Varga Peter, Hofmann-Fliri Ladina, Blauth Michael, Windolf Markus
AO Research Institute Davos , Davos Platz, Switzerland.
Department for Trauma Surgery, Medical University Innsbruck , Innsbruck, Austria.
Bonekey Rep. 2016 Dec 7;5:854. doi: 10.1038/bonekey.2016.86. eCollection 2016.
The high incidence of secondary hip fractures and the associated markedly increased mortality call for preventive actions that could help to avoid these injuries. By providing immediate strengthening and not relying on patient compliance, internal prophylactic augmentation of the osteoporotic proximal femur may overcome the main limitations of systemic bone drugs and wearable protective pads. However, such a method would have to provide sufficient and reliable strengthening effect with minimal risks and side effects to justify the need of an invasive treatment. The requirements for an internal reinforcement approach are thus strict and include mechanical, biological, clinical, ethical and financial criteria. Here we first attempt to describe the properties of an ideal augmentation method. Previously published methodologies and techniques developed at our research institute, including approaches using cements, metals, other materials or combined approaches, are then reviewed and evaluated according to these aspects. We conclude that none of the discussed methodologies appears to be able to deliver a sufficiently high gain-versus-risk ratio that could justify the clinical application and thus augmentation of the osteoporotic proximal femur remains a challenge. Finally, we provide suggestions for the development and evaluation of future strategies.
继发性髋部骨折的高发生率以及随之而来的显著增加的死亡率，促使人们采取预防措施以避免这些损伤。通过立即增强骨骼强度且不依赖患者的依从性，对骨质疏松性股骨近端进行内部预防性增强可能会克服全身性骨药物和可穿戴防护垫的主要局限性。然而，这样一种方法必须以最小的风险和副作用提供足够且可靠的增强效果，以证明进行侵入性治疗的必要性。因此，内部强化方法的要求很严格，包括机械、生物、临床、伦理和财务标准。在此，我们首先尝试描述理想增强方法的特性。然后根据这些方面对先前发表的方法以及我们研究所开发的技术进行回顾和评估，这些方法和技术包括使用骨水泥、金属、其他材料或联合方法的途径。我们得出结论，所讨论的方法似乎都无法提供足够高的收益风险比来证明其临床应用的合理性，因此对骨质疏松性股骨近端进行增强仍然是一项挑战。最后，我们为未来策略的开发和评估提供建议。
