Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
J Orthop Sci. 2024 May;29(3):880-884. doi: 10.1016/j.jos.2023.03.009. Epub 2023 Apr 7.
Atypical fractures are caused by the combined effects of severe suppression of bone metabolism (SSBT) due to long-term bisphosphonate therapy and chronic repetitive bone microdamage. Atypical ulnar fractures (AUFs) due to SSBT are rare, and there is no standard treatment strategy for such fractures. The relevant literature was reviewed, and the treatment strategy for AUF is discussed.
A systematic review was conducted. All studies on ulnar fractures in individuals with a history of bisphosphonate use were included, and the data were extracted and analyzed from the perspective of the therapeutic strategy.
Forty limbs of 35 patients were included. As for the treatment of AUF, 31 limbs were treated surgically, and conservative treatment with casting was performed for 9 limbs. The bone fusion rate was 22/40 (55.0%), and non-union was seen in all patients treated conservatively. There was a significant difference in the bone fusion rate between patients with surgical treatment and those with conservative treatment. The bone fusion rate of patients with parathyroid hormone (PTH) and surgery was 82.3% (14/17 limbs); the bone fusion rate with PTH and bone graft was 69.2% (9/13 limbs). However, there were no significant differences in the fusion rate in the groups with or without PTH, with or without bone grafting, or the combination of the two treatments. There was also no significant difference in the bone fusion rate in the groups with or without low-intensity pulsed ultrasound (LIPUS) treatment.
Based on the literature review, surgery is necessary to achieve bone union, but surgery alone is not adequate to achieve bony union. Bone grafting and the administration of PTH and LIPUS may promote early bone fusion, but the present study did not show significant advantages of these additional treatments for bone union.
由于长期双膦酸盐治疗和慢性反复性骨微损伤，导致严重的骨代谢抑制（SSBT），从而引起非典型性骨折。由 SSBT 引起的非典型性尺骨骨折（AUF）较为罕见，目前尚无针对此类骨折的标准治疗策略。我们对相关文献进行了复习，并讨论了 AUF 的治疗策略。
我们进行了系统评价。所有接受过双膦酸盐治疗的个体的尺骨骨折研究均包含在内，并从治疗策略的角度对数据进行了提取和分析。
35 例患者的 40 个肢体纳入研究。对于 AUF 的治疗，31 个肢体进行了手术治疗，9 个肢体采用石膏固定进行保守治疗。骨融合率为 22/40（55.0%），所有接受保守治疗的患者均出现了骨不连。手术治疗与保守治疗患者的骨融合率有显著差异。甲状旁腺激素（PTH）联合手术治疗患者的骨融合率为 82.3%（14/17 个肢体）；PTH 联合植骨治疗患者的骨融合率为 69.2%（9/13 个肢体）。但是，在有无 PTH、有无植骨或两者联合治疗的患者中，其融合率没有显著差异。有无低强度脉冲超声（LIPUS）治疗的患者之间的骨融合率也没有显著差异。
根据文献回顾，手术是实现骨愈合的必要手段，但单独手术并不能充分实现骨愈合。植骨和使用 PTH 及 LIPUS 可能会促进早期骨融合，但本研究并未显示这些附加治疗在促进骨融合方面有明显优势。
