Maccagnano G, Pesce V, Vicenti G, Noia G, Coviello M, Bortone I, Ziranu A, Causo F, Moretti B
Department of Clinical and Experimental Medicine, University of Foggia, Azienda Ospedaliero Universitaria Ospedali Riuniti, Foggia, Italy.
Eur Rev Med Pharmacol Sci. 2022 Nov;26(1 Suppl):43-52. doi: 10.26355/eurrev_202211_30281.
Due to a growing number of lateral fragility fractures, and their high economic and social impact, we evaluated the combined drug therapy effectiveness in lateral fragility femur fractures treated by intramedullary nailing surgery comparing the clinical and radiological results of two groups of patients.
From May 2019 to March 2020, we carried out a prospective observational study comparing the results of patients with femoral lateral fractures treated by the same intramedullary nail (PFNA Synthes®) using Clodronic acid and Vitamin D (study group, 25 patients) compared to patients with the same fractures treated with Vitamin D alone (control group, 25 patients). The evaluations were based on bone biochemical markers (serum calcium level, serum phosphate level, parathyroid hormone, Vitamin D, serum C-terminal telopeptide), Visual Analogic Scale and HHS (Harris Hip Score) score, and femur densitometric views. In order to evaluate the femur neck mineral bone density (BMD), two areas have been identified on the Anterior-Posterior view: the Region of Interest (ROI)1 (under the head screw) and the ROI2 (above the femoral screw). The BMD has been calculated using femur densitometric views at T0 (1st day post-surgery) and at T1 (12 months later).
As far as the BMD average of ROI1 is concerned, we found a significant statistical increase at T1 in the study group (0.93±0.07 gr/cm2) vs. control group (0.88±0.08 gr/cm2), p=0.04. Both biochemical and densitometric values were statistically increased in the study group from T0 to T1 (p<0.05), while control group showed an improvement in the biochemical values only.
Thanks to a one year follow-up, we are able to demonstrate that the administration of an adequate drug therapy after surgery can lead to a better control of the bone remodeling and reabsorption process.
由于外侧脆性骨折的数量不断增加，且其具有较高的经济和社会影响，我们通过比较两组患者的临床和放射学结果，评估了髓内钉手术治疗外侧脆性股骨骨折联合药物治疗的有效性。
2019年5月至2020年3月，我们进行了一项前瞻性观察研究，比较使用氯膦酸和维生素D治疗的股骨外侧骨折患者（研究组，25例）与仅使用维生素D治疗的相同骨折患者（对照组，25例）的结果。评估基于骨生化标志物（血清钙水平、血清磷水平、甲状旁腺激素、维生素D、血清C末端肽）、视觉模拟评分和HHS（Harris髋关节评分）评分以及股骨密度视图。为了评估股骨颈矿物质骨密度（BMD），在前后位视图上确定了两个区域：感兴趣区域（ROI）1（头螺钉下方）和ROI2（股骨螺钉上方）。使用T0（术后第1天）和T1（12个月后）的股骨密度视图计算BMD。
就ROI1的BMD平均值而言，我们发现研究组在T1时（0.93±0.07g/cm²）与对照组（0.88±0.08g/cm²）相比有显著的统计学增加，p = 0.04。研究组从T0到T1的生化和密度测量值均有统计学增加（p < 0.05），而对照组仅生化值有所改善。
经过一年的随访，我们能够证明术后给予适当的药物治疗可以更好地控制骨重塑和再吸收过程。
