血清指标评估老年股骨粗隆间骨折术后预后  

Serum markers of bone metabolism and inflammation for predicting prognosis of femoral intertrochanteric fractures fixed with intramedullary nail in the elderly

作　　者：刘胜才 朱令孝[1] 郭建中[1] 曾水平[1] 林健[1] 王勇[1] LIU Sheng-cai;ZHU Ling-xiao;GUO Jian-zhong;ZENG Shui-ping;LIN Jian;WANG Yong(Department of Orthopedics,Ji'an Central People's Hospital,Ji’an,343000,China)

机构地区：[1]吉安市中心人民医院骨科,江西吉安343000

出　　处：《中国矫形外科杂志》2021年第18期1648-1652,共5页Orthopedic Journal of China

基　　金：江西省卫生健康委科技计划(编号:20202111)。

摘　　要：[目的]探究老年股骨粗隆间骨折经股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)治疗后骨代谢及炎症因子水平变化及意义。[方法]老年股骨粗隆间骨折163例,给予PFNA治疗,采用Harris髋关节功能评分评定临床效果。术前术后检测Ⅰ型前胶原氨基端前肽(procollagen typeⅠN-terminal propetide, PINP)、Ⅰ型胶原羧基端交联肽(C-terminal telopeptides of type I collagen, CTX)、骨钙素(osteocalcin, OC)、血清白细胞介素6 (interleukin 6, IL-6)和肿瘤坏死因子α(tumor necrosis factorα, TNF-α)。采用单因素和多因素逻辑回归分析探索影响预后的因素。[结果]根据术后12个月Harris髋关节功能评分将患者分为两组:欠佳组28例,优良组135例。欠佳组的术前和术后PINP以及IL-6均高于优良组(P<0.05)。逻辑回归分析结果表明,术后引流量(OR=1.209, P=0.04)、术前PINP (OR=5.300, P=0.026)和术后IL-6 (OR=1.679, P=0.039)是老年粗隆间骨折术后髋关节功能恢复不良的独立危险因素。[结论]术前PINP和术后IL-6水平高预示老年粗隆间骨折PFNA术后髋关节功能不良。[Objective] To explore the significance of serum markers of bone metabolism and inflammation perioperatively for predicting prognosis of femoral intertrochanteric fractures fixed with proximal femoral nail anti-rotation(PFNA) in the elderly. [Method] A total of 163 elderly patients underwent closed reduction and internal fixation with PFNA for femoral intertrochanteric fractures, and the clinical outcomes were evaluated by Harris hip function score. The serum levels of procollagen type Ⅰ N-terminal propetide(PINP), C-terminal telopeptides of type I collagen(CTX), (osteocalcin OC), interleukin 6(IL-6) and tumor necrosis factor α(TNF-α) were assayed perioperatively. Univariate analysis and multiple logistic regression analysis were conducted to explore factors affecting prognosis. [Results] According to Harris hip function score at 12 months after operation, patients were divided into two groups: 28 cases in poor group and 135 cases in good group. The poor group had significantly higher levels of the preoperative and postoperative PINP and IL-6 than the good group(P<0.05). As results of logistic regression analysis, the more postoperative drainage(OR=1.209, P=0.04), higher preoperative PINP(OR=5.300, P=0.026) and postoperative IL-6(OR=1.679, P=0.039) were independent risk factors for poor hip function recovery after PFNA fixation of the femoral intertrochanteric fractures in elderly. [Conclusion] High preoperative PINP and high postoperative IL-6 levels might predict poor hip function recovery after internal fixation with PFNA for femoral intertrochanteric fractures in the elderly.

关 键 词：老年 股骨粗隆间骨折 股骨近端防旋髓内钉 骨代谢 炎症因子 HARRIS评分 

分 类 号：R683.42[医药卫生—骨科学]