СОВРЕМЕННЫЕ ПОДХОДЫ К ВЫЯВЛЕНИЮ, ТЕРАПИИ И ПРЕДОТВРАЩЕНИЮ ПОВТОРНЫХ ПЕРЕЛОМОВ ШЕЙКИ БЕДРА
Ключевые слова:
перелом шейки бедра, диагностика, хирургическое лечение, реабилитация, тромбоэмболическая профилактика, бисфосфонаты, профилактика паденийАннотация
Введение. Переломы шейки бедра являются одной из наиболее значимых проблем в травматологии и ортопедии, так как сопровождаются высокой заболеваемостью и летальностью, особенно среди пожилых пациентов. Женщины составляют 80% случаев, а средний возраст пациентов с данным типом перелома достигает 80 лет. Основными факторами риска являются падения, снижение минеральной плотности кости, низкий уровень физической активности и длительное применение некоторых лекарственных препаратов.
Методы. Диагностика переломов шейки бедра начинается с физикального осмотра, при котором у пациентов выявляются боли в паховой области и невозможность опоры на поражённую конечность. Смещённые переломы проявляются наружной ротацией, отведением бедра и укорочением конечности. Основным методом диагностики является рентгенография, выполняемая в переднезадней проекции таза и боковой проекции с перекрёстным лучом. В случаях подозрения на скрытый перелом при нормальных рентгенологических данных применяется магнитно-резонансная томография (МРТ).
Результаты. Большинство переломов шейки бедра требует хирургического лечения, выбор методики которого определяется консультирующим ортопедом. Основными хирургическими методами являются эндопротезирование и остеосинтез. Пациенты перед операцией получают профилактическую антибактериальную терапию, направленную в первую очередь против Staphylococcus aureus, а также тромбоэмболическую профилактику, предпочтительно с использованием низкомолекулярных гепаринов.
Заключение. Переломы шейки бедра представляют собой серьёзную медицинскую проблему, требующую своевременной диагностики и комплексного подхода к лечению. Хирургическое вмешательство в сочетании с профилактическими мерами, реабилитацией и коррекцией факторов риска играет ключевую роль в улучшении исходов и снижении смертности у данной категории пациентов.
Библиографические ссылки
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Kammerlander C, Gosch M, Blauth M, et al. The effects of comorbidities on outcomes in patients with hip fractures. Eur J Trauma Emerg Surg. 2017;43(3):349-357.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Kammerlander C, Gosch M, Blauth M, et al. The effects of comorbidities on outcomes in patients with hip fractures. Eur J Trauma Emerg Surg. 2017;43(3):349-357.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
Gjertsen JE, Baste V, Fevang JM, et al. Quality indicators for hip fracture care. A systematic review. Osteoporos Int. 2016;27(1):1-11.
Cummings SR, Cosman F, Eastell R, et al. Goal-directed treatment of osteoporosis in patients with a recent fracture: a randomized controlled trial. J Bone Miner Res. 2017;32(3):594-602.
Lalmohamed A, Vestergaard P, de Boer A, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2015;350:h3324.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2015;313(22):2221-2231.
Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2016;27(1):1-13.
Alimjanovich , R. Z., Maxammatkulovich , R. N., & Khikmatovich , K. K. (2022). Age Features of the Prevalence of Prostate Cancer in Uzbekistan. Central Asian Journal of Medical and Natural Science, 3(5), 154-157. Retrieved from
Rizaev Jasur , Rakhimov Nodir , Kodyrov Khamidullo , Shakhanova Shakhnoza . Study of prostate cancer death by regions of the republic of Uzbekistan.Journal of Biomedicine and Practice. 2022, vol . 7, issue 5, pp.202-210
Nodir RM, Shaxnoza SS, Farhod R. Development of new approaches in the treatment of metastatic renal cell carcinoma //Journal of research in health science. – 2020. – T. 5. – no. 4. – pp. 82-95.
ShSh Shakhanova , NM Rakhimov. Multimodal approach to the treatment of multiple osteogenic metastases of kidney and prostate cancer . Clinical and Experimental Oncology 2020, No. 4 Page 50-56.
Gosch M, Hoffmann-Weltin Y, Roth T, et al. Orthogeriatric care for patients with hip fractures: where are we now?. Eur J Trauma Emerg Surg. 2016;42(3):257-265.
Holt G, Smith R, Duncan K, et al. Early surgery for patients with a fracture of the hip decreases 30-day and one-year mortality. Bone Joint J. 2015;97-B(1):104-108.
Neuburger J, Currie C, Wakeman R, et al. The impact of comorbidities on mortality after hip fracture surgery. Age Ageing. 2017;46(3):397-404.
Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service—a literature review comparing different models. Osteoporos Int. 2017;28(3):637-646.
