辽宁省两所三甲医院老年骨质疏松性骨折的发病特点及诊疗现状

发布时间：2018-08-07 16:40

【摘要】：目的:通过对辽宁省沈阳、大连某两所三甲医院老年骨质疏松性骨折患者的临床资料调查分析,了解两地老年骨质疏松性骨折的发病特点、诊断、治疗以及二级预防现状,为该地区进一步做好老年骨质疏松性骨折的诊治和预防工作提供依据。方法:分别收集整理2015年1月至2015年12月大连市某三甲医院406例和沈阳市某三甲医院365例60岁以上老年骨质疏松性骨折住院患者的临床资料,对其基本情况(年龄、性别、舒张压、收缩压、体重、身高、BMI)、临床资料(血清碱性磷酸酶、血清白蛋白、血肌酐、内生肌酐清除率、空腹血糖、血清钙、血磷、合并症、骨折部位、骨折次数、骨折季节、影像学检查、是否手术)、诊断及抗骨质疏松治疗情况进行统计分析。结果:1.大连某医院60岁以上老年骨质疏松性骨折人数占骨折总人数的37.52%(406/1082例),其中女性291例,平均年龄(73.84±8.85)岁,白蛋白平均值(39.49±4.99)g/L,空腹血糖平均值(5.96±2.61)mmol/L;男性115例,平均年龄(74.92±9.79)岁,白蛋白平均值(38.90±4.92)g/L,空腹血糖平均值(6.02±1.75)mmol/L。沈阳某医院60岁以上老年骨质疏松性骨折人数占骨折总人数的47.10%(365/775例),其中女性252例,平均年龄(74.50±8.43)岁,白蛋白平均值(39.37±4.17)g/L,空腹血糖平均值(5.98±1.75)mmol/L;男性113例,平均年龄(71.65±8.20)岁,白蛋白平均值(38.06±3.99)g/L,空腹血糖平均值(5.85±1.49)mmol/L。两所医院老年骨质疏松性骨折占骨折总人数的比率均较高,且女性多于男性。患者血清白蛋白普遍较正常值偏低,空腹血糖为正常值高限。2.两所医院老年骨质疏松性骨折患者的常见合并症均为高血压、腔隙性脑梗塞、冠心病、糖尿病。大连某医院研究对象合并2种疾病者96例(23.65%),合并3种及以上疾病者82例(20.20%)。沈阳某医院研究对象合并2种疾病者99例(27.12%),合并3种及以上疾病者67例(18.36%)。两所医院老年骨质疏松性骨折患者多病共存现象较为普遍。3.两所医院老年骨质疏松性骨折的好发部位均依次为髋部、脊柱、尺桡骨远端、肱骨近端。大连某医院研究对象中单部位骨折327例(80.54%),多部位骨折79例(19.46%),发生再次骨折54例(13.30%)。沈阳某医院研究对象中单部位骨折310例(84.93%),多部位骨折55例(15.07%),发生再次骨折30例(8.22%)。4.大连某医院老年骨质疏松性骨折有52.96%发生在冬春季,47.04%发生在夏秋季。沈阳某医院老年骨质疏松性骨折有51.23%发生在冬春季,48.77%发生在夏秋季。两所医院老年骨质疏松性骨折患者的发病季节均为冬春季多于夏秋季。5.大连某医院老年骨质疏松性骨折患者中给予骨质疏松症诊断的有50例(12.32%),在院期间给予骨质疏松治疗的有91例(22.41%),其中抗骨质疏松治疗用药种类为1种者54例(13.30%)、2种27例(6.65%)、3种10例(2.46%);出院医嘱中给予骨质疏松治疗的有83例(20.45%),其中抗骨质疏松治疗用药种类为1种者57例(14.04%)、2种20例(4.93%)、3种6例(1.48%);有3例(0.74%)脆性骨折患者既诊断了骨质疏松症又在住院期间和出院医嘱中均给予骨质疏松规范治疗。沈阳某医院老年骨质疏松性骨折患者中给予骨质疏松症诊断的有57例(15.62%),在院期间给予骨质疏松治疗的有99例(27.12%),其中抗骨质疏松治疗用药种类为1种者60例(16.44%)、2种32例(8.76%)、3种7例(1.92%);出院医嘱中给予骨质疏松治疗的有62例(16.98%),其中抗骨质疏松治疗用药种类为1种者46例(12.60%)、2种12例(3.29%)、3种4例(1.09%);有2例(0.55%)脆性骨折患者既诊断了骨质疏松症又在住院期间和出院医嘱中均给予骨质疏松规范治疗。两所医院骨质疏松症的诊断率、规范化治疗率及联合用药率均较低。结论:1.辽宁该地区老年骨质疏松性骨折的患者发病有其地区特点,尤其在患病人数、性别、血清白蛋白、空腹血糖、骨折部位、骨折次数、骨折季节、合并症有一定分布规律。2.目前该地区老年骨质疏松症的重视程度仍然不够,骨质疏松症的诊断、治疗及二级预防现状不容乐观,应加强宣传并提高诊疗水平,采取防治策略以减缓老年骨质疏松症的进展和预防脆性骨折的发生。
[Abstract]:Objective: to understand the characteristics, diagnosis, treatment and the status of two grade prevention of osteoporotic fracture in the elderly of two hospitals in Shenyang and Dalian, Liaoning, and to provide the prevention and treatment and prevention of osteoporotic fracture in the area. Methods: to collect and collate the clinical data of 406 hospitalized patients with osteoporotic fractures over 60 years old in a three a hospital in Dalian from January 2015 to December 2015, and 365 cases of elderly osteoporotic fractures in a three a hospital in Shenyang. The basic conditions (age, sex, diastolic pressure, systolic pressure, weight, height, BMI), clinical data (serum alkaline phosphatase, blood) Albumin, blood creatinine, endogenous creatinine clearance, fasting blood glucose, serum calcium, blood phosphorus, complication, fracture site, fracture times, fracture season, imaging examination, or not surgery), diagnosis and treatment of anti osteoporosis. Results: 1. the number of osteoporotic fractures over 60 years old in a hospital in Dalian accounted for 3 of the total number of fractures. 7.52% (406/1082 cases), of which 291 were female, average age (73.84 + 8.85), albumin average (39.49 + 4.99) g/L, average value of fasting blood glucose (5.96 + 2.61) mmol/L, male 115, average age (74.92 + 9.79) years, average value of albumin (38.90 + 4.92) g/ L, and average value of fasting blood glucose (mmol/L.) in a certain hospital in Shenyang The number of osteoporotic fractures accounted for 47.10% of the total number of fractures (365/775 cases), of which 252 cases were female, average age (74.50 + 8.43) years, albumin average (39.37 + 4.17) g/L, average value of fasting blood glucose (5.98 + 1.75) mmol/L, male 113 cases, average