Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea.
Arch Orthop Trauma Surg. 2020 Oct;140(10):1567-1574. doi: 10.1007/s00402-020-03570-9. Epub 2020 Aug 8.
Nonunion after ulnar shortening osteotomy (USO) was observed at a high rate in patients undergoing long-term bisphosphonate (BP) maintenance treatment after breast cancer surgery. Here, we report the unique features of these nonunions.
In total, 485 patients who had undergone USO between March 2008 and September 2017 were screened for inclusion based on the following criteria: (1) definitive nonunion after USO; (2) prior history of or ongoing BP therapy after the diagnosis of breast cancer; and (3) no evidence of metastasis in the ulna treated with USO, as determined based on the radiological evaluation.
Five patients with histories of breast cancer and subsequent BP treatment were identified; all (100%) of these patients showed definitive nonunion after USO. The mean age was 56.2 years, and all ulnae were on the contralateral side to that of the original breast cancer. Intravenous Ibandronate and Zolendronate were administrated to one and four patients, respectively. The mean period of administration was 67.8 months. Three patients exhibited suspicious lesions impending atypical fracture on their femurs, and the other two patients were treated by intramedullary nailing after the occurrence of atypical fractures. Radiological evaluation revealed no evidence of a metastatic lesion, including in the musculoskeletal system, in any patient. Osteosynthesis was performed with cancellous iliac bone graft and mean of 4.3 months after osteosynthesis, union in all cases was achieved.
Problems associated with BP treatment are well known. Even in cases in which the agent is essential for preventing bony metastasis of breast cancer, the normal bony physiology, including bone turnover and healing, is likely to be compromised. In addition to atypical fractures of the femur and ulna, procedures such as USO are likely to be affected by BP. Furthermore, not only a primary iliac bone graft but also other method (oblique osteotomy) should be needed to avoid nonunion during plating in USO.
IV, Retrospective case series.
乳腺癌手术后长期接受双膦酸盐（BP）维持治疗的患者，行尺骨缩短截骨术后（USO），非愈合率较高。在此，我们报告这些不愈合的独特特征。
共筛选了 485 例 2008 年 3 月至 2017 年 9 月期间行 USO 的患者，纳入标准如下：（1）USO 后明确的不愈合；（2）乳腺癌诊断后有或正在接受 BP 治疗；（3）USO 治疗的尺骨无转移证据，这是通过影像学评估确定的。
发现 5 例有乳腺癌病史和随后 BP 治疗史的患者，所有（100%）患者在 USO 后均出现明确的不愈合。平均年龄为 56.2 岁，所有尺骨均位于原发乳腺癌的对侧。1 例患者静脉内应用伊班膦酸盐，4 例患者应用唑来膦酸。平均给药时间为 67.8 个月。3 例患者股骨出现可疑的即将发生非典型骨折的病变，另外 2 例患者在发生非典型骨折后采用髓内钉治疗。影像学评估显示，所有患者均无骨转移病变，包括肌肉骨骼系统。所有患者均采用松质髂骨移植进行内固定，平均 4.3 个月后所有患者均达到愈合。
BP 治疗相关的问题是众所周知的。即使该药物对预防乳腺癌骨转移是必需的，正常的骨生理，包括骨转换和愈合，也可能受到影响。除了股骨和尺骨的非典型骨折外，USO 等手术也可能受到 BP 的影响。此外，不仅需要原发性髂骨移植，还需要其他方法（斜行截骨）来避免 USO 内固定时不愈合。
IV，回顾性病例系列。
