背景:已发表的文献描述了股骨骨epi滑脱是重组人生长激素(rhGH)治疗的并发症,可能与骨强度降低有关。当前研究的目的是利用病例对照研究设计来确定与一组匹配的对照组相比,在受伤时是否有更大比例的胫骨近端植骨撕脱性骨折的儿科患者正在接受rhGH治疗。
方法:采用病例对照设计研究设计。我们确定了从2016年2月1日至2023年5月4日在我们机构治疗的4至18岁的胫骨近端植骨撕脱性骨折(病例)或胫骨中段骨折(对照)患者。病例和对照根据年龄(1年内)1:1匹配,性别,和体重指数(3kg/m2以内)。共有132名患者被纳入分析(平均年龄,13±2年)。使用条件逻辑回归和Firth校正比较rhGH暴露。
结果:我们发现,11%的胫骨近端撕脱性骨折患者在受伤时接受rhGH治疗,而0%的胫骨中段骨折患者接受rhGH治疗(比值比[OR],15.0;95%置信区间[CI],1.8至1,946.7;p=0.007)。病例(70%)和对照组(67%)之间运动相关损伤的比例没有显着差异(OR,1.15;95%CI,0.55至2.39;p=0.85)。在胫骨近端撕脱骨折患者中,需要手术的比例在接受和未接受rhGH治疗的患者之间没有显着差异(43%对41%,分别为;p=0.99)。
结论:这项研究表明,在受伤时,胫骨近端撕脱性骨折并接受重组人生长激素治疗的受试者比例明显高于年龄,性别,和体重指数匹配的对照组胫骨中段骨折(11%对0%,分别,代表15倍的暴露几率)。这量化了以前未报告的与rhGH治疗相关的严重骨科并发症。
方法:预后III级。有关证据级别的完整描述,请参阅作者说明。
BACKGROUND: Published literature describes slipped capital femoral epiphysis as a complication of recombinant human growth hormone (rhGH) therapy that may be related to decreased physeal strength. The purpose of the current investigation was to utilize a
case-control study design to determine whether a greater proportion of pediatric patients sustaining physeal avulsion fractures of the proximal tibia were undergoing rhGH therapy at the time of injury compared with a cohort of matched controls.
METHODS: A
case-control design study design was utilized. Patients 4 to 18 years of age with proximal tibial physeal avulsion fractures (cases) or midshaft tibial fractures (controls) at our institution from February 1, 2016, to May 4, 2023, were identified. Cases and controls were matched 1:1 on the basis of age (within 1 year), sex, and body mass index (within 3 kg/m 2 ). A total of 132 patients were included in the analysis (mean age, 13 ± 2 years). rhGH exposure was compared using conditional logistic regression with Firth correction.
RESULTS: We found that 11% of the patients with a proximal tibial physeal avulsion fracture were on rhGH therapy at the time of injury compared with 0% of patients with midshaft tibial fractures (odds ratio [OR], 15.0; 95% confidence interval [CI], 1.8 to 1,946.7; p = 0.007). There was no significant difference in the proportion of sports-related injuries between cases (70%) and controls (67%) (OR, 1.15; 95% CI, 0.55 to 2.39; p = 0.85). Among subjects with proximal tibial avulsion fractures, the proportion requiring surgery did not differ significantly between patients receiving and those not receiving rhGH therapy (43% versus 41%, respectively; p = 0.99).
CONCLUSIONS: This study demonstrates that the proportion of subjects who sustained proximal tibial physeal avulsion fractures and were receiving recombinant human growth hormone therapy at the time of injury was significantly greater than that of an age, sex, and body mass index-matched control group with midshaft tibial fractures (11% versus 0%, respectively, representing 15-times greater odds of exposure). This quantifies a previously unreported serious orthopaedic complication associated with rhGH therapy.
METHODS: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.