Lee Sang Yang, Niikura Takahiro, Iwakura Takashi, Fukui Tomoaki, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine.
J Orthop Trauma. 2017 Jul;31(7):S2. doi: 10.1097/01.bot.0000520889.69599.f3.
The aim of this study was to report the clinical results of atypical femoral fractures (AFFs) treated with low-intensity pulsed ultrasound (LIPUS).
The data on AFFs that were surgically treated in our hospital from 2010 to 2016 was retrospectively analyzed. AFF was diagnosed based on the criteria defined by the second report of an ASBMR task force.
Seven fractures in 6 cases were included in this study. Two fractures were referred to us as being nonunion. Five fractures were subtrochanteric fractures and 2 fractures were shaft fractures. Five fresh AFFs were fixed with an intramedullary nail and 2 nonunion fractures were fixed with plates. LIPUS was used in 6 fractures. Bone union was achieved in 5 fractures with the average time to union being 17 months (5-29). In 4 out of the 6 fractures treated with LIPUS, bone union was achieved after 14 months on average. In the other 2 LIPUS-treated fractures, bone union was not achieved even at 1 year after surgery.
It is known that AFF healing tends to be very slow. Some case reports indicate that AFF healing might be accelerated by LIPUS. In the current series, the subtrochanteric fracture that was not treated with LIPUS healed at 29 months after surgery, which was much longer than the average time to union in the 5 fractures that were treated with LIPUS. Although our number of cases is small, LIPUS may be a potentially useful tool for accelerating AFF repair.
本研究旨在报告采用低强度脉冲超声（LIPUS）治疗非典型股骨骨折（AFFs）的临床结果。
回顾性分析2010年至2016年在我院接受手术治疗的AFFs数据。AFF根据美国骨与矿物研究学会（ASBMR）特别工作组第二次报告定义的标准进行诊断。
本研究纳入6例患者的7处骨折。其中2处骨折转诊至我院时被诊断为骨不连。5处为转子下骨折，2处为股骨干骨折。5例新鲜AFF采用髓内钉固定，2例骨不连骨折采用钢板固定。6处骨折使用了LIPUS。5处骨折实现了骨愈合，平均愈合时间为17个月（5 - 29个月）。在接受LIPUS治疗的6处骨折中，4处平均在14个月后实现了骨愈合。另外2处接受LIPUS治疗的骨折即使在术后1年也未实现骨愈合。
已知AFF愈合往往非常缓慢。一些病例报告表明LIPUS可能会加速AFF愈合。在本系列研究中，未接受LIPUS治疗的转子下骨折在术后29个月愈合，这比接受LIPUS治疗的5处骨折的平均愈合时间长得多。尽管我们的病例数量较少，但LIPUS可能是加速AFF修复的一种潜在有用工具。
