Ahn Dong-Ki, Kim Jin-Hak, Lee Jae-Il, Kim Jin-Woo
Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
Hip Pelvis. 2015 Jun;27(2):115-9. doi: 10.5371/hp.2015.27.2.115. Epub 2015 Jun 30.
A 78-year-old woman developed an insufficiency fracture on her right femoral neck without trauma after four years of treatment with a bisphosphonate. Her fracture was fixed by two screws and her anti-osteoporotic drug was changed from an anti-resorptive to an anabolic agent. Seven months later, however, she sustained similar insufficiency fracture on the left femoral neck and was treated with the same method. She developed right inguinal pain again approximately eight months after her right side operation. The results of imaging tests revealed that her insufficiency fracture was converted to complete fracture, and that the fracture gap had widened as well. Her right hip was revised with hemiarthroplasty. A histological exam of the fracture site revealed evidence of decreased bone healing. Long-term administration of anti-resorptive drug prevents bone healing and remodeling and can result in atypical fractures of the femoral neck. Osteosynthesis was difficult to accomplish despite the application of proactive fixation. Therefore, more rigid fixation and careful postoperative treatment should be considered.
一名78岁女性在使用双膦酸盐治疗四年后，右侧股骨颈无外伤情况下发生了不全骨折。她的骨折通过两枚螺钉固定，抗骨质疏松药物从抗吸收剂改为合成代谢剂。然而，七个月后，她左侧股骨颈又发生了类似的不全骨折，并接受了相同的治疗方法。右侧手术约八个月后，她再次出现右腹股沟疼痛。影像学检查结果显示，她的不全骨折已转变为完全骨折，骨折间隙也变宽了。她的右髋进行了半髋关节置换翻修手术。骨折部位的组织学检查显示骨愈合减少的证据。长期使用抗吸收药物会妨碍骨愈合和重塑，并可能导致股骨颈非典型骨折。尽管采用了积极的固定方法，但骨接合术仍难以完成。因此，应考虑更坚固的固定和仔细的术后治疗。
