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ID:39201716
大小:721.50 KB
页数:69页
时间:2019-06-27
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1、Epidemiology,DiagnosisPreventionandManagementofOsteoporoticFracturesKennethA.Egol,MDNYU-HospitalForJointDiseasesCreatedMarch2004;RevisedMay2006BackgroundOsteoporosis--adecreasedbonedensitywithnormalbonemineralizationWHODefinition(1994)BoneMineralDensity≥2.5SD’sbelowthemeanseeninyoungnormalsubjectsIn
2、cidenceincreaseswithage15%ofwhitewomenage50-5970%ofwhitewomenolderthanage80BackgroundRiskfactorsforosteoporosisFemalesexEuropeanancestrySedentarylifestyleMultiplebirthsExcessivealcoholuseBackgroundSenileosteoporosiscommonSomedegreeofosteopeniaisfoundinvirtuallyallhealthyelderlypatientsTreatablecause
3、sshouldbeinvestigatedNutritionaldeficiencyMalabsorptionsyndromesHyperparathyroidismCushingsdiseaseTumorsBackgroundTheincidenceofosteoporoticfracturesisincreasingEstimatedthathalfofallwomenandone-thirdofallmenwillsustainafragilityfractureduringtheirlifetimeBy2050-->6.3millionhipfractureswilloccurglob
4、allyEnormouscosttosocietyBackgroundThemostcommonfracturesintheelderlyosteoporoticpatientinclude:HipFracturesFemoralneckfracturesIntertrochantericfracturesSubtrochantericfracturesAnklefracturesProximalhumerusfractureDistalradiusfracturesVertebralcompressionfracturesBackgroundFracturesintheelderlyoste
5、oporoticpatientrepresentachallengetotheorthopaedicsurgeonThegoaloftreatmentistorestorethepre-injuryleveloffunctionFracturecanrenderanelderlypatientunabletofunctionindependently--requiringinstitutionalizedcareBackgroundOsteopeniacomplicatesbothfracturetreatmentandhealingInternalfixationcompromisedPoo
6、rscrewpurchaseIncreasedriskofscrewpulloutAugmentationwithmethylmethacrylatehasbeenadvocatedIncreasedriskofnon-unionBoneaugmentation(bonegraft,substitutes)maybeindicatedPre-injuryStatusMedicalHistoryCognitiveHistoryFunctionalHistoryAmbulatorystatusCommunityAmbulatorHouseholdAmbulatorNon-FunctionalAmb
7、ulatorNon-AmbulatorLivingarrangementsPre-injuryStatusSystemicdiseasePre-existingcardiacandpulmonarydiseaseiscommonintheelderlyDiminishespatientsabilitytotolerateprolongedrecumbencyDiabetesincreaseswou
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