Das De S, Setiobudi T, Shen L, Das De S
University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, Singapore.
J Bone Joint Surg Br. 2010 May;92(5):679-86. doi: 10.1302/0301-620X.92B5.22941.
There have been recent reports linking alendronate and a specific pattern of subtrochanteric insufficiency fracture. We performed a retrospective review of all subtrochanteric fractures admitted to our institution between 2001 and 2007. There were 20 patients who met the inclusion criteria, 12 of whom were on long-term alendronate. Alendronate-associated fractures tend to be bilateral (Fisher's exact test, p = 0.018), have unique radiological features (p < 0.0005), be associated radiologically with a pre-existing ellipsoid thickening of the lateral femoral cortex and are likely to be preceded by prodromal pain. Biomechanical investigations did not suggest overt metabolic bone disease. Only one patient on alendronate had osteoporosis prior to the start of therapy. We used these findings to develop a management protocol to optimise fracture healing. We also advocate careful surveillance in individuals at-risk, and present our experience with screening and prophylactic fixation in selected patients.
最近有报告将阿仑膦酸盐与一种特定类型的转子下骨不连骨折联系起来。我们对2001年至2007年间我院收治的所有转子下骨折患者进行了回顾性研究。有20例患者符合纳入标准，其中12例长期服用阿仑膦酸盐。与阿仑膦酸盐相关的骨折往往是双侧的（Fisher精确检验，p = 0.018），具有独特的放射学特征（p < 0.0005），放射学上与股骨外侧皮质先前存在的椭圆形增厚有关，并且可能在骨折前有前驱疼痛。生物力学研究未提示明显的代谢性骨病。在开始治疗前，服用阿仑膦酸盐的患者中只有1例患有骨质疏松症。我们利用这些发现制定了一个优化骨折愈合的管理方案。我们还主张对高危个体进行仔细监测，并介绍我们在选定患者中进行筛查和预防性固定的经验。
