Aspenberg Per
Department of Clinical and Experimental Medicine, Division of Orthopaedics, Faculty of Medicine, Linköping University , Linköping, Sweden.
Bonekey Rep. 2013 Jan 9;2:244. doi: 10.1038/bonekey.2012.244.
Based on their mode of action and preclinical data, one would expect bisphosphonates to improve the healing of fractures in cancellous bone, and bone morphogenetic proteins (BMPs) to reduce the risk of non-union in severe shaft fractures. Parathyreoid hormone (PTH) can be expected to accelerate fracture healing in general. The clinical data in support of this is meager. Stimulation of cancellous bone healing and strength by bisphosphonates has been inadvertently shown in the context of implant fixation, but not convincingly in fractures per se. The clinical BMP literature is confusing, and the chance of ever demonstrating reduced numbers of non-union are small, due to power issues. Still, acceleration of 'normal' healing may be possible, but largely remains to show. For PTH, the two available clinical trials both show accelerated healing, but none of them is flawless, and there is a need for better studies.
基于双膦酸盐的作用方式和临床前数据，人们预期其能促进松质骨骨折的愈合，而骨形态发生蛋白（BMPs）能降低严重骨干骨折不愈合的风险。总体而言，甲状旁腺激素（PTH）有望加速骨折愈合。但支持这一观点的临床数据却很少。双膦酸盐对松质骨愈合和强度的刺激作用在植入物固定的情况下被无意地证实了，但在骨折本身中却没有令人信服的证据。关于BMP的临床文献令人困惑，由于效能问题，要证明其能减少不愈合的病例数量可能性很小。尽管如此，加速“正常”愈合仍有可能，但很大程度上仍有待证实。对于PTH，现有的两项临床试验均显示出愈合加速，但都并非完美无缺，因此需要开展更好的研究。
