胫骨骨折术后血清相关指标与骨折愈合的关系  

The Relationship between Serum Related Indexes and Fracture Healing after Tibial Fracture Surgery

作　　者：钱钧 王浩宇 方智敏 QIAN Jun;WANG Haoyu;FANG Zhimin(Department of Orthopedics,Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People's Hospital),Quzhou 324000,Zhejiang China.)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)骨科,浙江衢州324000

出　　处：《中国中医骨伤科杂志》2022年第5期23-27,33,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：衢州市科技局指导性项目(2019ASA90155)。

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1d、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1d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1d,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1d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。Objective:To investigate the relationship between the serum levels of collagen type I carboxy-terminal peptideβspecial 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 90patients with tibial fractures admitted from January 2019to January 2021were retrospectively analyzed,and they were divided into delayed union group(31 cases)and normal union group(59cases)according to postoperative fracture healing.The serumβ-CTX,sCD44and FGF-2levels were compared between the two groups at 1d,1week and 4weeks 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 serumβ-CTX,sCD44 and FGF-2levels on tibial fracture healing.Results:The levels of serumβ-CTX,sCD44and FGF-2in the two groups were shown a significant increase trend(P<0.05).There was no difference in serum levels ofβ-CTX,sCD44,and FGF-2between the two groups on the first day after surgery(P>0.05);the levels of serumβ-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 ofβ-CTX,sCD44and FGF-2in the two groups were higher than those in the 1 d and 1week after the operation.The serumβ-CTX levels in the delayed healing group was lower than the normal healing group,while the serum sCD44and FGF-2levels were higher than the normal healing group(P<0.05).Multivariate Logistic regression analysis were shown that postoperativeβ-CTX and FGF-2levels were independent protective factors for tibial fracture healing,and sCD44levels were independent risk factors for tibial fracture healing(P<0.05).The ROC curve was shown thatβ-CTX,sCD44and FGF-2had certain predictive value for tibial fracture healing(AUC=0.746,0.785,0.701,P<

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 

分 类 号：R683.42[医药卫生—骨科学]