Mautalen C A, Vega E M, Einhorn T A
Sección Osteopatías Médicas, Hospital de Clínicas, University of Buenos Aires, Argentina.
Bone. 1996 Mar;18(3 Suppl):133S-137S. doi: 10.1016/8756-3282(95)00490-4.
Review of results published in the past few years indicates that there are several differences between women sustaining trochanteric fractures of cervical hip fractures. In most series women with trochanteric fractures are older, shorter, and lighter than those with cervical fractures. The bone mineral density was found to be lower in trochanteric fractures, but although in the majority of the studies the diminution was statistically significant at the level of the trochanter and spine--with predominant trabecular bone--the decrease was not uniformly significant at the level of the femoral neck or total skeleton. Previous vertebral fractures were twice as common in patients with trochanteric fractures. Ultrasound exploration of the calcaneus disclosed that the values were significantly lower in women with trochanteric fractures and this finding was independent of the diminution of the bone mineral density. On the other hand, fall biomechanics have not been found to be different in the two types of hip fractures. In summary, women with trochanteric fractures have a more severe and generalized bone loss, especially of the trabecular component. Cervical fractures seem to be more related to pelvic structure-failure of the outer diameter of the femoral neck to expand with age and increased acetabular bone width-added to a focal bone loss. The two main types of fractures should be treated separately in epidemiological or clinical studies to increase the knowledge and the possibilities of preventing hip fractures.
对过去几年发表的研究结果进行回顾表明，髋部转子间骨折和髋部颈骨折的女性患者存在一些差异。在大多数研究系列中，转子间骨折的女性患者比颈骨折的女性患者年龄更大、身高更矮、体重更轻。研究发现，转子间骨折患者的骨密度较低，不过在大多数研究中，尽管在转子和脊柱水平（主要是小梁骨）骨密度降低具有统计学意义，但在股骨颈或全身骨骼水平，这种降低并不都具有显著意义。转子间骨折患者既往椎体骨折的发生率是其他患者的两倍。对跟骨进行超声检查发现，转子间骨折女性患者的相关数值显著更低，且这一发现与骨密度降低无关。另一方面，尚未发现两种类型髋部骨折的跌倒生物力学存在差异。总之，转子间骨折的女性患者存在更严重和更广泛的骨质流失，尤其是小梁骨部分。颈骨折似乎更与骨盆结构有关，即股骨颈外径未能随年龄增长而扩大以及髋臼骨宽度增加，再加上局部骨质流失。在流行病学或临床研究中，这两种主要类型的骨折应分开处理，以增加对髋部骨折的认识和预防可能性。
