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中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 88 -92. doi: 10.3877/cma.j.issn.2095-5790.2022.01.016

综述

骨质疏松:老年肱骨近端骨折手术治疗的考量
郝平1, 李亘1, 庄澄宇1,()   
  1. 1. 200025 上海交通大学医学院附属瑞金医院骨科
  • 收稿日期:2021-05-24 出版日期:2022-02-05
  • 通信作者: 庄澄宇
  • 基金资助:
    上海市老龄化和妇儿健康研究专项资助(2020YJZX0126); 上海市临床重点专科建设项目中西医结合骨关节病科(SHSLCZDZK04802); 上海市卫生健康委员会卫生行业临床研究专项青年项目(20204Y0351); 国家自然科学基金委员会青年科学基金项目(82102618)

Osteoporosis: considerations for surgical treatment of proximal humeral fractures in the elderly

Ping Hao1, Gen Li1, Chengyu Zhuang1()   

  • Received:2021-05-24 Published:2022-02-05
  • Corresponding author: Chengyu Zhuang
引用本文:

郝平, 李亘, 庄澄宇. 骨质疏松:老年肱骨近端骨折手术治疗的考量[J]. 中华肩肘外科电子杂志, 2022, 10(01): 88-92.

Ping Hao, Gen Li, Chengyu Zhuang. Osteoporosis: considerations for surgical treatment of proximal humeral fractures in the elderly[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(01): 88-92.

