骨质疏松骨折PPT课件.ppt

骨质疏松骨折Osteoporosisfracture,1,.-,2019/11/12,骨质疏松症是一种以骨量降低、骨微结构破坏、骨脆性增加、骨强度下降、骨折风险增大为特征的全身性、代谢性骨骼系统疾病Osteoporosisisasystemic,metabolicskeletalsystemcharacterizedbydecreasedbonemass,bonemicrostructuraldamage,increasedbonefragility,decreasedbonestrength,andincreasedriskoffracture,2,.-,2019/12/15,骨质疏松骨折的特点及治疗难点：CharacteristicsandTreatmentDifficultiesofOsteoporosisfracture：,1、骨质疏松骨折患者卧床制动后骨丢失加快，骨质疏松会加重；Osteoporosisfracturesinpatientswithbedpressureafterbonelossaccelerated，osteoporosiswillincrease2、骨折多为粉碎性，难以获得满意的固定；Fracturesaremostlycomminuted,itisdifficulttoobtainasatisfactoryfixation3、内固定易松动，植骨易被吸收；Internalfixationeasytoloose,bonegrafteasilyabsorbed,3,.-,2019/12/15,4、骨折愈合时间长，易发生延迟愈合、不愈合；Fracturehealingtimeislong,pronetodelayedhealingornonunion5、再骨折风险大；Easytorecurfractureagain6、多为老年人，常合并多器官疾病，全身状况差；Patientsaremostlyelderly,oftenassociatedwithmultipleorgandiseases,pooroverallcondition7、致残率、致死率较高，严重影响生活质量和寿命。disabilityrateandfatalityratearehigher,seriouslyaffectingthequalityoflifeandlife.,4,.-,2019/12/15,骨质疏松症的诊断标准：Diagnosticcriteriaforosteoporosis：,双能X线吸收法（DXA）是目前国际公认的骨密度检查方法。DXAistheinternationallyrecognizedmethodofbonemineraldensity.,5,.-,2019/12/15,根据中国人骨质疏松症诊断标准专家共识（第三稿2014版），年轻白人女性峰值骨量减少2.5标准差（-2.5SD）作为骨质疏松症的诊断标准。由于黄种人峰值骨量低于白种人等原因，国内推荐使用低于峰值骨量2标准差（-2.0SD），或者骨量下降25%作为诊断标准。AccordingtotheChineseosteoporosisdiagnosticcriteriaexpertconsensus(thirdedition2014version),youngwhitefemalepeakbonemassreductionof2.5standarddeviation(-2.5SD)asthediagnosticcriteriaforosteoporosis.Astheyellowpopulationofbonemassbelowthewhiteandotherreasons,thedomesticrecommendedlowerthanthepeakbonemass2standarddeviation(-2.0SD),orbonelossof25%asadiagnosticstandard.,6,.-,2019/12/15,骨折后抗骨质疏松用药建议：Preventionofosteoporosisafterfracture:,根据中华医师学会骨科分会骨质疏松骨质诊疗指南，重要有如下几个要点：AccordingtotheChinesePhysiciansSocietyOrthopedicBranchosteoporosisbonediagnosisandtreatmentguide,Themainpointsareasfollows:,7,.-,2019/12/15,1、合理使用钙剂：Rationaluseofcalcium钙需要量为800-1200mg，骨折后补钙剂量应酌情适当加量。建议分次服用Calciumrequirementsforthe800-1200mg,Afterthefracture,thedosageofcalciumshouldbeappropriatelyadded.Suggestedfract.dos.2、推荐活性维生素D3RecommendeduseofvitaminD3建议用法为0.25-0.5ug/d，不仅能够增进肠钙吸收，促进骨形成和骨矿化，而且有助于增强肌力，增强神经肌肉协调性，防止跌倒倾向。Suggestedusageis0.25-0.5ug/d,notonlycanenhanceintestinalcalciumabsorption,promoteboneformationandbonemineralization,butalsohelptoenhancemusclestrength,enhanceneuromuscularcoordination,topreventthetendencytofall.,8,.