概述

髋部骨折是一种严重的损伤,其并发症可能危及生命。髋部骨折的风险随着年龄的增长而升高。

风险升高的原因是骨骼会随年龄的增长而变弱(骨质疏松症)。服用多种药物、视力较差和平衡问题也会使老年人更容易跌倒,这是导致髋部骨折最常见的原因之一。

髋部骨折几乎都需要通过外科手术进行修复或置换,随后再接受物理疗法。采取措施保持骨密度并避免跌倒有助于预防髋部骨折。

症状

髋部骨折的体征和症状包括:

  • 无法从跌倒中站起或行走
  • 髋关节或腹股沟剧烈疼痛
  • 无法将重心放在受伤髋关节一侧的腿部
  • 髋关节区域及其周围的瘀伤和肿胀
  • 受伤髋关节一侧的下肢较短
  • 受伤髋关节一侧腿部外翻

病因

严重的冲击(例如车祸)可能导致各个年龄段的人群出现髋部骨折。在老年人中,髋部骨折的常见原因是站立时跌倒。对于骨骼极弱的人群中,只需要用腿部站立并扭摆就可能发生髋部骨折。

风险因素

髋部骨折的发生率因以下因素而显著增加:

  • 年龄。骨密度和肌肉质量有随年龄增长而降低的趋势。老年人也可能存在视力和平衡问题,这会增加跌倒的风险。
  • 您的性别。女性发生髋部骨折的发生率约为男性的三倍。女性的骨密度流失比男性更快,部分原因是绝经时发生的雌激素水平下降会加速骨量丢失。然而,男性也可能出现危险的低骨密度水平。
  • 骨质疏松症。如果您患有这种会导致骨骼变弱的疾病,您的骨折风险就会增加。
  • 其他慢性疾病。内分泌疾病,如甲状腺机能亢进,可导致骨骼脆弱。肠道疾病,会减少您对维生素 D 和钙的吸收,也会导致骨骼脆弱。

    影响大脑和神经系统的医学疾病,包括认知损害、痴呆、帕金森氏病、卒中和周围神经病变,也会增加跌倒的风险。

    低血糖和低血压也会导致跌倒风险。

  • 某些药物。如果您长期服用可的松药物,如泼尼松,可能导致骨骼弱化。某些药物或某些药物组合可能使您头晕,更容易跌倒。作用于中枢神经系统的药物(如睡眠药物、抗精神病药物和镇静剂)最常与跌倒相关。
  • 营养问题。在年轻时,如果您的饮食中缺乏钙和维生素 D ,这会降低您的峰值骨量,并增加在您年龄较大时发生骨折的风险。老年人补充足够的钙和维生素 D 同样重要,以尽量维持您的骨骼。随着年龄的增长,尽量保持健康的体重。体重过轻会增加骨量丢失的风险。
  • 缺乏运动。缺乏规律的负重运动,如步行,会导致骨骼和肌肉变弱,增加跌倒和骨折的可能性。
  • 吸烟和饮酒。两者都会干扰正常的骨骼构建和维持过程,导致骨量丢失。

Your age and sex

Bone density and muscle mass tend to decrease with age. Older people can also have problems with vision and balance, which can increase the risk of falling.

Hip fractures occur in women about three times more often than they do in men. Women lose bone density faster than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density.

Medical conditions

The risk of hip fracture can be increased if you have:

  • Osteoporosis. This condition weakens bones and makes them more likely to break.
  • Thyroid problems. An overactive thyroid can lead to fragile bones.
  • Intestinal disorders. Conditions that reduce absorption of vitamin D and calcium also can cause weakened bones.
  • Problems with balance. Parkinson's disease, stroke and peripheral neuropathy can increase the risk of falling. Having low blood sugar or low blood pressure also can contribute to the risk of falls.

Certain medications

Cortisone medications, such as prednisone, can weaken bones if taken long-term. Certain drugs or certain combinations of medications can cause dizziness, which can increase the risk of falling. The most common drugs associated with falls include sleep medications, antipsychotics and sedatives.

Nutritional problems

Lack of calcium and vitamin D in the diet of young people lowers peak bone mass and increases risk of fracture later in life. It's also important to get enough calcium and vitamin D in older age to try to maintain bone density. Being underweight also increases the risk of bone loss.

Lifestyle choices

Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely.

Tobacco and alcohol both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.

并发症

髋部骨折会降低您的自主性,有时会缩短您的寿命。大约一半的髋部骨折患者无法恢复自主生活的能力。

如果髋部骨折使您长时间无法活动,则并发症可能包括:

  • 腿部或肺部有血凝块
  • 褥疮
  • 尿路感染
  • 感染性肺炎
  • 更多的肌肉流失,增加了跌倒和受伤的风险
  • 死亡

预防

在成年早期选择健康的生活方式不仅能构建更高的峰值骨量,还能降低您晚年发生骨质疏松症的风险。在任何年龄采取这些相同措施都可能会降低跌倒风险,并改善整体健康状况。

为了避免跌倒并保持骨骼健康,请采取以下措施:

  • 摄入足够的钙和维生素 D。通常而言,50 岁及以上的男性和女性每天应摄入 1,200 毫克钙和 600 国际单位的维生素 D。
  • 进行锻炼以强健骨骼和提高平衡能力。进行散步等负重运动,以帮助您保持峰值骨密度。锻炼还能增加整体力量,降低跌倒的可能性。由于平衡能力会随着年龄的增长而下降,所以平衡训练对于降低跌倒风险也很重要。
  • 避免抽烟或过量饮酒。吸烟和饮酒可能导致骨密度降低。饮酒过多还会损害平衡能力,使您更容易跌倒。
  • 评估家中是否存在危险。移走装饰地毯、确保电线沿墙设置,并清理多余的家具和可能使您绊倒的任何物品。确保每个房间和通道都拥有良好照明。
  • 检查眼睛。每隔一年接受一次眼科检查,如果患有糖尿病或眼病,则应增加检查频率。
  • 留意药物。很多药物都可能导致无力和头晕等副作用,这可能增加跌倒风险。向医生咨询药物会导致哪些副作用。
  • 慢慢起身。起身太快会导致血压下降,使您感觉有些站不稳。
  • 使用手杖、拐杖或助行器。如果您走路时感觉不稳,可以向医生或作业治疗师咨询这些辅助器具是否有用。

July 03, 2022
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