Yoshii Ichiro, Kitaoka Kenichi, Hashimoto Kyuichi
Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, 6-7-5 Nakamura-Ohashidori, Shimanto-City, 787-0033, Kochi Prefecture, Japan.
Department of Orthopaedic Surgery, Kochi Prefectural Hata Kenmin Hospital, 3-1 Yoshina, Yamada-cho, Sukumo, 788-0785, Kochi Prefecture, Japan.
J Orthop Sci. 2019 Sep;24(5):836-841. doi: 10.1016/j.jos.2018.12.029. Epub 2019 Feb 13.
Second osteoporotic fracture of the hip is a serious comorbidity that can directly cause mortality. Preventing its occurrence is particularly important in Japan, given its rapidly aging society. Here, the clinical characteristics of such recurrence were evaluated using the data of the Clinical Pathway with Regional Alliance (CPRA).
CPRA for hip fracture started in 2007 and has allowed intranet-based data sharing since July 2011. Data from this alliance, such as number of second cases, duration from initial fracture, Functional Impairment Measure (FIM), revised Hasegawa Dementia Scale (HDS-R) score, muscle force and range of motion of hip joint, and gait status (GS) were collected and statistically evaluated.
Overall, 45 of 1118 cases (2.68/100 person-years) developed a second fracture. The mean interval from initial to second fracture was 13.3 months. Thirty of these cases (66.7%, 1.79/100 person-years) occurred within 1 year from initial fracture (G < 1Y). The second fracture tended to be associated with worse parameter values than initial fracture, especially for GS. FIM score for cognitive function, HDS-R score, and GS at acute fracture in the G < 1Y group were significantly lower than in the initial fracture patient group (Initial). The withdrawal rate was also significantly higher than for Initial, whereas deaths and serious comorbidities were also much more numerous.
Osteoporotic second hip fracture is a severe issue, and its prognosis is remarkably poor. The majority of these cases may occur within 1 year from the initial fracture. Dementia severity correlates with such recurrence within 1 year.
髋部骨质疏松性二次骨折是一种严重的合并症，可直接导致死亡。鉴于日本社会老龄化迅速，预防其发生尤为重要。在此，我们使用区域联盟临床路径（CPRA）的数据评估了此类复发的临床特征。
髋部骨折的CPRA始于2007年，自2011年7月起允许基于内部网的数据共享。收集了该联盟的数据，如二次骨折病例数、距初次骨折的时间、功能障碍测量（FIM）、修订的长谷川痴呆量表（HDS-R）评分、髋关节肌力和活动范围以及步态状态（GS），并进行了统计学评估。
总体而言，1118例中有45例（2.68/100人年）发生了二次骨折。初次骨折至二次骨折的平均间隔时间为13.3个月。其中30例（66.7%，1.79/100人年）在初次骨折后1年内发生（G<1Y）。二次骨折的参数值往往比初次骨折更差，尤其是GS。G<1Y组急性骨折时的认知功能FIM评分、HDS-R评分和GS显著低于初次骨折患者组（初始组）。退出率也显著高于初始组，而死亡和严重合并症也更多。
骨质疏松性髋部二次骨折是一个严重问题，其预后非常差。这些病例大多数可能在初次骨折后1年内发生。痴呆严重程度与1年内的此类复发相关。
