掌骨基底关节外骨折预后的预测因素分析  

Analysis in prognostic factors of patients with metacarpal basal extra articular fractures

作　　者：赵越[1] 汤泽 梁博瑞 徐用亿[2] ZHAO Yue;TANG Ze;LIANG Borui;XU Yongyi(Department of Bone Surgery,Branch of Huai′an First People′s Hospital,Huaian,Jiangsu,223000;Department of Bone Surgery,Huai′an First Hospital Affiliated to Nanjing Medical University,Huaian,Jiangsu,223000)

机构地区：[1]江苏省淮安市第一人民医院分院骨外科,江苏淮安223000 [2]南京医科大学附属淮安第一医院骨外科,江苏淮安223000

出　　处：《实用临床医药杂志》2021年第12期78-82,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生计生委科技项目(Z201623)。

摘　　要：目的探讨掌骨基底关节外骨折患者预后的预测因素。方法回顾性分析102例掌骨关节外骨折患者的临床资料,根据术后骨愈合情况的不同将患者分为愈合良好组(n=55)和愈合不良组(n=47)。比较2组患者的临床资料[年龄、性别、手术固定类型、骨折原因、骨折分型、术后感染、骨折类型以及骨形态发生蛋白(BMP)、骨骼生长因子(SGF)、血小板衍生生长因子(PDGF)水平],采用受试者工作特征(ROC)曲线分析BMP、SGF和PDGF水平预测掌骨关节外骨折术后骨愈合不良的曲线下面积、灵敏度、特异度,并通过Logistic回归分析模型明确掌骨关节外骨折术后骨愈合不良的危险因素。结果愈合不良组术后感染、开放性骨折、粉碎性骨折等比率高于愈合良好组,差异有统计学意义(P<0.05);愈合不良组BMP、SGF和PDGF水平低于愈合良好组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,BMP、SGF和PDGF的曲线下面积分别为0.618、0.644和0.737。多因素Logistic回归分析显示,术后感染、开放性骨折、粉碎性骨折、BMP<7.415 pg/mL、SGF<85.705 ng/mL和PDGF<5.235 ng/mL是骨关节外骨折术后骨愈合不良的危险因素(P<0.05)。结论术后感染、开放性骨折、粉碎性骨折等临床特征和BMP<7.415 pg/mL、SGF<85.705 ng/mL、PDGF<5.235 ng/mL均可能引起骨关节外骨折患者术后骨愈合不良。Objective To study the predictive factors of patients with metacarpal basal extra articular fractures.Methods The clinical data of 102 patients with extra-articular metacarpal fractures treated was retrospectively analyzed.They were divided into good healing group(n=55)and poor healing group(n=47)according to their postoperative bone healing.The basic data[age,gender,fixation type of surgery,fracture causes,postoperative infection,fracture classification,fracture types,bone morphogenetic protein(BMP),bone growth factor(SGF),and platelet-derived growth factor(PDGF)]of the two groups were compared,and Receiver Operating Characteristic(ROC)curve was used to analyze the area under the curve,sensitivity and specificity of BMP,SGF and PDGF levels in predicting poor bone healing after metacarpal extra-articular fracture surgery.Finally,Logistic regression analysis model was used to identify the risk factors of poor bone healing after metacarpal extra-articular fracture surgery.Results The ratios of patients with postoperative infection,open fracture and comminuted fracture in the poor healing group were significantly higher than those in the good healing group(P<0.05);BMP,SGF and PDGF levels in the poor healing group were significantly lower than those in the good healing group(P<0.05).ROC analysis results showed that the areas under the curve of BMP,SGF and PDGF were 0.618,0.644 and 0.737,respectively.Multivariate Logistic regression analysis showed that postoperative infection,open fracture,comminuted fracture,BMP<7.415 pg/mL,SGF<85.705 ng/mL and PDGF<5.235 ng/mL were the risk factors of poor bone union(P<0.05).Conclusion Postoperative infection,open fracture,comminuted fracture and other clinical features,as well as BMP<7.415 pg/mL,SGF<85.705 ng/mL and PDGF<5.235 ng/mL all lead to the poor bone healing in patients with extra-articular fractures.

关 键 词：掌骨关节外骨折 受试者工作特征曲线 骨骼生长因子 骨形态发生蛋白 血小板衍生生长因子 预后 

分 类 号：R683.41[医药卫生—骨科学] R446.11[医药卫生—外科学]