骨质疏松性骨折osteoporotic-fxs ppt课件

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1、Epidemiology,DiagnosisPreventionandManagementofOsteoporoticFracturesKennethA.Egol,MDNYU-HospitalForJointDiseasesCreatedMarch2004;RevisedMay2006BackgroundOsteoporosis--adecreasedbonedensitywithnormalbonemineralizationWHODefinition(1994)BoneMineralDensity≥2.5SD’sbelowthemeanseeninyoung

2、normalsubjectsIncidenceincreaseswithage15%ofwhitewomenage50-5970%ofwhitewomenolderthanage80BackgroundRiskfactorsforosteoporosisFemalesexEuropeanancestrySedentarylifestyleMultiplebirthsExcessivealcoholuseBackgroundSenileosteoporosiscommonSomedegreeofosteopeniaisfoundinvirtuallyallheal

3、thyelderlypatientsTreatablecausesshouldbeinvestigatedNutritionaldeficiencyMalabsorptionsyndromesHyperparathyroidismCushingsdiseaseTumorsBackgroundTheincidenceofosteoporoticfracturesisincreasingEstimatedthathalfofallwomenandone-thirdofallmenwillsustainafragilityfractureduringtheirlife

4、timeBy2050-->6.3millionhipfractureswilloccurgloballyEnormouscosttosocietyBackgroundThemostcommonfracturesintheelderlyosteoporoticpatientinclude:HipFracturesFemoralneckfracturesIntertrochantericfracturesSubtrochantericfracturesAnklefracturesProximalhumerusfractureDistalradiusfractures

5、VertebralcompressionfracturesBackgroundFracturesintheelderlyosteoporoticpatientrepresentachallengetotheorthopaedicsurgeonThegoaloftreatmentistorestorethepre-injuryleveloffunctionFracturecanrenderanelderlypatientunabletofunctionindependently--requiringinstitutionalizedcareBackgroundOs

6、teopeniacomplicatesbothfracturetreatmentandhealingInternalfixationcompromisedPoorscrewpurchaseIncreasedriskofscrewpulloutAugmentationwithmethylmethacrylatehasbeenadvocatedIncreasedriskofnon-unionBoneaugmentation(bonegraft,substitutes)maybeindicatedPre-injuryStatusMedicalHistoryCognit

7、iveHistoryFunctionalHistoryAmbulatorystatusCommunityAmbulatorHouseholdAmbulatorNon-FunctionalAmbulatorNon-AmbulatorLivingarrangementsPre-injuryStatusSystemicdiseasePre-existingcardiacandpulmonarydiseaseiscommonintheelderlyDiminishespatientsabilitytotolerateprolongedrecumbencyDiabetes

8、increaseswou