-,2019/12/15,3、降钙素（Calcitonin）如鲑鱼降钙素皮下或肌肉内注射50IU/d，鼻喷剂200IU/d。能够提高骨密度、改善骨质量、增强骨的生物力学性能、降低椎体骨质疏松骨折发生率，还有止痛作用。Suchassalmoncalcitoninsubcutaneousorintramuscularinjectionof50IU/d,nasalspray200IU/d.Canimprovebonedensity,improvebonemass,enhancebonebiomechanicalproperties,Reducetheincidenceofosteoporoticvertebralfractures,aswellasanalgesiceffect.但少数患者可有面部潮红、恶心等不良反应，其中多数患者症状可在数小时内自行缓解，有明显药物过敏史者禁用。Butmayhavefacialflushing,nauseaandotheradversereactions,mostofwhichpatientscanbeself-mitigationwithinafewhours,thereareobvioushistoryofdrugallergydisabled.,9,.-,2019/12/15,如阿伦磷酸钠、利赛磷酸钠、唑来磷酸钠等，可提高腰椎和髋部骨密度，降低骨折风险及再骨折发生率。阿伦磷酸钠有口服70mg/w和10mg/d两种用法，应当日首次就餐前30min以一杯白开水送服，矿泉水不可用。为减轻药物对胃与食管的刺激，服药后至少30分钟内避免躺卧。双磷酸盐类药物主要不良反应是胃肠道反应，如恶心、呕吐、腹痛、腹泻等。Suchassodiumalendate,sodiumphosphate,sodiumazolephosphate,etc.,canimprovethelumbarandhipbonedensity,reducetheriskoffractureandfracturerate.Alansodiumphosphateoraladministrationof70mg/wand10mg/dtwokindsofusage,shouldbethefirstdaybeforedinner30mintoacupofboiledwaterdeliveryservice,mineralwaterisnotavailable.Toreducethestimulationofthestomachandesophagus,medicationatleast30minutesaftertheavoidanceoflying.Themainadverseeffectsofbisphosphonatesaregastrointestinalreactions,suchasnausea,vomiting,abdominalpain,diarrheaandsoon.,4、双磷酸盐（Bisphosphonates）,10,.-,2019/12/15,5、选择性雌激素受体调节剂（SERMs）,6、锶盐（Strontiumsalt）如雷耐酸锶2g/d，睡前服用。具有双重作用机制，可提高骨强度、降低椎体及髋部骨折风险。Suchasstrontiumstrontium2g/d,takenbeforegoingtobed.Hasadualmechanismofaction,canimprovebonestrength,reducetheriskofvertebralandhipfractures.,如雷洛昔芬60mg/d，服药时间不受饮食影响。在提高骨密度、降低绝经后骨质疏松骨折发生率方面有良好疗效。Suchasraloxifene60mg/d,medicationtimefromdiet.Inimprovingbonedensity,reducetheincidenceofpostmenopausalosteoporoticfractureshaveagoodeffect.,11,.-,2019/12/15,骨质疏松骨折危险因素：Riskfactorsforosteoporosisfracture:,1，主要危险因素Majorriskfactors跌倒，低骨密度，脆性骨折史，年龄大于65岁，有骨折家族病史Fall,lowbonedensity,brittlebrtlfracturehistory,olderthan65yearsold,withahistoryoffracturefamily2、次要危险因素Secondaryriskfactors嗜烟，酗酒，低体重指数，性腺机能减退，早期绝经（45岁），长期营养不良，影响骨代谢药物使用史（糖皮质激素、肝素），类风湿性关节炎、甲状腺功能亢进、甲状旁腺功能亢进患者。Smoking,alcoholism,lowbodymassindex,hypogonadismhapgndzm,Earlymenopause(45years),long-termmalnutrition,thehistoryofbonemetabolismuseddrugs(glucocorticoid,heparin),rheumatoidarthritis,hyperthyroidism,hyperparathyroidismpatients.,12,.-,2019/12/15,如何预防Howtoprevent,1、戒烟戒酒，均衡膳食；Quitsmoking,balanceddiet2、保持适度体重；Main