医学专题—卫小春-骨质疏松诊疗.ppt

起起 草草 过过 程程n n编写调查问卷，广泛征求意见编写调查问卷，广泛征求意见n n专家负责，分部撰写（脊柱骨折、髋部骨折、专家负责，分部撰写（脊柱骨折、髋部骨折、肱骨近端骨折、桡尺骨远端骨折、药物治疗）肱骨近端骨折、桡尺骨远端骨折、药物治疗）n n邱贵兴教授任组长，专家组集体讨论邱贵兴教授任组长，专家组集体讨论(toln)(toln)(toln)(toln)（关（关节、脊柱、创伤、内分泌、老年病等专家）节、脊柱、创伤、内分泌、老年病等专家）n n衷心感谢各位专家的辛勤劳动衷心感谢各位专家的辛勤劳动第一页，共四十三页。一一、概述概述(i sh)i sh)1.1.特点：属于脆性骨折特点：属于脆性骨折特点：属于脆性骨折特点：属于脆性骨折 好发于老年人好发于老年人好发于老年人好发于老年人2.2.好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端3.3.面临问题：内固定松动面临问题：内固定松动面临问题：内固定松动面临问题：内固定松动 再次骨折再次骨折再次骨折再次骨折 致残率及致残率及致残率及致残率及 致死率高致死率高致死率高致死率高4.4.治疗措施：骨折和骨质疏松治疗措施：骨折和骨质疏松治疗措施：骨折和骨质疏松治疗措施：骨折和骨质疏松(sh sn(sh sn)同时治疗同时治疗同时治疗同时治疗第二页，共四十三页。二二、临床表现临床表现一般表现：出现压痛、疼痛或原有疼痛加重一般表现：出现压痛、疼痛或原有疼痛加重一般表现：出现压痛、疼痛或原有疼痛加重一般表现：出现压痛、疼痛或原有疼痛加重特有表现：出现畸形、骨擦感、反常活动、功能障碍特有表现：出现畸形、骨擦感、反常活动、功能障碍特有表现：出现畸形、骨擦感、反常活动、功能障碍特有表现：出现畸形、骨擦感、反常活动、功能障碍脊柱脊柱脊柱脊柱(j(j zh)zh)变形：身高变矮或驼背畸形变形：身高变矮或驼背畸形变形：身高变矮或驼背畸形变形：身高变矮或驼背畸形第三页，共四十三页。三三、诊断诊断(zhndun)(zhndun)与鉴别诊断与鉴别诊断(zhndun)(zhndun)1.1.性别：女性多见，也可见于男性性别：女性多见，也可见于男性性别：女性多见，也可见于男性性别：女性多见，也可见于男性 2.2.年龄年龄年龄年龄(ninlng)(ninlng)：多见于：多见于：多见于：多见于6060岁以上老年人岁以上老年人岁以上老年人岁以上老年人 3.3.外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史4.4.临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍第四页，共四十三页。三三、诊断诊断(zhndun)(zhndun)与鉴别诊断与鉴别诊断(zhndun)(zhndun)5.5.影像学检查影像学检查影像学检查影像学检查 ：一般要求拍摄正、侧位：一般要求拍摄正、侧位：一般要求拍摄正、侧位：一般要求拍摄正、侧位X X片合理应用片合理应用片合理应用片合理应用CTCT、MRIMRI、CTCT三维成像技术三维成像技术三维成像技术三维成像技术 6.6.骨密度检查骨密度检查骨密度检查骨密度检查 ：双能：双能：双能：双能X X线吸收法线吸收法线吸收法线吸收法(DXA)(DXA)7.7.实验室检查：血、尿常规，肝肾实验室检查：血、尿常规，肝肾实验室检查：血、尿常规，肝肾实验室检查：血、尿常规，肝肾(n shn)n shn)功能，血糖、钙、功能，血糖、钙、功能，血糖、钙、功能，血糖、钙、磷、碱性磷酸酶、磷、碱性磷酸酶、磷、碱性磷酸酶、磷、碱性磷酸酶、25(OH)D25(OH)D和甲状旁腺激素等和甲状旁腺激素等和甲状旁腺激素等和甲状旁腺激素等第五页，共四十三页。三、三、诊断诊断(zhndun)(zhndun)与鉴别诊断与鉴别诊断(zhndun)(zhndun)8.8.8.8.鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折折折折9.9.9.9.危险因素：危险因素：危险因素：危险因素：(1)(1)(1)(1)主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄65656565岁、岁、岁、岁、骨折家族病史骨折家族病史骨折家族病史骨折家族病史(bn sh)(bn sh)(bn sh)(bn sh)(2)(2)(2)(2)次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经（早期绝经（早期绝经（早期绝经（45454520202020，同时，同时，同时，同时-2.5SDT-1.0SD2.5SDT-1.0SD2.5SDT-1.0SD2.5SDT50505050岁男性岁男性岁男性岁男性2.T-2.5SD2.T-2.5SD2.T-2.5SD2.T-2.5SD者者者者3.3.3.3.骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者4.4.4.4.