Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital.
Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital.
Bone. 2019 Nov;128:115033. doi: 10.1016/j.bone.2019.08.006. Epub 2019 Aug 6.
The main purpose of the present study was to assess the radiologic effect of teriparatide on fracture healing, including union rate, union time, and callus formation, by quantitative measurements using serial follow-up X-ray imaging examinations in patients with complete atypical femoral fractures (AFFs) treated using closed intramedullary nailing.
From January 2010 to October 2017, 58 consecutive patients with complete AFF who were treated with intramedullary nailing at two institutions were enrolled. Patients were classified into two groups: those who received teriparatide therapy (group A) and those who did not (group B). Teriparatide (Forsteo®; Eli Lily Co., Indianapolis, IN, USA) at a once-daily 20 μg dose was prescribed as continuous treatment of osteoporosis or with the expectation of better bone healing. Surgical outcomes, including union rate, union time, modified radiologic union score (mRUS), and callus formation at 3, 6, and 12 months postoperatively, were assessed to evaluate the effect of teriparatide on fracture healing. Quantitative measurement of callus formation was performed using the region of interest (ROI) tool in the picture archiving communication system (PACS).
Non-union was not observed in group A, whereas two patients had non-union in group B. Union time was 18.3 ± 4.8 (range, 12-28) weeks in group A and 23.6 ± 9.5 (range, 12-64) weeks in group B and was significantly shorter in group A than group B (p = 0.010). The average mRUSs during periods A (3-4 months postoperatively), B (6-8 months postoperatively), and C (12-14 months postoperatively) were 10.0, 13.9, and 15.9 in group A, and 8.7, 12.0, and 14.9 in group B, respectively. The average mRUSs during periods A and B were significantly different (p = 0.027 and 0.011, respectively). The medial, posterior, and total callus areas during periods A and B were also significantly greater in group A than in group B. No difference was observed in the union rate between the two groups (p = 0.492).
Teriparatide may improve callus formation and shorten union time in patients with complete diaphyseal AFF who underwent closed intramedullary nailing.
Level III retrospective comparative study.
本研究的主要目的是通过对接受闭合髓内钉治疗的完全性非典型股骨骨折（AFF）患者进行连续随访 X 线影像学检查，定量评估特立帕肽对骨折愈合的放射学效果，包括愈合率、愈合时间和骨痂形成。
2010 年 1 月至 2017 年 10 月，在两个机构共纳入 58 例接受闭合髓内钉治疗的完全性 AFF 患者。将患者分为两组：接受特立帕肽治疗组（A 组）和未接受特立帕肽治疗组（B 组）。特立帕肽（福善美®；美国印第安纳州印第安纳波利斯 Eli Lily 公司）以每日 20 μg 的剂量连续治疗骨质疏松症或期望更好的骨愈合。评估手术结果，包括愈合率、愈合时间、改良放射学愈合评分（mRUS）以及术后 3、6 和 12 个月的骨痂形成，以评估特立帕肽对骨折愈合的影响。使用图像存档与通信系统（PACS）中的感兴趣区域（ROI）工具对骨痂形成进行定量测量。
A 组无骨不愈合，B 组有 2 例骨不愈合。A 组愈合时间为 18.3±4.8（12-28）周，B 组为 23.6±9.5（12-64）周，A 组明显短于 B 组（p=0.010）。A 组在术后 3-4 个月（A 期）、6-8 个月（B 期）和 12-14 个月（C 期）的平均 mRUS 分别为 10.0、13.9 和 15.9，B 组分别为 8.7、12.0 和 14.9。A 组 A 期和 B 期的平均 mRUS 差异均有统计学意义（p=0.027 和 0.011）。A 组在 A 期和 B 期的内侧、后侧和总骨痂面积也明显大于 B 组。两组愈合率无差异（p=0.492）。
特立帕肽可能会改善接受闭合髓内钉治疗的完全骨干 AFF 患者的骨痂形成，并缩短愈合时间。
III 级回顾性比较研究。
