Kim Seung-Ju, Park Hyun-Soo, Lee Dong-Woo, Lee Jae-Won
Department of Orthopaedics, Hanil General Hospital, Seoul, Korea.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802485. doi: 10.1177/2309499018802485.
Slow recovery after hip fracture has been associated with negative consequences. Thus, there is medical need to improve healing and functional recovery after intertrochanteric fracture. The aim of this study was to measure whether short-term teriparatide would improve healing in intertrochanteric fractures after internal fixation as measured by (1) clinical scores, (2) radiographic fracture healing, and (3) complication rates. We retrospectively reviewed 96 patients (average age, 82 years) who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures between 2014 and 2016. Of the 96 patients, 56 patients were treated with a PFN alone (group 1). These patients were compared with 46 patients for whom the same device was used and a weekly subcutaneous injection of PTH 1-34 (teriparatide) was prescribed postoperatively (group 2). Questionnaire surveys or telephone interviews were conducted, and patients completed a self-report Harris hip score and visual analog scale scores. The radiological time to fracture healing was assessed as the primary end point. Postoperative complication rates were compared. Functional outcomes at 6 months after surgery were similar in both groups. There were no differences between groups in the proportion of patients achieving radiographic fracture healing. The frequency of patients reporting adverse events was 20% (10 of 50) in group 1 versus 17% (8 of 46) in group 2 ( p = 0.744). Short-term teriparatide did not improve radiographic signs of fracture healing of an intertrochanteric fracture and reduce the incidence of complications. The effect of teriparatide on fracture healing remains uncertain. Further multicenter prospective studies are needed to demonstrate objective long-term results of parathyroid hormone therapy in patient with hip fracture.
Level IV, therapeutic study.
髋部骨折后恢复缓慢会带来不良后果。因此，医学上需要改善粗隆间骨折后的愈合和功能恢复。本研究的目的是通过（1）临床评分、（2）影像学骨折愈合情况和（3）并发症发生率来衡量短期使用特立帕肽是否能改善内固定术后粗隆间骨折的愈合情况。我们回顾性分析了2014年至2016年间96例（平均年龄82岁）因不稳定粗隆间骨折接受闭合复位并用股骨近端髓内钉（PFN）进行内固定的患者。在这96例患者中，56例仅接受PFN治疗（第1组）。将这些患者与46例使用相同器械且术后每周皮下注射甲状旁腺激素1-34（特立帕肽）的患者进行比较（第2组）。进行问卷调查或电话访谈，患者完成自我报告的Harris髋关节评分和视觉模拟量表评分。将骨折愈合的放射学时间作为主要终点进行评估。比较术后并发症发生率。两组术后6个月的功能结果相似。两组在实现影像学骨折愈合的患者比例上没有差异。报告不良事件的患者频率在第1组为20%（50例中的10例），在第2组为17%（46例中的8例）（p = 0.744）。短期使用特立帕肽并未改善粗隆间骨折的影像学愈合迹象，也未降低并发症发生率。特立帕肽对骨折愈合的影响仍不确定。需要进一步的多中心前瞻性研究来证明甲状旁腺激素治疗髋部骨折患者的客观长期结果。
IV级，治疗性研究。