age (71.65 + 8.20) years, albumin average (38.06 + 3.99) g/L, average value of fasting blood glucose (mmol/) mmol/ L. two hospital aged osteoporotic fractures accounted for a higher proportion of the total number of fractures, and women were more than men. The serum albumin was generally lower than the normal value. The common complications of osteoporotic fracture patients in the elderly.2. two hospital were high blood pressure, lacunar cerebral infarction, coronary heart disease and diabetes. In a hospital in Dalian, 96 cases (23.65%) were combined with 2 diseases, 82 cases (20.20%) were combined with 3 or more diseases. 99 cases (27.12%) were combined with 2 diseases in a hospital in Shenyang, 3 or 67 (18.36%) were combined with 3 or more diseases. The coexistence of multiple diseases in elderly osteoporotic fractures in the hospital was more common in.3. hospitals. There were 327 cases of single part fracture in Dalian hospital (80.54%), 79 cases of multiple fractures (19.46%), 54 cases of fracture (13.30%), and 310 cases (84.93%) of single site fracture in a hospital in Shenyang, 55 cases of multiple site fractures (15. 07%), there were 30 cases of fracture again (8.22%) in.4. Dalian, 52.96% of the elderly osteoporotic fractures occurred in winter and spring, 47.04% occurred in summer and autumn. 51.23% of old osteoporotic fractures occurred in winter and spring in a hospital in Shenyang, 48.77% occurred in summer and autumn. Two hospital old osteoporotic fractures were in winter. There were 50 cases (12.32%) in the diagnosis of osteoporosis in the elderly patients with osteoporotic fracture in.5. Dalian hospital in spring more than in summer and autumn. 91 cases (22.41%) were given osteoporosis treatment during the hospital, of which 54 cases (13.30%), 2 27 cases (6.65%) and 3 10 (2.46%) were treated with anti osteoporosis treatment, and the medical orders were given to bone. There were 83 cases of osteoporosis treatment (20.45%), of which 1 kinds of anti osteoporosis treatment were 1 species (14.04%), 2 20 cases (4.93%), 3 6 cases (1.48%), and 3 (0.74%) brittle fracture patients both diagnosed osteoporosis and given osteoporosis standard treatment during hospitalization and discharge medical advice. The elderly osteoporotic bone in a hospital in Shenyang There were 57 cases (15.62%) in the diagnosis of osteoporosis and 99 cases (27.12%) for osteoporosis treatment during the hospital, of which 60 cases (16.44%), 2 32 cases (8.76%) and 3 7 cases (1.92%) were treated with anti osteoporosis treatment, and the treatment of osteoporosis was given in 99 cases (8.76%). There were 1 species (12.60%), 2 12 cases (3.29%), 3 4 cases (1.09%); 2 cases (0.55%) fragile fracture patients both diagnosed osteoporosis and given osteoporosis during hospitalization and discharged medical orders. The diagnosis rate of osteoporosis, standardized treatment rate and combination rate were low in two hospital. Conclusion: 1. Liaoning Patients with osteoporotic fractures in the area have their regional characteristics, especially in the number of diseases, sex, serum albumin, fasting blood sugar, fracture site, fracture times, fracture season, and the regularity of complication,.2. is still not paid enough attention to the elderly osteoporosis in this area, diagnosis, treatment and treatment of osteoporosis. The status of the two level prevention is not optimistic. We should strengthen the publicity and improve the level of diagnosis and treatment, take prevention and cure strategies to slow down the progress of senile osteoporosis and prevent the occurrence of brittle fracture.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580;R683

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