Jalan Harsh, Perumal Ramesh, Prabhu Suresh, Palanivelayutham Sivakumar, Viswanathan Vibhu Krishnan, Rajasekaran S
Department of Orthopaedics, Ganga Medical Centre and Hospital, 313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamil Nadu, India, 641001.
J Clin Orthop Trauma. 2021 Jun 8;20:101472. doi: 10.1016/j.jcot.2021.06.002. eCollection 2021 Sep.
Hip fractures in elderly are commonly associated with osteoporosis and surgical outcome is influenced by its concurrent management. The purpose of our study is to determine the association between timing of bisphosphonate administration in inter-trochanteric (IT) fractures and fracture healing. Patients with IT fractures (aged≥50 years) and T-score ≤ -1.5 [WHO defines osteopenia as T-score between -1 and -2.5, and osteoporosis as T-score ≤ -2.5 on DEXA scan (which was obtained post-operatively in our cohort)], who underwent proximal femoral nailing were included. Patients were divided into three groups: group 1a-intravenous bisphosphonate {ivBP [zoledronic acid (ZA)]} given within one week, group 1b-ZA at six weeks and group 2-control group. Post-operative radiographs were assessed for reduction parameters [neck-shaft angle, tip-apex distance, reduction variance]. Radiological union was determined using RUSH score and functional outcome (at one year) with Modified Harris Hip Scores. 41 (23 males), 40 (15 males) and 42 (15 males) patients were included in groups 1a, 1b and 2, respectively (no statistical difference in sex distribution among the groups; p = 0.12). Mean age in groups 1a, 1b and 2 was 71.8 ± 8.1, 75.9 ± 8.5 and 72.3 ± 10.6 years (p = 0.09). There was no significant difference in the pattern of injuries (AO classification) among the groups (p = 0.72). Mean time to union in groups 1a, 1b and 2 was 13.7,13.7 and 14.2 weeks, respectively (p = 0.69). Mean time to union in AO types A1, A2 and A3 fractures was 13.2 ± 2.1, 13.7 ± 2.8 and 16.1 ± 4.9 weeks (p = 0.01). We did not observe any association between T-scores and fracture union (hip:p = 0.52, spine:p = 0.93).The functional outcome was similar among groups (p = 0.96). Early administration of ZA did not negatively influence fracture healing in patients undergoing fixation of IT fractures. Among the various other factors analyzed, there was a statistically significant association between the fracture type (AO type A3) and longer time to fracture union.
老年人髋部骨折通常与骨质疏松症相关，手术结果受其同期治疗的影响。我们研究的目的是确定在股骨转子间（IT）骨折中双膦酸盐给药时间与骨折愈合之间的关联。纳入年龄≥50岁、T值≤ -1.5的IT骨折患者（世界卫生组织将骨量减少定义为双能X线吸收法扫描T值在-1至-2.5之间，骨质疏松症定义为T值≤ -2.5，本队列中该扫描在术后进行），这些患者接受了股骨近端钉固定术。患者分为三组：1a组——在一周内静脉注射双膦酸盐{静脉注射BP[唑来膦酸（ZA）]}，1b组——在六周时注射ZA，2组——对照组。对术后X线片评估复位参数[颈干角、尖顶距、复位差异]。使用RUSH评分确定影像学愈合情况，并采用改良Harris髋关节评分评估（一年时的）功能结果。1a组、1b组和2组分别纳入41例（23例男性）、40例（15例男性）和42例（15例男性）患者（各组间性别分布无统计学差异；p = 0.12）。1a组、1b组和2组的平均年龄分别为71.8±8.1岁、75.9±8.5岁和72.3±10.6岁（p = 0.09）。各组间损伤类型（AO分类）无显著差异（p = 0.72）。1a组、1b组和2组的平均愈合时间分别为13.7周、13.7周和14.2周（p = 0.69）。AO A1型、A2型和A3型骨折的平均愈合时间分别为13.2±2.1周、13.7±2.8周和16.1±4.9周（p = 0.01）。我们未观察到T值与骨折愈合之间存在任何关联（髋部：p = 0.52，脊柱：p = 0.93）。各组间功能结果相似（p = 0.96）。早期给予ZA对接受IT骨折固定术的患者的骨折愈合没有负面影响。在分析的其他各种因素中，骨折类型（AO A3型）与骨折愈合时间延长之间存在统计学显著关联。
