Thompson R N, Phillips J R A, McCauley S H J, Elliott J R M, Moran C G
Royal Victoria Hospital, Department of Trauma and Orthopaedics, Grosvenor Road, Belfast BT12 6BA, UK.
J Bone Joint Surg Br. 2012 Mar;94(3):385-90. doi: 10.1302/0301-620X.94B3.27999.
We performed a retrospective review of all patients admitted to two large University Hospitals in the United Kingdom over a 24-month period from January 2008 to January 2010 to identify the incidence of atypical subtrochanteric and femoral shaft fractures and their relationship to bisphosphonate treatment. Of the 3515 patients with a fracture of the proximal femur, 156 fractures were in the subtrochanteric region. There were 251 femoral shaft fractures. The atypical fracture pattern was seen in 27 patients (7%) with 29 femoral shaft or subtrochanteric fractures. A total of 22 patients with 24 atypical fractures were receiving bisphosphonate treatment at the time of fracture. Prodromal pain was present in nine patients (11 fractures); 11 (50%) of the patients on bisphosphonates suffered 12 spontaneous fractures, and healing of these fractures was delayed in a number of patients. This large dual-centre review has established the incidence of atypical femoral fractures at 7% of the study population, 81% of whom had been on bisphosphonate treatment for a mean of 4.6 years (0.04 to 12.1). This study does not advocate any change in the use of bisphosphonates to prevent fragility fractures but attempts to raise awareness of this possible problem so symptomatic patients will be appropriately investigated. However, more work is required to identify the true extent of this new and possibly increasing problem.
我们对2008年1月至2010年1月这24个月期间入住英国两家大型大学医院的所有患者进行了回顾性研究，以确定非典型转子下和股骨干骨折的发生率及其与双膦酸盐治疗的关系。在3515例股骨近端骨折患者中，156例骨折发生在转子下区域。有251例股骨干骨折。27例患者（7%）出现非典型骨折模式，共29处股骨干或转子下骨折。共有22例患者发生24处非典型骨折，骨折时正在接受双膦酸盐治疗。9例患者（11处骨折）出现前驱疼痛；11例（50%）接受双膦酸盐治疗的患者发生了12处自发性骨折，其中一些患者的骨折愈合延迟。这项大型双中心研究确定非典型股骨骨折的发生率为研究人群的7%，其中81%的患者接受双膦酸盐治疗的平均时间为4.6年（0.04至12.1年）。本研究不主张在使用双膦酸盐预防脆性骨折方面进行任何改变，而是试图提高对这一可能问题的认识，以便对有症状的患者进行适当的调查。然而，需要更多的工作来确定这个新的且可能在增加的问题的真实程度。
