骨質(zhì)疏松骨折課件

1、骨質(zhì)疏松骨折Osteoporosis fracture,,骨質(zhì)疏松癥是一種以骨量降低、骨微結(jié)構(gòu)破壞、骨脆性增加、骨強(qiáng)度下降、骨折風(fēng)險(xiǎn)增大為特征的全身性、代謝性骨骼系統(tǒng)疾病Osteoporosis is a systemic, metabolic skeletal system characterized by decreased bone mass, bone microstructural damage, increased bo

2、ne fragility, decreased bone strength, and increased risk of fracture,骨質(zhì)疏松骨折的特點(diǎn)及治療難點(diǎn)：Characteristics and Treatment Difficulties of Osteoporosis fracture：,1、骨質(zhì)疏松骨折患者臥床制動(dòng)后骨丟失加快，骨質(zhì)疏松會(huì)加重；Osteoporosis fractures in patients

3、with bed pressure after bone loss accelerated ，osteoporosis will increase2、骨折多為粉碎性，難以獲得滿意的固定；Fractures are mostly comminuted , it is difficult to obtain a satisfactory fixation3、內(nèi)固定易松動(dòng)，植骨易被吸收；Internal fixation eas

4、y to loose,bone graft easily absorbed,4、骨折愈合時(shí)間長，易發(fā)生延遲愈合、不愈合；Fracture healing time is long, prone to delayed healing or nonunion5、再骨折風(fēng)險(xiǎn)大；Easy to recur fracture again6、多為老年人，常合并多器官疾病，全身狀況差；Patients are mostly elderly

5、, often associated with multiple organ diseases, poor overall condition7、致殘率、致死率較高，嚴(yán)重影響生活質(zhì)量和壽命。disability rate and fatality rate are higher, seriously affecting the quality of life and life.,骨質(zhì)疏松癥的診斷標(biāo)準(zhǔn)：Diagnosti

6、c criteria for osteoporosis：,雙能X線吸收法（DXA）是目前國際公認(rèn)的骨密度檢查方法。DXA is the internationally recognized method of bone mineral density .,根據(jù)《中國人骨質(zhì)疏松癥診斷標(biāo)準(zhǔn)專家共識(shí)（第三稿2014版）》，年輕白人女性峰值骨量減少2.5標(biāo)準(zhǔn)差（-2.5SD）作為骨質(zhì)疏松癥的診斷標(biāo)準(zhǔn)。由于黃種人峰值骨量低于白種人等原因，國內(nèi)

7、推薦使用低于峰值骨量2標(biāo)準(zhǔn)差（-2.0SD），或者骨量下降25%作為診斷標(biāo)準(zhǔn)。According to the "Chinese osteoporosis diagnostic criteria expert consensus (third edition 2014 version)", young white female peak bone mass reduction of 2.5 standard

8、deviation (-2.5SD) as the diagnostic criteria for osteoporosis. As the yellow population of bone mass below the white and other reasons, the domestic recommended lower than the peak bone mass 2 standard deviation (-2.0S

9、D), or bone loss of 25% as a diagnostic standard.,骨折后抗骨質(zhì)疏松用藥建議：Prevention of osteoporosis after fracture:,根據(jù)中華醫(yī)師學(xué)會(huì)骨科分會(huì)《骨質(zhì)疏松骨質(zhì)診療指南》，重要有如下幾個(gè)要點(diǎn)：According to the Chinese Physicians Society Orthopedic Branch "osteoporo

10、sis bone diagnosis and treatment guide", The main points are as follows:,1、合理使用鈣劑：Rational use of calcium鈣需要量為800-1200mg，骨折后補(bǔ)鈣劑量應(yīng)酌情適當(dāng)加量。建議分次服用Calcium requirements for the 800-1200mg, After the fracture, the dosag

11、e of calcium should be appropriately added. Suggested fract. dos.2、推薦活性維生素D3Recommended use of vitamin D3建議用法為0.25-0.5ug/d，不僅能夠增進(jìn)腸鈣吸收，促進(jìn)骨形成和骨礦化，而且有助于增強(qiáng)肌力，增強(qiáng)神經(jīng)肌肉協(xié)調(diào)性，防止跌倒傾向。Suggested usage is 0.25-0.5ug / d, not only

12、can enhance intestinal calcium absorption, promote bone formation and bone mineralization, but also help to enhance muscle strength, enhance neuromuscular coordination, to prevent the tendency to fall.,3、降鈣素（Calcitonin）

