Kigera James W M, Gichangi Peter B, Abdelmalek Adel K M, Ogeng'o Julius A
College of Health Sciences, University of Nairobi, P.O Box 30197-00100, Nairobi, Kenya.
J Clin Orthop Trauma. 2022 Jan 12;25:101763. doi: 10.1016/j.jcot.2022.101763. eCollection 2022 Feb.
Fractures are increasing worldwide and with an aging population, are frequent in the elderly. The healing of fractures progresses through various phases including the inflammatory stage. Aging is associated with slower healing and the use of non steroidal anti-inflammatory drugs (NSAIDs) may interrupt bone healing processes. We designed a study to compare the effect of diclofenac and celecoxib on fracture callus histomorphometry in a rat model of different age groups.
Using 5 and 15 month old rats, fractures were induced on the left tibia and the animals allocated to receive one of the drugs. Animals were sacrificed at day 21 and 42 and the fracture callus harvested for processing and histological evaluation. Tissue proportions and histological grades were determined and compared across the groups.
Across all groups, the histological grade increased with time and animals in the young diclofenac group had the highest grade at day 42 (p = 0.004). The proportion of bone increased in all groups and was highest in the young diclofenac group at day 21 and day 42 (p = 0.003). Post hoc analysis showed that the young celecoxib and old celecoxib groups had the least proportion of bone (p = 0.032 and p = 0.003). The proportion of cartilage reduced in all groups at both time points.
Celecoxib was associated with lower histological grade and lower proportion of bone in older animals. We urge for caution regarding the use of celecoxib in older people for the management of pain associated with fractures. Diclofenac may be a better option in this group.
全球骨折发生率呈上升趋势，随着人口老龄化，老年人骨折频发。骨折愈合历经包括炎症阶段在内的多个阶段。衰老与愈合缓慢相关，使用非甾体抗炎药（NSAIDs）可能会干扰骨愈合过程。我们设计了一项研究，以比较双氯芬酸和塞来昔布对不同年龄组大鼠骨折骨痂组织形态计量学的影响。
使用5月龄和15月龄大鼠，在左胫骨诱导骨折，并将动物分配接受其中一种药物。在第21天和第42天处死动物，采集骨折骨痂进行处理和组织学评估。确定并比较各组的组织比例和组织学分级。
在所有组中，组织学分级随时间增加，年轻双氯芬酸组动物在第42天的分级最高（p = 0.004）。所有组中骨的比例均增加，年轻双氯芬酸组在第21天和第42天骨的比例最高（p = 0.003）。事后分析表明，年轻塞来昔布组和老年塞来昔布组的骨比例最低（p = 0.032和p = 0.003）。在两个时间点，所有组中软骨的比例均降低。
塞来昔布与老年动物较低的组织学分级和较低的骨比例相关。我们敦促在老年人中使用塞来昔布治疗骨折相关疼痛时要谨慎。在这组人群中，双氯芬酸可能是更好的选择。
