고령 환자 대퇴골 원위부 골절에서 가골 생성 촉진을 위한 부갑상선 호르몬의 간헐적 투여
Intermittent Parathyroid Hormone Treatment for Stimulation of Callus Formation on Distal Femoral Fracture in Elderly Patients - Case Report -
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초록
골절의 치유는 스스로 진행되는 과정이지만 고령의 환자에서는 골절 치유가 지연되는 경우가 많다. 골다공증이 동반된고령 환자가 골절상을 입은 경우에는 골절 분쇄상이 심하고 골질이 약하여 수술적 내고정력이 견고하지 못하기 때문에,이러한 골절 치유의 지연은 수술적 실패로 이어질 가능성이 높다. 최근에 골절 치유를 촉진시키는 방법으로 간헐적인 부갑상선 호르몬의 전신적 투여에 대한 연구가 활발히 진행되고 있다. 부갑상선 호르몬의 골절 치유 촉진 효과는 여러 동물실험을 통해 입증되어 잘 알려져 있음에도 불구하고 임상적인 투여 사례는 많지 않다. 저자들은 원위 대퇴골 과상부 골절이 있는 고령의 환자에서 골막을 최대한 보존한 수술적 치료 후, 부갑상선 호르몬 (teriparatide)을 간헐적으로 투여하여 가골 형성 시간이 단축된 2례를 경험하였기에 보고한다.
Abstract
Fracture healing is the ongoing process but it is often delayed in elderly patients. Because the fractures in elderly patients with osteoporosis are severely comminuted and their quality of bone is poor, the associated delay of fracture healing is likely to lead to surgical failure. Recently, as a way to promote healing fractures, intermittent systemic parathyroid hormone treatment has been actively researched. Although the effect of parathyroid hormone, which is demonstrated by animal experiments, is well known, there are not many clinical applications. The authors report 2 cases which had the time-shortened callus formation by intermittent parathyroid hormone (teriparatide) administration after surgical treatment, maximum preservation of periosteum as possible, in elderly patients who have supracondylar fracture on distal femur. [Korean Journal of Bone Metabolism, 18(2): 137-141, 2011
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