Moroni Antonio, Faldini Cesare, Hoang-Kim Amy, Pegreffi Francesco, Giannini Sandro
Rizzoli Orthopaedic Institute, University of Bologna, Via GC Pupilli 1, 40136 Bologna, Italy.
J Bone Joint Surg Am. 2007 Jan;89(1):96-101. doi: 10.2106/JBJS.F.00484.
Animal studies have demonstrated the efficacy of the use of bisphosphonates to enhance screw fixation in bone. In this prospective, randomized study of pertrochanteric fractures treated with external fixation, we tested whether systemic administration of bisphosphonates would improve the fixation of hydroxyapatite-coated screws implanted in osteoporotic bone.
Sixteen consecutive patients with a pertrochanteric fracture were selected. Inclusion criteria were female gender, an age of at least sixty-five years, and a bone mineral density T-score of less than -2.5 standard deviations. Exclusion criteria included bisphosphonate treatment during the two-year period prior to the fracture. Fractures were fixed with a pertrochanteric fixator and four hydroxyapatite-coated pins. Two pins were implanted in the femoral head (pin positions 1 and 2), and two were placed in the femoral diaphysis (pin positions 3 and 4). The patients were randomized either to therapy with alendronate for a three-month postoperative period (Group A) or to no therapy (Group B). The Group-A patients received an oral dose of 70 mg of alendronate per week. The fixators were removed after three months.
All of the fractures healed, and no loss of reduction, nonunion, or delayed union was observed. The combined mean extraction torque (and standard deviation) of the pins implanted at positions 1 and 2 (cancellous bone) was 2558 +/- 1103 N/mm in Group A and 1171 +/- 480 N/mm in Group B (p < 0.0005). The combined mean extraction torque of the pins implanted at positions 3 and 4 (cortical bone) was 4327 +/- 1720 N/mm in Group A and 4075 +/- 1022 N/mm in Group B.
These data show that weekly systemic administration of alendronate improves pin fixation in cancellous bone in elderly female patients with osteoporosis. We observed a twofold increase in extraction torque with the pins implanted in cancellous bone. These results support the use of alendronate in the treatment of osteoporotic pertrochanteric fractures to improve screw fixation in the femoral head.
动物研究已证明使用双膦酸盐可增强骨内螺钉固定的效果。在这项对外固定治疗转子间骨折的前瞻性随机研究中，我们测试了双膦酸盐的全身给药是否会改善植入骨质疏松骨的羟基磷灰石涂层螺钉的固定。
选择16例连续的转子间骨折患者。纳入标准为女性、年龄至少65岁且骨密度T值小于-2.5标准差。排除标准包括骨折前两年内接受双膦酸盐治疗。骨折用转子间固定器和4根羟基磷灰石涂层钢针固定。两根钢针植入股骨头（钢针位置1和2），两根置于股骨干（钢针位置3和4）。患者被随机分为术后三个月接受阿仑膦酸钠治疗组（A组）或不接受治疗组（B组）。A组患者每周口服70mg阿仑膦酸钠。三个月后取出固定器。
所有骨折均愈合，未观察到复位丢失、骨不连或延迟愈合。位置1和2（松质骨）植入钢针的联合平均拔出扭矩（及标准差）在A组为2558±1103N/mm，在B组为1171±480N/mm（p<0.0005）。位置3和4（皮质骨）植入钢针的联合平均拔出扭矩在A组为4327±1720N/mm，在B组为4075±1022N/mm。
这些数据表明，每周全身给予阿仑膦酸钠可改善老年骨质疏松女性患者松质骨中的钢针固定。我们观察到植入松质骨的钢针拔出扭矩增加了两倍。这些结果支持使用阿仑膦酸钠治疗骨质疏松性转子间骨折，以改善股骨头的螺钉固定。