继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者5.5.5.5.有骨折史伴有低骨密度（有骨折史伴有低骨密度（有骨折史伴有低骨密度（有骨折史伴有低骨密度（-2.5SDT-1.0SD-2.5SDT-1.0SD-2.5SDT-1.0SD-2.5SDT651.651.651.65岁女性、岁女性、岁女性、岁女性、70707070岁男性，需进行骨密度检测岁男性，需进行骨密度检测岁男性，需进行骨密度检测岁男性，需进行骨密度检测2.2.2.2.绝经后妇女、绝经后妇女、绝经后妇女、绝经后妇女、5050505070707070岁男性，依临床危险岁男性，依临床危险岁男性，依临床危险岁男性，依临床危险(wixin)(wixin)(wixin)(wixin)因素因素因素因素程度每两年进行一次骨密度检测程度每两年进行一次骨密度检测程度每两年进行一次骨密度检测程度每两年进行一次骨密度检测3.3.3.3.经期过渡期伴有危险因素者（如低体重、脆性骨折史、经期过渡期伴有危险因素者（如低体重、脆性骨折史、经期过渡期伴有危险因素者（如低体重、脆性骨折史、经期过渡期伴有危险因素者（如低体重、脆性骨折史、服用某些药物史）服用某些药物史）服用某些药物史）服用某些药物史）4.504.504.504.50岁成人且有骨折史者岁成人且有骨折史者岁成人且有骨折史者岁成人且有骨折史者第三十六页，共四十三页。六六.预预 防防（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估5.5.5.5.继发性骨质疏松症患者（如类风湿性关节炎、服用激继发性骨质疏松症患者（如类风湿性关节炎、服用激继发性骨质疏松症患者（如类风湿性关节炎、服用激继发性骨质疏松症患者（如类风湿性关节炎、服用激素史、低骨量）素史、低骨量）素史、低骨量）素史、低骨量）6.6.6.6.接受骨质疏松症治疗或正在接受骨质疏松症治疗或正在接受骨质疏松症治疗或正在接受骨质疏松症治疗或正在(zhngzi)(zhngzi)(zhngzi)(zhngzi)观察疗效者观察疗效者观察疗效者观察疗效者7.7.7.7.显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者8.8.8.8.经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者第三十七页，共四十三页。六六.预预 防防（三）患者的自我管理（三）患者的自我管理（三）患者的自我管理（三）患者的自我管理1.1.1.1.坚持坚持坚持坚持(jinch)(jinch)(jinch)(jinch)预防预防预防预防2.2.2.2.戒烟限酒戒烟限酒戒烟限酒戒烟限酒3.3.3.3.减肥减肥减肥减肥4.4.4.4.增加肌力运动增加肌力运动增加肌力运动增加肌力运动5.5.5.5.预防跌倒预防跌倒预防跌倒预防跌倒第三十八页，共四十三页。参参 考考 文文 献献Cummings SRCummings SRCummings SRCummings SR，Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol Rev,1985,7:178-208osteoporotic fractures.Epidemiol Rev,1985,7:178-208osteoporotic fractures.Epidemiol 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trial of intranasal calcitonin treatment in patients with trial of intranasal calcitonin treatment in patients with trial of intranasal calcitonin treatment in patients with trial of intranasal calcitonin treatment in patients with hip fracture.Calcif Tissre Int 2002,71:478-484hip fracture.Calcif Tissre Int 2002,71:478-484hip fracture.Calcif Tissre Int 2002,71:478-484hip fracture.Calcif Tissre Int 2002,71:478-484第四十二页，共四十三页。内容(nirng)总结起 草 过 程。近年发现他汀类制剂及雷奈酸锶在抗骨吸收的同时也有促进成骨的作用。6必须注意用药前后血钙或尿钙的变化，原则上应用(yngyng)活性VitD3的同时要有意识地提高饮食中的钙含量。1包括股骨颈骨折和股骨转子间骨折。2累及关节面的桡骨远端粉碎性骨折、不稳定的桡骨远端骨折倾向于手术治疗。（4）腕关节镜技术目前已应用(yngyng)到关节面骨折的复位及骨折后关节内紊乱征的治疗第四十三页，共四十三页。