Pain-killer affects the healing of osteoporotic fracture

doi:10.3969/j.issn.2095-4344.2013.35.023

Abstract

Abstract:

BACKGROUND: Studies have shown that non-steroidal drugs have analgesic effect and can also adversely affect the fracture healing. However, the effect of non-steroidal anti-inflammatory drugs on osteoporotic fracture healing is reported less at home and abroad.
OBJECTIVE: To perform the animal experiment and clinical observation with the commonly used non-steroidal anti-inflammatory drug diclofenac sodium and central inflammatory drug tramadol hydrochloride, in order to investigate the effect of pain-killer on the union of osteoporotic fracture.
METHODS: Animal experiment: female rats received double side castrations and were fed for three months to make osteoporosis model. Then the rats received intramedullary nail fixation for the treatment of middle femur fracture. All drugs were applied by intragastric administration, once per day, and lasted for 6 weeks. The animals were randomly divided into four groups. The control group was injected with normal saline after fracture; tramadol hydrochloride group was injected with tramadol hydrochloride after fracture; diclofenac sodium A group was injected with diclofenac sodium before fracture and after establishment of osteoporosis model; diclofenac sodium B group was injected with diclofenac sodium after fracture. Gray value was measured by X-ray film at different time points after operation. Clinical observation: 21 patients with osteoporotic thoracolumbar vertebral compression fractures were randomly divided into three groups: control group (n=6), tramadol hydrochloride group (n=7, 100 mg/d) and diclofenac sodium group (n=8, 75 mg/d). All patients were treated with anti-osteoporosis drugs in the same dose and required to lie on broad bed. The patients in the tramadol hydrochloride group and diclofenac sodium group received drug treatment for 1 month. The visual analogue scale score, clinical symptoms disappeared time, vertebral height variation, and L₃vertebral bone mineral density changes were recorded.
RESULTS AND CONCLUSION: Animal experiment results: the quantity and density of newly formed bone callus and the gray value of fracture site on X-ray film in the diclofenac sodium A and B groups were lower than those in the control group and the tramadol hydrochloride group at 2, 3, 4 and 6 weeks after operation (P < 0.01). The quantity and density of newly formed bone callus and the gray value of fracture site on X-ray film in the diclofenac sodium B group were lower than those in the other three groups at 4 and 6 weeks after operation (P < 0.05). Clinical observation results: the visual analogue scale score of the patients in the tramadol hydrochloride group and diclofenac sodium group at the first day,1, 2 and 3 weeks after operation was lower than that in the control group (P < 0.01). There was no statistically significant difference in disappeared time of clinical symptoms between groups (P > 0.05). The average gray value of vertebral compression and L3 vertebral bone mineral density in the diclofenac sodium group at 1 month after treatment were lower than those in the control group (P < 0.05). The non-steroidal anti-inflammatory drugs can delay the osteoporotic fracture healing and degrade the intensity of fracture healing, and mainly affect early osteoporotic fracture healing. So, non-steroidal anti-inflammatory drugs should not be the first choice for acute osteoporotic fracture. Central analgesic drugs should be the first choice, such as tramadol hydrochloride.

Key words: bone and joint implants, clinical practice of bone and joint implants, painkillers, osteoporotic fracture, fracture healing, animal experiments, clinical observation, fixation, tramadol hydrochloride, central analgesic drugs, diclofenac sodium, non-steroidal drugs

CLC Number:

R318

Zhang Tian-hao, Dong Ying-hai, Yu Si-ming, Zhang Chao, Yao Bing. Pain-killer affects the healing of osteoporotic fracture

[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(35): 6364-6374.

Figures/Tables 7

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