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PTH 1-84(重组人甲状旁腺素)治疗萎缩性股骨干骨不连  

2015-04-26 17:36:58|  分类: 骨科文献 |  标签: |举报 |字号 订阅

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Case

      A 48 year old male patient (heavy smoker) sustained a high energy, two level, comminuted fracture (pertrochanteric and middiaphyseal), of his right femur in a road traffic accident. He initially underwent internal fixation of both fractures with a hip sliding screw and a dynamic compression plate, at an emergency basis. 
病例

    一例48岁男性患者(重度吸烟者)因道路交通事故导致高能量的2级右股骨粉碎性骨折(股骨大转子与股骨干中段)。紧急情况下,初次施行双骨折内固定术(采用髋部滑动螺钉和动力加压接骨板)。

      Despite several surgical attempts at fixation (plates and external fixators) and biological enhancement of the nonunion environment (autologous bone grafting in combination with bone morphogenetic protein 7), the mid-diaphysis femoral fracture failed to unite and structural failures of the materials of internal fixation were observed (Figure 1). 
    尽管在固定术(采用钢板和外固定器)与骨折不愈合环境的生物学增效(与骨形态发生蛋白结合自体骨移植术)上进行了几次手术尝试,但发生了中段股骨干骨折不愈合和内固定材质结构损坏(图1
)。

PTH 1-84(重组人甲状旁腺素)治疗萎缩性股骨干骨不连 - 小骨头 - 小骨头的博客

Figure 1(a-f). a) anteroposterior view of the right femur showing structural failure of the initial plate fixation,
b) lateral view, after the second attempt for fixation with a long locking plate, showing the extended avital fracture area,c) anteroposterior view of the femur following the second structural failure of the plate (broken screws and pain), d)lateral view of the nonunion area following the application of a Spatial Taylor Frame with autografting and BMP-7, e)anteroposterior and f) 
lateral view showing the consolidation of the fracture nonunion following a 2 months administration of 1-84 PTH.

1a-f a右股骨正位片显示:初次应用钢板内固定后,材质结构性损坏;b侧位片显示:第二次采用长型锁定钢板固定后,扩展的骨折轴线区;c股骨正位片显示:第二次的手术钢板损坏(螺钉断裂);d骨不连区域的侧位片显示:联合采用自体骨移植BMP-7后使用立体Taylor结构外固定;e正位片;f侧位片显示:给予1-84 PTH治疗骨折不愈合,2个月后骨折获得坚强愈合。

    During the treatment course, smoking, high energy of both bone and soft tissue envelope trauma, fracture comminution and iatrogenic technical fixation errors were recognized as causative factors for the development of nonunion. Alternative anabolic treatment strategies for fracture healing were considered following a thorough literature search. An “off label”, daily dose of PTH 1-84, was administered to the patient for a period of two months.

    在治疗过程中,吸烟、高能量损伤、软组织包膜创伤、骨折粉碎程度及医源性固定术失误等均被认为是骨不连发生发展的诱因。一个全面的文献检索后,应用合成代谢治疗骨折愈合的方案已获得公认。采取“标记清除”法,每日给予患者固定剂量的PTH1-84(重组人甲状旁腺激素),为期两个月。

      At the end of the second month, satisfactory radiological callus formation was observed and the patient was allowed to walk full weight bearing. At one year follow up, the patient regained painless, full range, motion of the adjacent joints and walked with a mild limp due to a minor leg length discrepancy.

      第二个月末,患者放射性骨痂形成良好,并且完全负重行走。一年的随访后,患者疼痛感消失,相邻关节的活动度完全恢复,但是因双下肢不等长导致轻度跛行。

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