骨质疏松性骨折.pptxVIP

骨质疏松性骨折第1页/共69页 BackgroundOsteoporosis -- a decreased bone density with normal bone mineralizationWHO Definition (1994)Bone Mineral Density ≥2.5 SD’s below the mean seen in young normal subjectsIncidence increases with age15% of white women age 50-5970% of white women older than age 80第2页/共69页 BackgroundRisk factors for osteoporosisFemale sexEuropean ancestrySedentary lifestyleMultiple birthsExcessive alcohol use第3页/共69页 BackgroundSenile osteoporosis commonSome degree of osteopenia is found in virtually all healthy elderly patientsTreatable causes should be investigatedNutritional deficiencyMalabsorption syndromesHyperparathyroidismCushings diseaseTumors第4页/共69页 Background The incidence of osteoporotic fractures is increasingEstimated that half of all women and one-third of all men will sustain a fragility fracture during their lifetimeBy 2050 -- 6.3 million hip fractures will occur globallyEnormous cost to society第5页/共69页 BackgroundThe most common fractures in the elderly osteoporotic patient include:Hip FracturesFemoral neck fracturesIntertrochanteric fracturesSubtrochanteric fracturesAnkle fracturesProximal humerus fractureDistal radius fracturesVertebral compression fractures第6页/共69页 BackgroundFractures in the elderly osteoporotic patient represent a challenge to the orthopaedic surgeonThe goal of treatment is to restore the pre-injury level of functionFracture can render an elderly patient unable to function independently --requiring institutionalized care第7页/共69页 Background Osteopenia complicates both fracture treatment and healingInternal fixation compromisedPoor screw purchaseIncreased risk of screw pull outAugmentation with methylmethacrylate has been advocated Increased risk of non-unionBone augmentation (bone graft, substitutes) may be indicated第8页/共69页 Pre-injury StatusMedical HistoryCognitive HistoryFunctional HistoryAmbulatory statusCommunity AmbulatorHousehold AmbulatorNon-Functional AmbulatorNon-AmbulatorLiving arrangements第9页/共69页 Pre-injury StatusS