Simpson C, Jayaramaraju D, Agraharam D, Gudipati S, Shanmuganathan R, Giannoudis P V
Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, England, UK.
, 35 Potters Lane, East Leake, Loughborough, LE12 6NQ, England, UK.
Eur J Orthop Surg Traumatol. 2015 Dec;25(8):1239-43. doi: 10.1007/s00590-015-1691-5. Epub 2015 Aug 29.
Diabetes has long been known to have an impact on bone repair. More recently, however, most diabetic patients receive medications to normalise this hyperglycaemic environment. To date, no studies have investigated the effects of diabetic medications on fracture healing in humans.
Patients were identified from two tertiary trauma centres. Inclusion criteria were adult patients having sustained a closed diaphyseal femoral or tibial fracture, treated surgically. Exclusion criteria were open, pathological or peri-prosthetic fractures, and patients having sustained polytrauma. Matched non-diabetic controls were identified, matched for age, sex, fracture classification and osteosynthesis. Output measures were: time to callus first appearance, bridging of involved cortices and time to union, along with the eventual outcome: union/non-union.
A total of 36 (25 males) eligible patients were identified with a control group of 166 patients (138 males). ANOVA demonstrated class of medication to have a significant effect at two of the three time points and on the eventual outcome. Multiple regression analysis also demonstrated significant impact (p = 0.02).
All classes of medication demonstrated anti-osteogenic effects compared to the control cohort. Biguanides demonstrated this in contrast to the in vitro evidence to date. Sulphonylureas demonstrated this to a greater extent; however, no in vitro evidence is available for comparison within this class. Clinicians should be aware of these delays in bone healing when treating diabetic patients and aim for optimal blood glucose control until such time as further research can be undertaken.
长期以来，人们都知道糖尿病会对骨修复产生影响。然而，最近大多数糖尿病患者都在接受药物治疗以使这种高血糖环境正常化。迄今为止，尚无研究调查糖尿病药物对人类骨折愈合的影响。
从两个三级创伤中心识别患者。纳入标准为成年患者，发生闭合性股骨干或胫骨干骨折并接受手术治疗。排除标准为开放性骨折、病理性骨折或假体周围骨折，以及多发伤患者。确定匹配的非糖尿病对照组，根据年龄、性别、骨折分类和骨合成情况进行匹配。输出指标为：骨痂首次出现时间、受累皮质骨桥接时间和愈合时间，以及最终结果：愈合/不愈合。
共识别出36例（25例男性）符合条件的患者，对照组有166例患者（138例男性）。方差分析表明，药物类别在三个时间点中的两个时间点以及最终结果上具有显著影响。多元回归分析也显示出显著影响（p = 0.02）。
与对照组相比，所有药物类别均显示出抗成骨作用。双胍类药物的情况与迄今为止的体外证据相反。磺脲类药物的这种作用更为明显；然而，该类别内尚无体外证据可供比较。临床医生在治疗糖尿病患者时应意识到这些骨愈合延迟情况，并在能够进行进一步研究之前，力求实现最佳血糖控制。
