【看護師解説】転倒したら入院に?!大腿骨頸部骨折に注意!
骨折の中でも、「大腿骨頸部骨折」と呼ばれる骨折についてご存じですか？実は、大腿骨頸部骨折は高齢者に多いと言われています。この記事では、その理由や治療、予防法についてまとめています。
目次
大腿骨ってなんでしょう、大腿骨頸部とはどこにあるのか
まずは大腿骨がどのような骨なのかを確認しましょう。大腿は股関節から膝までの間の部分のことを指し、俗に「ふともも」と呼ばれています。そのふとももの部位を形作る骨が大腿骨です。図を見ていただくと、L字型を逆さにした様になっており、直線的な骨でないことがわかります。
人間の体幹を支える、蝶ちょうのような形をした、「骨盤」に対し、軟骨を介して大腿骨ははまっている状態です。骨盤側（頭側）は丸くなっており「大腿骨骨頭」と呼ばれ、膝側（足側）は平たくなっています。この大腿骨骨頭の次に来るのが、「大腿骨頸部」で大腿骨のクビれた部位を指します。
大腿骨は人間の骨の中でも、最も長い部位で、個人差はあるものの、40cm程度もの長さがあると言われています。体重や骨盤を支える大切な役目を果たしてるのも、大腿骨です。
大腿骨頸部骨折はどんなことが原因で起こるのか
この大腿骨のくびれの曲がった部位に何らかの理由で、圧がかかり、ひびが入ったり、折れてしまった状態を、「大腿骨頸部骨折」と呼びます。
大腿骨頸部骨折は、「大腿骨頸部内側骨折」と「大腿骨頸部外側骨折」の2つに分類されます。
この２つの違いは、関節の中で折れているか、それとも膝側の関節の外側で折れているかという点です。
では、どのような場面で、それぞれの大腿骨頸部骨折が起こるのでしょうか。
・大腿骨頸部内側骨折
骨粗しょう症を持つ方が、発症しやすいと言われている。
損傷部位のズレが生じるだけでも、痛みや腫れ等の症状が見られる。
痛みが出現⇒急に立てなくなるといった症状もある。
外側骨折と比較し、血液の循環が悪いことから、治りづらい。(骨結合が得づらい)
内出血等の症状は比較的、少ないと言われている。
・大腿骨頸部外側骨折
転倒や転落など、明らかな外傷により発症することが多い。
内出血等の症状は比較的、少ないと言われている。
内側骨折と比較すると、血液の循環の関係から骨結合が得やすい。
血流が多い部位の骨折のため、内出血が多いことがある。
内出血が多く、全身に影響がでることがある。
いずれにしても、加齢による骨の脆弱性が増大した、高齢者に起こりやすいと言われています。
毎年15万件以上もの大腿骨頸部骨折が発生しており、そのうち、男性より女性についての患者数が多いこともわかっています。
(*1)高齢になればなるほど、男性と比較し、女性のほうが生存者が多いということもあります。しかしそれだけではなく、女性は閉経とホルモンの影響で、骨粗しょう症になりやすいことがわかっています。骨粗しょう症は、骨の密度が低下し、かすかすになった状態。そのため、女性のほうがより、骨折のリスクがあることが理解できます。
どんな治療をするのか
大腿骨頸部骨折にはどのような治療があるのでしょうか。
おもな治療法は2つ存在し、手術的療法と、保存的療法が挙げられます。
・手術的療法⇒外科的手術療法を行う
・保存的療法⇒ギブスで、骨折部位を固定することで治癒を期待する。
身体を支える大腿骨の頸部の骨折をしてしまうことで、寝たきりになってしまう方は、少なくありません。
高齢者にとって、寝たきりになることは、生命予後の悪化につながるリスクがあります。そのことからも、手術的療法が可能な場合は、極力手術療法を勧める医師が多いようです。
とは言っても、手術を行うことにもリスクはつきものですから、患者本人が手術に耐えられる状況か、手術的療法、保存的療法それぞれのメリット・デメリットを視野に入れ、患者本人やその家族に検討してもらうことになります。
大腿骨頸部骨折を起こさないための予防法とは
大腿骨頸部骨折を発症させないためにも、予防できることがあります。
本日から次の点に取り組んでいきましょう。
・自宅内の環境整備
・骨粗しょう症の早期発見、早期治療
・運動の継続
・自宅内外の環境整備
滑りやすい床、床に物が散乱している、玄関に段差がある、急な階段であるなど、自宅内外に滑りやすい、転びやすい箇所はないかを、探してみます。転びやすい箇所に対し、対策を行います。例えば、脱衣所のマットには滑り止めを付ける、段差のある箇所には、手すりをDIYするといったことです。
・骨粗しょう症の早期発見、早期治療
最近背丈が縮んだような気がする、高い棚に手が届かなくなったといった..といったことはありませんか。その場合、骨粗しょう症の症状が出現している場合があります。骨粗しょう症は内服・外用治療で、骨密度増加が期待できる薬が存在します。骨そしょう症の早期発見に努めましょう。
・運動の継続
運動をし、骨に負荷がかかることで、カルシウムの利用を体内で行い、骨密度が上がると言われています。ウォーキングなど負荷の少ない、継続できる運動に取り組んでみましょう。
まとめ
高齢者に多いと言われているのが、太もも（大腿）にある骨の骨折です。
大腿骨はL字型をしており、人の身体を支える大きな役割があります。
主な治療法は手術的療法と保存的療法ですが、手術に耐えることのできる患者であれば、医師は、手術療法をお勧めする場合が、あります。
運動を継続して行うことや、自宅内の環境整備などで、転倒予防に努めましょう。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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