双膦酸盐相关非典型股骨骨折的手术治疗

Surgical treatment for bisphosphonate-related atypical femoral fractures

目的探讨手术治疗双膦酸盐相关非典型股骨骨折的疗效。方法回顾性分析2011年1月至2012年12月手术治疗的15例(15侧骨折)双膦酸盐相关非典型股骨骨折患者资料,平均年龄76.0±6.4岁(65~88岁)。所有病例骨折时髋部骨密度T值平均为-3.1±0.7(-1.8^-4.5)。9病例骨折部位位于转子下,6例位于股骨干。12例采用髓内针固定。3例采用钢板螺钉固定。术后观察患者的骨折愈合情况。结果所有患者术后均获骨性愈合,平均愈合时间为5.9±1.4个月(4~8个月)。无感染、骨折不愈合,内固定物松动或断裂,下肢深静脉血栓等并发症发生。不同固定方式骨折愈合时间无差异(t=1.56,P=0.14)。服药时间与骨折愈合时间无相关性(r=0.034,P=0.904)。结论手术治疗是双膦酸盐相关非典型股骨骨折的有效方法。

Objective To investigate the effect of surgical treatment for bisphosphonate-related atypical femoral fractures. Methods The clinical data of 15 patients with bisphosphonate-related atypical femoral fractures （ 15 sides）, who received operations from January 2011 to December 2012, aging from 65 to 88 years old, with an average age of 76. 0 - 6.4 years old, were retrospectively analyzed. The average T-score of the hip BMD in all the cases was - 3.1 ＋ 0. 7 （ 1.8 - - 4. 5）. Nine cases were subtroehanteric fractures, and 6 cases were femoral shaft fractures. Twelve cases were operated using intramedullary nail fixation. Three cases were operated using steel screws. The healing of the fractures in all patients was observed. Results All fractures after the operations had healed, with an average healing duration of 5.9 ± 1.4 months, ranging from 4 to 8 months. No infection, nonunion, fixation loosening or rupture, deep vein thrombosis, and other complications occurred. No difference of healing duration in different fixation methods was observed （t = 1.56, P = 0. 14）. No correlation between the duration of fracture healing and the period of medication was observed （ r = 0. 034, P = 0. 904）. Conclusion Surgical treatment is an effective treatment for bisphosphonate-related atypical femoral fractures.