Kim Jung Taek, Jeong Hyung Jun, Lee Soong Joon, Kim Hee Joong, Yoo Jeong Joon
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.; Seoul National University Medical Research Center, Seoul, Korea.
Hip Pelvis. 2016 Sep;28(3):148-156. doi: 10.5371/hp.2016.28.3.148. Epub 2016 Sep 30.
Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects.
Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed.
Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea.
Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.
非典型股骨骨折（AFF）、假体周围股骨骨折（PPFF）和股骨骨不连（FNU）是骨科医生面临的棘手挑战。在多项研究中已证实特立帕肽（TPTD）对骨骼具有合成代谢作用。我们推测术后辅助使用TPTD会增强对骨形成的生物刺激作用。我们研究了：（1）辅助使用TPTD能否使移位型AFF、PPFF和FNU等手术难度较大的病例获得满意的骨愈合率；（2）辅助使用TPTD能否促进手术固定后大量骨痂的形成；（3）辅助使用TPTD是否有严重的医学不良反应。
本回顾性病例系列纳入了13例同意在手术中使用TPTD的患者。患者年龄中位数为68.7岁，男性3例，女性10例。其中6例诊断为骨不连，7例为急性骨折。对病历和影像学资料进行了回顾。
13例骨折中有12例在辅助使用TPTD后的一年内实现了临床和影像学愈合。用药后影像学愈合中位数为5.4个月，临床愈合中位数为5.7个月。术后骨痂大量出现，骨折愈合反应中位数为1.4级。除瘙痒、肌肉痉挛或恶心外，未出现严重的药物不良反应。
尽管适当的手术治疗是AFF、PPFF和FNU治疗的主要手段，但本报告表明，辅助使用TPTD并结合稳定固定可使具有挑战性的股骨骨折获得满意的治疗效果。
