Nghiên cứu tình trạng loãng xương và kết quả phẫu thuật thay khớp háng bipolar điều trị gãy liên mấu chuyển xương đùi ở người cao tuổi tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF DEFENSE MILITARY ACADEMY LE NGOC HAI RESEARCH ON OSTEOPOROSIS SITUATION AND RESULTS OF BIPOLAR HIP REPLACEMENT SURGERY TO TREATMENT INTERTROCHANTERIC FRACTURE IN THE ELDERLY Specialization: Surgery Code: 9720104 SUMMARY OF THE DISSERTATION OF MEDICINE HANOI - 2020 WORKS ARE COMPLETED AT MILITARY ACADEMY Science instructor: Assoc.Prof.Dr TRAN DINH CHIEN Reviewer 1: Assoc.Prof.Dr Ngo Van Toan Viet Duc Hospital Reviewer 2: Assoc.Dr Nguyen Nang Gioi Central Military Hospital 108 Reviewer 3: Assoc.Prof.Dr Pham Dang Ninh Military Medical Academy The dissertation will be protected before the school-level thesis dissertation council at: 14:00 on October 10, 2019 The thesis can be found at: National Library Library of Military Medical Academy QUESTION The urgency of the topic Intertrochanteric fractures in the elderly are very common, women are more male than men, often due to falls In the USA, it is estimated that there are about 200,000 intertrochanteric fractured patients each year, the mortality rate is up to 15% - 30%, mostly in patients over 70 years old, the cost of this type of treatment is about 10 billion USD a year [1] Intertrochanteric fractures are a large fracture, treatment is often difficult in the elderly due to complex fracture properties, poor bone quality (osteoporosis) and a combination of chronic systemic diseases The intertrochanteric fracture treatments have been studied and applied such as fracture with DHS braces, locking braces, gama nails or hip replacement, if properly indicated, the results will be good The choice of treatment for intertrochanteric fractured patients is based on many factors such as age, fracture location, fracture properties and bone quality The intertrochanteric fractured patients have good bone quality, firm fractures, age is not too high often indicated to combine bones to preserve hip joints However, in the case of elderly patients with unstable fractures, fractures with fragments or osteoporosis, bone resorption methods are often difficult, skeletal unstable so the rate of bone fractures, false joints, or immediately high deviation Moreover, according to some studies, the failure rate is up to 50-56% [2], [3], [4], after surgery the patient must have time to wait for bone to not move, move early so easily develop more systemic complications such as pneumonia, spleen ulcers For these cases, many authors advocated the replacement of the hip joint for bipolar purpose to help patients recover early movement or sit up early to avoid systemic complications due to prolonged immobilization of spleen ulcers pneumonia, urinary inflammation or other systemic diseases [2], [5] To assess the quality of the head bone area on the femur, there are many different methods such as X-ray, dual energy X-ray (DEXA), CT.scaner or MRI [6], [7], [8], [9],[10] In fact, surgical doctors often rely on Singh's index (number of osteosarcoma in the femoral neck) [6], or bone thickness [7], [11], however these methods The price of osteoporosis accuracy is not high, depending on the shooting technique, film quality, beam density and the level of readers The method of common osteoporosis diagnosis currently being widely used in the world is bone density measurement according to DEXA method [9], [12], [15] This is a method of using dual-energy X-rays that allows a quantitative assessment of bone mineral mass at a specific location in the body, or measure bone mineral Density (BMD), thus determining the bone or osteoporosis through T-score index This method is considered by the WHO to be the gold standard for diagnosing osteoporosis [14] In Vietnam, in recent years, many treatment facilities have replaced the hip joint joint of bipolar for elderly patients with intertrochanteric fractures However, there is no agreement on the indication and no studies have evaluated and monitored osteoporosis status in elderly patients with broken intertrochanteric by DEXA method From the above fact, we conducted research on the topic "Research on osteoporosis situation and results of Bipolar hip replacement surgery for intertrochanteric fracture treatment in the elderly" Research objectives - Survey of osteoporosis in the femoral head in patients ≥ 70 years of age, intertrochanteric fractures were replaced with Bipolar by DEXA method - Evaluate the results of Bipolar hip replacement surgery in elderly patients with intertrochanteric fractures New contributions of the thesis - The study showed that elderly patients with Intertrochanteric fractures with osteoporosis of 1,2,3 degrees according to Singh's degree were osteoporosis when measured by DEXA method with Tscore ≤ -2,5 The degree of osteoporosis in the areas of the head above the femur is: T-score neck: -3.62 ± 0.55 (-4.7 to -2.6); T-score Troch: -3.03 ± 0.44 (-4.4 to -2.5); Inter T-score: -3.02 ± 0.40 (-3.8 to -2.5); Tscore Wards = -3.91 ± 0.58 (-5.1 to -2.6); T-score total: -3,20 ± 0,53 (5,0 to -2,5) The rate of female osteoporosis is higher than that of men with P