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Contents : 11 1997 . 3 s. 151 160 PREH ADN REFER T JE ETIOL GIA CERVIK LNEJ A TROCHANTEROVEJ ZLOMENINY BEDRA ODLI N C.A. MAUTALEN E.M. VEGA T.A. EINHORN1 ARE THE ETIOLOGIES OF CERVICAL AND TROCHANTERIC HIP FRACTURES DIFFERENT Secci n Osteopat as M dicas Hospital de Cl nicas University of Buenos Aires 1 Department of Orthopaedics The Mount Sinai School of Medicine New York S hrn Preh ad v sledkov publikovan ch v posledn ch rokoch poukazuje na existenciu rozdielov medzi enami s trochanterovou a cervik lnou zlomeninou bedra. eny s trochanterovou zlomeninou s vo v ine t di star ie maj ni iu hmotnos a men iu v ku ako eny postihnut cervik lnou zlomeninou. Zistilo sa e pri trochanterov ch zlomenin ch bola denzita kost ni ia a vo v ine t di sa pozoroval tatisticky signifikantn pokles v oblasti trochantera a chrbtice najm v tr mcovej kosti. Pokles denzity v oblasti kr ka stehna i kostry cel ho tela nebol v dy v znamn . U pacientov s trochanterovou zlomeninou sa dvojn sobne astej ie vyskytli predch dzaj ce zlomeniny stavcov. Ultrazvukov vy etrenia p tovej kosti odhalili signifikantne ni ie hodnoty u ien s trochanterov mi zlomeninami no n lezy nes viseli so zn en m denzity kosti. Na druhej strane sa nezistili iadne odli nosti biomechaniky p du pri t chto typoch zlomen n bedra. eny s trochanterovou zlomeninou maj z va nej a generalizovan bytok kostnej hmoty najm v tr mcovom komponente. Zd sa e cervik lne zlomeniny maj u vz ah ku trukt re panvy: s postupuj cim vekom rast a kosti pri roz irovan vonkaj ieho priemeru kr ka stehnovej kosti a roz iruje sa acet bulum k omu pristupuje fok lna strata kostnej hmoty. V epidemiologick ch alebo klinick ch t di ch by sa mali tieto dva hlavn typy zlomen n sprac va samostatne. Roz rili by sa t m poznatky o zlomenin ch bedra a mo nosti ich prevencie. K ov slov : osteopor za zlomeniny bedra cervik lne zlomeniny trochanterov zlomeniny ultrazvuk hustota kostnej hmoty. Summary The review of the results published in the last few years indicates that there are several differences between women with trochanteric or cervical hip fractures. In most series women with trochanteric fractures are older shorter and lighter than those with cervical fractures. Th bone mineral density wass found to be lower in trochanteric fractures but while in the majority of the studies the diminution was statistically significant at the level of the trochanter ans 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 value were significantly lower in women with trochanteric fractures abd 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. Women with trochanteric fractures have a more severe and generalized bone loss especially of the trabecular component. Cervical factures seems to be more related to pelvic structure failure of the outer diameter of the femoral neck to expand with age increased acetabular bone width added to 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. Key words: osteoporosis hip fractures cervical fractures trochanteric fractures ultrasound bone mineral density. Zlomenina bedra je u pacientov s osteopor zou najv nej ou komplik ciou. V d sledku morbidity a mortality zlomen n bedra sa zna n silie venuje zis ovaniu epidemiologick ch biomechanick ch klinick ch a kostrov ch charakterist k pacientov s t mito zlomeninami. Hip fracture is the most serious complication in patients with osteoporosis. Due to the morbidity and mortality associated with hip fractures considerable effort is being devoted to determine the epidemiological biomechanical clinical and skeletal characteristic of patients with these fractures. 152 Na z klade anatomickej lokaliz cie sa zlomeniny proxim lneho femuru zvy ajne delia na cervik lne (intrakapsul rne kr ek stehnovej kosti) a trochanterov (extrakapsul rne) zlomeniny. Aj ke je tret typ zlomen n bedra subtrochanterov frakt ra anatomicky lokalizovan dist lne od mal ho trochantera stehnovej kosti vyskytuje sa menej asto ako ostatn dva typy a jej etiol gia vo vz ahu k osteopor ze je nejasn . Vo v ine t di v ak autori pokladali zlomeniny bedra za jednu nozologick jednotku bez toho aby presk mali mo n rozdiely dvoch hlavn ch typov proxim

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