Các yếu tố ảnh hưởng đến quá trình hồi phục và tiến triển của gãy xương đùi không điển hình chưa hoàn chỉnh được điều trị bảo tồn: Nghiên cứu quan sát hồi cứu

Springer Science and Business Media LLC - Tập 41 - Trang 61-73 - 2022
Meng Ai Png1, Joyce Suang Bee Koh2, P. Chandra Mohan1, Choong Yin Howe3, Tet Sen Howe2
1Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Republic of Singapore
2Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Republic of Singapore
3Singapore, Republic of Singapore

Tóm tắt

Gãy xương đùi không điển hình chưa hoàn chỉnh (iAFF) có thể xảy ra khi sử dụng bisphosphonate trong thời gian dài. Các yếu tố ảnh hưởng đến quá trình hồi phục và tiến triển của iAFF vẫn chưa được hiểu rõ. Nghiên cứu này đánh giá các yếu tố ảnh hưởng đến quá trình hồi phục và tiến triển của iAFF được điều trị bảo tồn, bao gồm tác động của bisphosphonates và teriparatide. Nghiên cứu quan sát hồi cứu tại một trung tâm với 69 bệnh nhân liên tiếp có 78 trường hợp iAFF được xác nhận qua hình ảnh từ năm 2002 đến 2017. Các hình ảnh X-quang đã được đánh giá cho sự dày đặc hình thái vỏ, đường đen đáng sợ (DBL) và gãy hoàn toàn. Các chỉ số kết quả chính là hồi phục DBL và gãy hoàn toàn. DBL có mối liên hệ đáng kể (p < 0.05) với sự tiến triển của gãy xương qua hồi quy logistic đa biến (55.8% so với 25.7%, tỷ lệ odds [OR] 26.57 (95% CI 1.40–504.78)) và thời gian sống sót không gãy xương ngắn hơn (trung bình 3.21 so với 6.27 năm). Sự hiện diện của triệu chứng có liên quan đến thời gian sống sót không gãy xương ngắn hơn (trung bình 2.68 so với 5.98 năm). Việc ngừng sử dụng bisphosphonates có mối liên hệ đáng kể (p < 0.001) qua hồi quy logistic đa biến với tỷ lệ gãy xương giảm (11.6% so với 92.0%; OR 0.00, 95% CI 0.00–0.08) và thời gian sống sót không gãy xương dài hơn (trung bình 7.52 so với 1.99 năm). Hồi phục DBL xảy ra ở 36.4%, chỉ khi bisphosphonates được ngừng sử dụng. Tuổi tác, giới tính, chủng tộc, vị trí gãy xương, sử dụng glucocorticoid, bổ sung teriparatide và thời gian sử dụng bisphosphonate không cho thấy ảnh hưởng đáng kể về mặt thống kê, mặc dù việc sử dụng teriparatide dường như cải thiện hồi phục DBL (50% so với 17.9%, p = 0.188). Trong iAFF được điều trị bảo tồn, hồi phục DBL xảy ra ở 36.4% nếu ngừng bisphosphonates. Bisphosphonates và DBL có mối liên hệ quan trọng với sự tiến triển của gãy xương và cùng với triệu chứng có liên quan đến sự sống sót sau gãy xương.

Từ khóa


Tài liệu tham khảo

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