髋部骨折：诊断和管理
Hip Fractures: Diagnosis and Management
影响因子:3.50000
分区:医学3区 / 医学：内科3区 初级卫生保健3区
发表日期:2022 Dec
作者:
Jeremy D Schroeder, Sean P Turner, Emily Buck
摘要
髋部骨折是残疾的常见原因，死亡率在一年中达到30％。不可修改的危险因素包括较低的社会经济状况，年龄较大，女性，先前的骨折，代谢骨病和骨恶性肿瘤。可修改的危险因素包括低体重指数，骨质疏松症，跌落风险增加，增加跌落风险或降低骨矿物质密度的药物以及使用物质。髋部骨折出现前腹股沟疼痛，无法承受重量或缩短，绑架，外部旋转的肢体。普通X线照相通常足以诊断，但是如果怀疑骨折持续存在正常的射线照相，则应获得磁共振成像。骨折的24至48小时内的手术管理优化了结果。骨折通常是通过手术管理的，其方法基于断裂类型和位置；可以使用脊柱或全身麻醉。对于不是好的手术候选者的患者，可以考虑非手术管理。给予术前和术后抗磷灰球菌抗生素，以防止关节感染。还建议预防静脉血栓栓塞的药物。医生应警惕存在ir妄的存在，这是常见的术后并发症。术后早期动员，然后进行康复，改善了结果。随后的护理专注于预防，体育锻炼，家庭安全评估增加以及最大程度地减少多药。还可能发生两个较少常见的髋部骨折：股骨颈部应力骨折和不足骨折。股骨颈部应力骨折通常发生在20至30岁的舞者中，耐力运动员和兵役人员通常是由于训练超负荷而发生的。绝经后妇女由于骨骼强度损害而导致的不足骨折。如果未被识别和治疗，这些骨折可以进展到骨不连和血管坏死率高的裂缝。
Abstract
Hip fractures are common causes of disability, with mortality rates reaching 30% at one year. Nonmodifiable risk factors include lower socioeconomic status, older age, female sex, prior fracture, metabolic bone disease, and bony malignancy. Modifiable risk factors include low body mass index, having osteoporosis, increased fall risk, medications that increase fall risk or decrease bone mineral density, and substance use. Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. Operative management within 24 to 48 hours of the fracture optimizes outcomes. Fractures are usually managed by surgery, with the approach based on fracture type and location; spinal or general anesthesia can be used. Nonsurgical management can be considered for patients who are not good surgical candidates. Pre- and postoperative antistaphylococcal antibiotics are given to prevent joint infection. Medications for venous thromboembolism prophylaxis are also recommended. Physicians should be alert for the presence of delirium, which is a common postoperative complication. Early postoperative mobilization, followed by rehabilitation, improves outcomes. Subsequent care focuses on prevention, with increased physical activity, home safety assessments, and minimizing polypharmacy. Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures. Femoral neck stress fractures typically occur in dancers 20 to 30 years of age, endurance athletes, and military service members, often because of training overload. Insufficiency fractures due to compromised bone strength occur without trauma in postmenopausal women. If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis.