[1]钱钧 王浩宇 方智敏.胫骨骨折术后血清相关指标与骨折愈合的关系[J].中国中医骨伤科杂志,2022,30(05):23-27.
　QIAN Jun WANG Haoyu FANG Zhimin.The Relationship between Serum Related Indexes and FractureHealing after Tibial Fracture Surgery[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(05):23-27.
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胫骨骨折术后血清相关指标与骨折愈合的关系()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年05期
页码:
23-27
栏目:
临床研究
出版日期:
2022-05-15

文章信息/Info

Title:
The Relationship between Serum Related Indexes and FractureHealing after Tibial Fracture Surgery
文章编号:
1005-0205(2022)05-0023-05
作者:
钱钧1 王浩宇1 方智敏1
1温州医科大学附属衢州医院(衢州市人民医院)骨科
Author(s):
QIAN Jun1 WANG Haoyu1 FANG Zhimin1
1Department of Orthopedics, Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People’s Hospital), Quzhou 324000, Zhejiang China.
关键词:
胫骨骨折; 术后; Ⅰ型胶原羧基端肽β特殊序列; 可溶性黏附分子CD44; 成纤维细胞生长因子-2; 延迟愈合
Keywords:
tibia fracture;  postoperative;  β C-terminal cross-linked telopeptides of type Ⅰcollagen(β-CTX);  soluble adhesion molecule CD44(sCD44);  fibroblast growth factor-2(FGF-2);  delayed union
分类号:
R683.42
文献标志码:
A
摘要:
目的:探讨胫骨骨折患者术后血清相关指标Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、可溶性黏附分子CD44(sCD44)、成纤维细胞生长因子-2(FGF-2)水平与骨折愈合的关系。方法: 回顾性分析2019年1月至2021年1月收治的90例胫骨骨折患者的临床资料,根据术后骨折愈合情况分为延迟愈合组(31例)和正常愈合组(59例)。对比两组术后1 d、1周、4周血清β-CTX、sCD44、FGF-2水平。采用单因素分析、多因素Logistic回归分析胫骨骨折愈合影响因素,并采用受试者工作特征曲线(ROC曲线)分析术后血清β-CTX、sCD44、FGF-2水平对胫骨骨折愈合的预测价值。结果: 两组患者术后血清β-CTX、sCD44、FGF-2水平均呈显著升高趋势,差异有统计学意义(P<0.05)。术后1 d两组患者血清β-CTX、sCD44、FGF-2水平比较差异无统计学意义(P>0.05); 术后1周两组患者血清β-CTX、sCD44、FGF-2水平均高于术后1 d,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05); 术后4周两组患者血清β-CTX、sCD44、FGF-2水平均高于术后1 d和1周,延迟愈合组血清β-CTX水平低于正常愈合组,而血清sCD44、FGF-2水平高于正常愈合组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术后β-CTX、FGF-2水平为胫骨骨折愈合的独立保护因素,sCD44水平为胫骨骨折愈合的独立危险因素,差异有统计学意义(P<0.05)。ROC曲线显示,β-CTX、sCD44、FGF-2对胫骨骨折愈合具有一定预测价值,差异有统计学意义(AUC=0.746,0.785,0.701,P<0.01),且联合差异有统计学意义(AUC=0.907,P<0.01),预测价值较高。结论: 胫骨骨折延迟愈合患者术后血清β-CTX、FGF-2水平低于正常愈合患者,而sCD44水平高于正常愈合患者,联合检测术后血清β-CTX、sCD44、FGF-2水平对预测胫骨骨折愈合具有一定参考价值。
Abstract:
To investigate the relationship between the serum levels of collagen type I carboxy-terminal peptide β special sequence(β-CTX), soluble adhesion molecule CD44(sCD44), fibroblast growth factor-2(FGF-2)and fracture healing in patients with tibial fractures after surgery. Methods:The clinical data of 90 patients with tibial fractures admitted from January 2019 to January 2021 were retrospectively analyzed, and they were divided into delayed union group(31 cases)and normal union group(59 cases)according to postoperative fracture healing. The serum β-CTX, sCD44 and FGF-2 levels were compared between the two groups at 1 d, 1 week and 4 weeks after operation. Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of tibial fracture healing, and the receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of postoperative serum β-CTX, sCD44 and FGF-2 levels on tibial fracture healing. Results:The levels of serum β-CTX, sCD44 and FGF-2 in the two groups were shown a significant increase trend(P<0.05). There was no difference in serum levels of β-CTX, sCD44, and FGF-2 between the two groups on the first day after surgery(P>0.05); the levels of serum β-CTX, sCD44, and FGF-2 in the two groups were higher than those on the first day after surgery(P<0.05), but there was no difference between the groups(P>0.05); the serum levels of β-CTX, sCD44 and FGF-2 in the two groups were higher than those in the 1 d and 1 week after the operation. The serum β-CTX levels in the delayed healing group was lower than the normal healing group, while the serum sCD44 and FGF-2 levels were higher than the normal healing group(P<0.05). Multivariate Logistic regression analysis were shown that postoperative β-CTX and FGF-2 levels were independent protective factors for tibial fracture healing, and sCD44 levels were independent risk factors for tibial fracture healing(P<0.05). The ROC curve was shown that β-CTX, sCD44 and FGF-2 had certain predictive value for tibial fracture healing(AUC=0.746, 0.785, 0.701, P<0.01), and the combination(AUC=0.907, P<0.01)had higher predictive value. Conclusion:Postoperative serum β-CTX and FGF-2 levels in patients with delayed union of tibial fractures are lower than those in normal union patients, while sCD44 levels are higher than those in normal union patients. The combined detection of postoperative serum β-CTX, sCD44 and FGF-2 levels has a certain reference value for predicting tibial fracture healing.

参考文献/References:

[1] 戚记伟,李强,刘俊生,等.髓内钉联合空心螺钉治疗胫骨下1/3螺旋形骨折合并后踝骨折26例[J].中国中医骨伤科杂志,2019,27(7):51-53.
[2] 张文莉,孙萍,杜彦懿,等.骨折延迟愈合患者血液流变学、血清黏附分子及骨代谢指标的检测及临床意义[J].中国卫生检验杂志,2018,28(16):2001-2003.
[3] LIN Y H,WENG C J,CHANG S S,et al.Treatment and clinical results of distal radial fractures nonunion or delayed union[J].Formosan Journal of Musculoskeletal Disorders,2019,10(1):9-16.
[4] 姚颖,刘玮.骨代谢生化指标与绝经后骨质疏松性腰椎骨折的关系[J].实用临床医药杂志,2020,24(7):112-115.
[5] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012.
[6] 郭建兴.分型治疗创伤性髋关节骨折脱位对骨折愈合时间及治疗满意度的影响探讨[J].中国基层医药,2017,24(11):1723-1726.
[7] 徐向勇,余永斌.血流变学指标血清炎症因子水平变化在骨折延迟愈合患者中的临床研究[J].河北医学,2020,26(5):810-815.
[8] LIU Y Z,AKHTER M P,XIANG G,et al.Glucocorticoid-induced delayed fracture healing and impaired bone biomechanical properties in mice[J].Clin Interv Aging,2018,13:1465-1474.
[9] 薛徽,孙瑶.影响骨折愈合的生物因素研究新进展[J].口腔医学,2018,38(11):1043-1047.
[10] 胡小刚,王红祥,王巧娥,等.tP1NP、OCN和β-CTX在骨质疏松性骨折和骨关节炎老年患者唑来膦酸治疗前后变化[J].临床和实验医学杂志,2018,17(12):1299-1302.
[11] 葛向荣,马红霞,林继红.胫骨骨折患者术后血清IGF-1,β-CTX,CYR61蛋白的表达与延迟愈合的关系[J].创伤外科杂志,2020,22(3):51-54.
[12] 周伟,黄松,魏优秀.四肢骨折延迟愈合患者血清miR-206、IGF-1、sICAM-1水平变化及诊断效能[J].山东医药,2020,60(30):22-26.
[13] 闫献雨,赵治邦,樊文良,等.血清黏附分子及微量元素与胫腓骨骨折延迟愈合的关系分析[J].海南医学院学报,2017,23(1):107-109.
[14] 章坚林,于博,刘柱同.胫骨骨折髓内钉固定围术期血清FGF-2和IGF-1水平联合预测其术后骨不连的价值[J].广东医学,2018,39(1):122-125.
[15] 刘善明,赵元,陈黎兵,等.胫骨骨折髓内钉固定术患者血清FGF-2、IGF-1、sICAM-1水平与骨折愈合的关系研究[J].创伤外科杂志,2019,21(11):846-849.

备注/Memo

备注/Memo:
基金项目:衢州市科技局指导性项目(2019ASA90155)
更新日期/Last Update: 1900-01-01