Wang Kemble, Moaveni Afshin, Dowrick Adam, Liew Susan
Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia.
J Orthop Surg (Hong Kong). 2011 Apr;19(1):89-92. doi: 10.1177/230949901101900121.
To report characteristics and outcomes of 8 patients who underwent intramedullary nailing for alendronate-associated femoral insufficiency fractures.
Records of 7 women and one man aged 54 to 91 (mean, 72) years who underwent intramedullary nailing for spontaneous or low-energy, alendronateassociated femoral insufficiency fractures were retrospectively reviewed. Contralateral femurs were assessed for stress reactions.
All patients had at least 4 (range, 4-10) years of alendronate use. Five patients had experienced prodromal pain lasting one day to 5 months. Five patients had received concurrent glucocorticoid therapy. At the 6-month follow-up, 6 patients had bony union, one had hypertrophic non-union and underwent dynamisation and nail exchange and eventually achieved union at month 16, and one had fixation loss and underwent nail exchange and bone grafting and eventually achieved union at month 9. In 3 patients, the contralateral femurs were painful, and cortical stress reactions were noted. They underwent prophylactic intramedullary nailing. Radiographs showed no evidence of new stress reactions or fractures.
Contralateral involvement in patients with alendronate-associated femoral insufficiency fractures is not uncommon. Early prophylactic intramedullary nailing may provide effective pain relief and prevent progression to a fracture.
报告8例因阿仑膦酸盐相关股骨不全骨折接受髓内钉固定治疗患者的特征及治疗结果。
回顾性分析7例女性和1例男性患者的记录，年龄54至91岁（平均72岁），他们因自发性或低能量阿仑膦酸盐相关股骨不全骨折接受了髓内钉固定治疗。对侧股骨进行应力反应评估。
所有患者使用阿仑膦酸盐至少4年（范围4 - 10年）。5例患者经历了前驱疼痛，持续1天至5个月。5例患者同时接受了糖皮质激素治疗。在6个月随访时，6例患者实现了骨愈合，1例为肥大性骨不连，接受了动力化和更换髓内钉治疗，最终在第16个月实现愈合，1例出现内固定失败，接受了更换髓内钉和植骨治疗，最终在第9个月实现愈合。3例患者对侧股骨疼痛，观察到皮质应力反应。他们接受了预防性髓内钉固定。X线片显示无新的应力反应或骨折迹象。
阿仑膦酸盐相关股骨不全骨折患者对侧受累并不少见。早期预防性髓内钉固定可有效缓解疼痛并预防骨折进展。
