生堡置拄塞志婴!!生!旦筮31鲞筮!期￡蜒坠』堕h!P，』坠!Y垫!!，yQ!：≥!：丛Q：2骨质疏松骨折后再骨折的临床风险因素阮文东王沛雪原马信龙周先虎·789··临床论著·【摘要】目的探讨骨质疏松患者初次骨折后发生再骨折的风险及其临床特点。方法收集2006年1月至2008年1月门诊及住院的年龄50岁以上、临床可确诊的骨质疏松骨折患者273例，根据是否有骨质疏松骨折病史分为再骨折组48例和骨折组225例。分析患者一般资料、骨折类型、股骨颈DXA骨密度测定T值、Charlson合并症指数、骨折时间等临床特征，并行运动协调技能评价。结果骨折组年龄(67．7±8．5)岁，再骨折组(72．7±9．5)岁；再骨折组女性占77．1％，高于骨折组女性构成比70．2％；再骨折类型以椎体骨折后再次发生股骨颈骨折最多见，其次为股骨颈骨折后再次发生股骨颈骨折。再骨折发生的风险因素包括高龄(>75岁，舰=1．23；>85岁，艘=1．68)、女性(舰=1．36)、曾发生椎体骨折(HR=1．62)、曾发生髋部骨折(HR=1．27)，骨密度一T值<一3．5(HR=1．38)及运动协调技能减退(H尺=1．27)。再骨折平均发生于初次骨折后(3．7±2．5)年。骨折组随访2年内再骨折发生率4．9％(11／225)。结论有初次骨质疏松骨折病史的患者发生再骨折的风险仍然很明显，两次骨折之间有足够的间隔采取措施降低再骨折的风险。特别是对发生椎体、髋部骨折的老年女性应进行干预，进行运动协调技能的康复训练和防跌倒练习。【关键词】骨质疏松；骨折；危险性评估【证据等级】预后判断性研究Ⅲ级AnaIvsiSontllerisk1．ac加Irsofsecondf}actIlreinf}actI"erelatedtoosteoporosisRMⅣ形en．don品WANcPet，xUEYu辅?，MAxi渺kn昏zHoUX妇I—h‰Departmem《om硇paed谊s，Ge他rdHosp讧正《死锄i讥胁d拓缸‰西e瑙如仉孔n，l，流30DD52，劬im【Abstr舵t】objectiveToexploretheclinicalcharacteristicsandriskfactorsofre—fractureinpa-tientssufkringf如mosteoporosis—relatedfhcturesasweⅡaseff-ectiveinterventions．IⅥethodsFromJanuary2006toJanuary2008，atotaIof273patients“thosteoporosis．relatedfhcturewereenteredinthestudy'in．cludingout．patientsandin．patientswhoweI琶over50yeaI_sold．Thepatientsweredividedintoftacturegmup∞=225)andre—fracturegmup∞=48)．111ere-fractureratewasfollowedupfor2years，duringwhich1lpatientsdevelopedre．fhcture．Generaldataincludingageandsex，fhcture竹pes，femoralneckbonemineraldensity(BMD)T-scorestestedbydual—energyx—raysabsorptiomeⅡy(DEXA)，Chdsonindex，time-inten，albetweentwof}acturesaswellasmobilitvskillassessmentweIecoUectedandanahrzed．ResIIlts7Iheaverageageatthefir8tf-Tacturewas67．7±8．5yearsvs．72．7士9．5yearsforthere一曲ctureca8e8．Femaleaccountedfbr70．2％ofthefhctur℃P疆Dupand77．1％ofthere—fhcturegroup．Themostcommonre—fjacturetypewasvertebralfhctureforthefirsttimeandfemoralneckfhctureforthesecondtimedunngthefollow—up．Riskfactorsforasecondfhcturein08teopomticfhcturespatientsincludeage(>75years，HR=1．23；>85years，Ⅲz=1．68)，femalesex似尺=1．36)，priorvertebraJfractures饵尺=1．62)，priorhiphctures旧冗=1．27)，BMDT—score<一3．5旧尺=1．381蛐dweakenednlotorskiⅡs旧尺=1．27)．7nlerefhctur；erateinosteoporosis．re．1atedfhctureswas4．9％followeduDfor2vears．Thesecondfhcturehappened3．7vears出er山efirstoneonaveraP犯．ConclusioⅡTherisksofsecondfhctureamongpatientswithinitialbritdefhcturearesub．stantial．Mobilitvskiuassessmentisanimportantriskfactorforosteopomsisfhcturesrecun-ence．Thereisadequatetimebetweenf}actureandre．fhcturefbrefE毫ctiveinterventionstopreventorreducetherisksofre—fhcture，especiaUvfbrtlleoldwomenwithavertebT．alorhip曲ctuIe．Medication，motorfhnctionrehabilita—tionandfhll．downpreventiontIainingw叫ldbehelp{-u1．【Keywords】Osteoporosi...