图1 骨质疏松发病机制注:PTH为甲状旁腺素;RANKL/OPG为核因子KB受体活化因子配体/骨保护素;TNF-α为肿瘤坏死因子α;IL-1为白介素-1;PGE2为前列腺E2;GH-IGF为生长激素-胰岛素样生长因子
图2 对肱骨近端不同部位的切取范围 图A:切面1;图B:切面2;图C:切面3;图D:每个点的缩写名称注:AS为前上侧;MS为中上侧;PS为后上侧;AM为前中侧;MM为中间;PM为后中侧;AI为前下侧;MI为中下侧;PI为后下侧
图3 Tingart指数的测量(取肱骨近端内外侧骨皮质首次平行处的连线,纪录两侧骨皮质的值,再予远端2 cm处做平行线,取两侧的骨皮质值,两者相加平均的皮质厚度值为4.4 mm±1.0 mm)
图4 三角肌粗隆指数,当肱骨近端骨折,难以使用Tingart指数进行评估,可使用三角肌粗隆指数评估,三角肌粗隆(星号表示)近端,骨皮质外界相互平行,在这一平面,骨皮质外缘直径与内缘直径的比值(a/b)即三角肌粗隆指数
图5 术后3个月螺钉突破关节面(图A),顶入盂肱关节(图B)
[1]
Johnell O, Kamis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures [J]. Osteoporos Int, 2006, 17(12): 1726-1733.
[2]
Johnell O, Kanis JA, Oden A, et al. Mortality after osteoporotic fractures [J]. Osteoporos Int, 2004, 15(1): 38-42.
[3]
Gradl G, Diertze A, Arndt D, et al. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures [J]. Arch Orthop Trauma Surg, 2007, 127(10): 937-944.
[4]
Court-Brown CM, Mcqueen MM. The relationship between fractures and increasing age with reference to the proximal humerus [J]. Cur Orthop, 2002, 16(3): 213-222.
[5]
Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review [J]. Injury, 2006, 37(8): 691-697.
[6]
Dimai HP, Svedbom A, Fahrleitner-Pammer A, et al. Epidemiology of proximal humeral fractures in Austria between 1989 and 2008 [J]. Osteoporos Int, 2013, 24(9): 2413-3421.
[7]
Sumrein BO, Huttunen TT, Launonen AP, et al. Proximal humeral fractures in Sweden-a registry-based study [J]. Osteoporos Int, 2017, 28(3): 901-907.
[8]
Bahrs C, Stojicevic T, Blumenstock G, et al. Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures [J]. Int Orthop, 2014, 38(8): 1697-1704.
[9]
中华人民共和国国家统计局. 中国统计年鉴 [M]. 北京:中国统计出版社,2020.
[10]
Carbone S, Mezzoprete R, Papalia M, et al. Radiographic patterns of osteoporotic proximal humerus fractures [J]. Eur J Radiol, 2018, 100(1): 43-48.
[11]
European Foundation for Dsteoprosis and Bone Disease. Consensus development conference: prophylaxis and treatment of osteoporosis [C]. The United States: Am J Med, 1991, 90(1): 107-110.
[12]
National Institute of Health. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: highlights of the conference [C]. The United States: South Med J, 2001, 94(6): 569-573.
[13]
Ling X, Cummings SR, Mingwei Q, et al. Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project [J]. J Bone Miner Res, 2000, 15(10): 2019-2025.
[14]
中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017) [J]. 中国实用内科杂志, 2018, 38(2): 127-150.
[15]
中华人民共和国国务院. 中国防治慢性病中长期规划(2017-2025年) [J]. 中国实用乡村医生杂志, 2017, 24(11): 6-11.
[16]
Saitoh S, Nakatsuchi Y. Osteoporosis of the proximal humerus: Comparison of bone-mineral density and mechanical strength with the proximal femur [J]. J Shoulder Elbow Surg, 1993, 2(2): 78-84.
[17]
Saitoh S, Nakatsuchi Y, Latta L, et al. Distribution of bone mineral density and bone strength of the proximal humerus [J]. J Shoulder Elbow Surg, 1994, 3(4): 234-242.
[18]
Sprecher CM, Schmidutz F, Helfen T, et al. Histomorphometric Assessment of Cancellous and Cortical Bone Material Distribution in the Proximal Humerus of Normal and Osteoporotic Individuals: Significantly Reduced Bone Stock in the Metaphyseal and Subcapital Regions of Osteoporotic Individuals [J]. Medicine (Baltimore), 2015, 94(51): e2043.
[19]
Tingart MJ, Apreleva M, Von Stechow D, et al. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus [J]. J Bone Joint Surg Br, 2003, 85(4): 611-617.
[20]
Spross C, Kaestle N, Benninger E, et al. Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures [J]. Clin Orthop Relat Res, 2015, 473(9): 3038-3045.
[21]
Mather J, Macdermid JC, Faber KJ, et al. Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis [J]. J Shoulder Elbow Surg, 2013, 22(6): 732-738.
[22]
Krappinger D, Roth T, Gschwentner M, et al. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data [J]. Skeletal Radiol, 2012, 41(3): 299-304.
[23]
Brown JP, Josse RG.Scientific advisory council of the osteoporosis society of canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada [J]. CMAJ, 2002, 167(10 Suppl): S1-34.
[24]
Solberg BD, Moon CN, Franco DP, et al. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome [J]. J Orthop Trauma, 2009, 23(2): 113-119.
[25]
Jung WB, Moon ES, Kim SK, et al. Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate? [J]. BMC Musculoskelet Disord, 2013, 14(1):102.
[26]
Carbone S, Papalia M. The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation [J]. Osteoporos Int, 2016, 27(2): 627-633.
[27]
Roderer G, Scola A, Schmolz W, et al. Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures [J]. Injury, 2013, 44(10): 1327-1332.
[28]
Kim TI, Choi JH, Kim SH, et al. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures [J]. Clin Orthop Surg, 2016, 8(3): 274-279.
[29]
Kolios L, Hoerster AK, Sehmisch S, et al. Do estrogen and alendronate improve metaphyseal fracture healing when applied as osteoporosis prophylaxis? [J]. Calcif Tissue Int, 2010, 86(1): 23-32.
[30]
Li YT, Cai HF, Zhang ZL. Timing of the initiation of bisphosphonates after surgery for fracture healing: a systematic review and meta-analysis of randomized controlled trials [J]. Osteoporos Int, 2015, 26(2): 431-441.
[31]
Singh A, Adams AL, Burchette R, et al. The effect of osteoporosis management on proximal humeral fracture [J]. J Shoulder Elbow Surg, 2015, 24(2): 191-198.
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