13、如鮭魚降鈣素皮下或肌肉內(nèi)注射50IU/d，鼻噴劑200IU/d。能夠提高骨密度、改善骨質(zhì)量、增強(qiáng)骨的生物力學(xué)性能、降低椎體骨質(zhì)疏松骨折發(fā)生率，還有止痛作用。Such as salmon calcitonin subcutaneous or intramuscular injection of 50IU / d, nasal spray 200IU / d. Can improve bone density, improve bone

14、mass, enhance bone biomechanical properties, Reduce the incidence of osteoporotic vertebral fractures, as well as analgesic effect.但少數(shù)患者可有面部潮紅、惡心等不良反應(yīng)，其中多數(shù)患者癥狀可在數(shù)小時(shí)內(nèi)自行緩解，有明顯藥物過敏史者禁用。But may have facial flushing, nause

15、a and other adverse reactions, most of which patients can be self-mitigation within a few hours, there are obvious history of drug allergy disabled.,如阿倫磷酸鈉、利賽磷酸鈉、唑來磷酸鈉等，可提高腰椎和髖部骨密度，降低骨折風(fēng)險(xiǎn)及再骨折發(fā)生率。阿倫磷酸鈉有口服70mg/w和10mg/d兩種用法

16、，應(yīng)當(dāng)日首次就餐前30min以一杯白開水送服，礦泉水不可用。為減輕藥物對(duì)胃與食管的刺激，服藥后至少30分鐘內(nèi)避免躺臥。雙磷酸鹽類藥物主要不良反應(yīng)是胃腸道反應(yīng)，如惡心、嘔吐、腹痛、腹瀉等。Such as sodium alendate, sodium phosphate, sodium azole phosphate, etc., can improve the lumbar and hip bone density, reduce t

17、he risk of fracture and fracture rate. Alan sodium phosphate oral administration of 70mg / w and 10mg / d two kinds of usage, should be the first day before dinner 30min to a cup of boiled water delivery service, mineral

18、 water is not available. To reduce the stimulation of the stomach and esophagus, medication at least 30 minutes after the avoidance of lying. The main adverse effects of bisphosphonates are gastrointestinal reactions, su

19、ch as nausea, vomiting, abdominal pain, diarrhea and so on.,4、雙磷酸鹽（Bisphosphonates）,5、選擇性雌激素受體調(diào)節(jié)劑（SERMs）,6、鍶鹽（Strontium salt）如雷耐酸鍶2g/d，睡前服用。具有雙重作用機(jī)制，可提高骨強(qiáng)度、降低椎體及髖部骨折風(fēng)險(xiǎn)。Such as strontium strontium 2g / d, taken before g

20、oing to bed. Has a dual mechanism of action, can improve bone strength, reduce the risk of vertebral and hip fractures.,如雷洛昔芬60mg/d，服藥時(shí)間不受飲食影響。在提高骨密度、降低絕經(jīng)后骨質(zhì)疏松骨折發(fā)生率方面有良好療效。Such as raloxifene 60mg / d, medication time fr

21、om diet. In improving bone density, reduce the incidence of postmenopausal osteoporotic fractures have a good effect.,骨質(zhì)疏松骨折危險(xiǎn)因素：Risk factors for osteoporosis fracture:,1，主要危險(xiǎn)因素Major risk factors跌倒，低骨密度，脆性骨折史，年齡大于65歲，

22、有骨折家族病史Fall, low bone density, brittle [?br?tl] fracture history, older than 65 years old, with a history of fracture family2、次要危險(xiǎn)因素Secondary risk factors嗜煙，酗酒，低體重指數(shù)，性腺機(jī)能減退，早期絕經(jīng)（＜45歲），長期營養(yǎng)不良，影響骨代謝藥物使用史（糖皮質(zhì)激素、肝素），類風(fēng)濕性

23、關(guān)節(jié)炎、甲狀腺功能亢進(jìn)、甲狀旁腺功能亢進(jìn)患者。Smoking, alcoholism, low body mass index , hypogonadism[ha?p??'g?næd?z?m,Early menopause (<45 years), long-term malnutrition, the history of bone metabolism used drugs (glucocorticoid,

24、 heparin), rheumatoid arthritis, hyperthyroidism, hyperparathyroidism patients.,如何預(yù)防How to prevent,1、戒煙戒酒，均衡膳食；Quit smoking, balanced diet2、保持適度體重；Maintain moderate weight3、肌力鍛煉及全身平衡性與協(xié)調(diào)性鍛煉；Muscle exercise and body b