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特立帕肽对完全性非典型股骨骨折的骨愈合无有益作用。

Teriparatide Does not Have Beneficial Effects on Bone Healing in Complete Atypical Femur Fractures.

作者信息

Song Gill, Jeong Yerang, Nam Woo Dong, Kim Keong-Hwan

机构信息

Department of Orthopaedic Surgery, College of Medicine Kangwon National University, Kangwon National University Hospital, Baengnyeong-Ro 156, Chuncheon-si, Gangwon-do, 24289, Republic of Korea.

出版信息

Calcif Tissue Int. 2024 Aug;115(2):169-173. doi: 10.1007/s00223-024-01244-x. Epub 2024 Jun 21.

Abstract

Teriparatide is an anabolic drug sometimes administered to patients who have atypical femoral fracture (AFF). However, whether teriparatide has beneficial effects on bone healing remains uncertain. The present study aimed to analyze the association between teriparatide and bone healing in complete AFF. A total of 59 consecutive cases (58 patients) who underwent intramedullary nailing for complete AFF were categorized based on postoperative use of teriparatide into the non-teriparatide (non-TPTD, n = 34) and teriparatide groups (TPTD, n = 25). Time-to-bone union was evaluated and compared between the two groups. Additionally, multiple regression analysis was performed to evaluate factors affecting time-to-bone union. All participants were women, with a mean age of 77.6 years (range: 62-92). No significant difference in time-to-bone union was found between the non-TPTD and TPTD groups (5.5 months vs. 5.8 months, p = 0.359). Two patients in the non-TPTD group underwent reoperation (p = 0.503) due to failure caused by inadequate fixation, and both achieved bone healing after additional fixation with blocking screws. Multiple regression analysis revealed that the anterior gap of the fracture site postoperatively was a factor affecting time-to-bone union (p = 0.014). The beneficial effect of teriparatide on bone healing in complete AFF could not be confirmed. Additional randomized controlled trials are required. Nonetheless, appropriate techniques, including efforts to reduce the gap on the tensile side during the surgery, are important for reliable bone healing.

摘要

特立帕肽是一种合成代谢药物,有时用于患有非典型股骨骨折(AFF)的患者。然而,特立帕肽对骨愈合是否具有有益作用仍不确定。本研究旨在分析特立帕肽与完全性AFF骨愈合之间的关联。共有59例连续接受完全性AFF髓内钉固定术的病例(58例患者),根据术后是否使用特立帕肽分为非特立帕肽组(非TPTD,n = 34)和特立帕肽组(TPTD,n = 25)。评估并比较两组的骨愈合时间。此外,进行多元回归分析以评估影响骨愈合时间的因素。所有参与者均为女性,平均年龄77.6岁(范围:62 - 92岁)。非TPTD组和TPTD组在骨愈合时间上未发现显著差异(5.5个月对5.8个月,p = 0.359)。非TPTD组有2例患者因固定不充分导致失败而接受再次手术(p = 0.503),在使用阻挡螺钉进行额外固定后均实现了骨愈合。多元回归分析显示,术后骨折部位的前方间隙是影响骨愈合时间的一个因素(p = 0.014)。无法证实特立帕肽对完全性AFF骨愈合的有益作用。需要进一步的随机对照试验。尽管如此,包括在手术中努力减小张力侧间隙在内的适当技术对于可靠的骨愈合很重要。

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