Leiden University Medical Center, Leiden, The Netherlands.
Int Orthop. 2011 Oct;35(10):1545-51. doi: 10.1007/s00264-010-1176-4. Epub 2010 Dec 17.
The aim of this study was the evaluation of contralateral hip fractures after a previous hip fracture. For this retrospective analysis patients were selected from the database of the LUMC, a teaching hospital in the south-west of the Netherlands. We analyzed all patients with a second fracture of a hip between 1992 and 2007. The exclusion criteria were high impact trauma and patients with diseases or medication known to have a negative effect on bone metabolism. A total of 1,604 hip fractures were identified. The possible predictive factors for the second fracture and descriptive statistics related to surgery (Hb and HT before and after the operation, total amount of intra- and postoperative blood loss, type of osteosynthesis, complications, time of death after the last fracture, time between arrival in the hospital and operation and hospital stay for both fractures) were recorded. A total of 32 second hip fractures were identified (2%) at a mean of 27.5 (SD 28.9) months after the initial hip fracture. The mean age at the first fracture was 77.2 years (SD 11.7), and 27 of 32 patients were female. Of these 32 patients (64 bilateral hip fractures), 32 fractures were intracapsular (1 femoral neck, 31 subcapital) and 32 were extracapsular fractures (6 subtrochanteric, 26 transtrochanteric). Although 24 of the 32 patients had identical first and second hip fractures, only eight out of 32 hips were treated with the same implants. There was a significant difference in Singh index between both hips at the time of the first fracture. There was also a significant difference in Singh index between the hip which was not fractured compared with its subsequent index when it was broken. All other studied patient and fracture characteristics were not significantly different. In this population the percentage of second hip fractures was relatively low compared to other studies. The choice of implants in this study shows that implants were chosen randomly. Because there is a significant difference in the Singh index during first and second hip fracture, osteoporosis medication might help reduce the incidence of second hip fractures.
本研究的目的是评估先前髋部骨折后对侧髋部骨折的情况。为此，我们从荷兰西南部教学医院 LUMC 的数据库中选择了患者进行回顾性分析。我们分析了 1992 年至 2007 年间所有第二次髋部骨折的患者。排除标准为高能量创伤以及已知对骨代谢有负面影响的疾病或药物的患者。共确定了 1604 例髋部骨折。记录了第二次骨折的可能预测因素和与手术相关的描述性统计数据（手术前后的 Hb 和 HT、术中及术后总失血量、内固定类型、并发症、最后一次骨折后死亡时间、从入院到手术的时间以及两次骨折的住院时间）。在初次髋部骨折后平均 27.5（SD 28.9）个月时，共确定了 32 例第二次髋部骨折（2%）。第一次骨折时的平均年龄为 77.2 岁（SD 11.7），32 例患者中有 27 例为女性。这 32 例患者（64 例双侧髋部骨折）中，32 例为囊内骨折（1 例股骨颈骨折，31 例股骨颈基底部骨折），32 例为囊外骨折（6 例转子下骨折，26 例转子间骨折）。尽管 32 例患者中有 24 例初次和第二次髋部骨折相同，但 32 个髋部中只有 8 个使用了相同的植入物。第一次骨折时两侧髋部的 Singh 指数有显著差异。初次未骨折的髋部与随后骨折时的指数相比，也有显著差异。所有其他研究的患者和骨折特征均无显著差异。与其他研究相比，该人群的第二次髋部骨折比例相对较低。本研究中植入物的选择表明植入物是随机选择的。由于第一次和第二次髋部骨折时 Singh 指数有显著差异，骨质疏松症药物治疗可能有助于降低第二次髋部骨折的发生率。
