaison service in Israel addressing hip fracture patients. The primary endpoint was attending the Metabolic Clinic. Secondary endpoints included vitamin D measurement, calcium and vitamin D recommendations, initiation of osteoporosis treatment, and mortality 1-year post-fracture.Methods: This prospective study included 219 hip fracture patients who were compared with historical controls. Data on hospitalized patients were collected before and after implementation of a structured protocol for hip fracture patients, led by a multidisciplinary team, without a coordinator.Results: The study included 219 and 218 patients ≥60 years old who were operated on in 2013 and 2012, respectively. Metabolic Clinic visits increased from 6.4 to 40.2% after the intervention (P<.001). Among 14 patients who attended the Clinic in 2012, 85.7% began osteoporosis therapy; among 88 who attended in 2013, 45.5% were treated at the first visit. Vitamin D measurements and calcium and vitamin D supplementation increased postintervention (0.5–80.1%, P<.001; 30.8–84.7%, P<.001, respectively). Patients receiving osteoporosis medications had lower mortality rates than untreated patients (4.3% vs. 21.8%).Conclusion: An Orthopedic-Metabolic team implemented by existing staff without a coordinator can improve osteoporosis care for hip fracture patients. Yet, gaps remain as only 40% had Metabolic Clinic follow-up postintervention, and of these, only half received specific treatment recommendations. Hospitals are encouraged to adopt secondary fracture prevention protocols and continuously improve them to close the gaps between current management and appropriate metabolic assessment and treatment.Abbreviations: CHS = Clalit Health Services; CI = confidence interval; FLS = fracture liaison service; HMO = health maintenance organization; OR = odds ratio