《骨质疏松性骨折》PPT课件

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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