骨质疏松性椎体压缩性骨折患者血清BMP-2,Runx2水平对术后骨折延迟愈合的预测价值  

Predictive value of serum bone morphogenetic protein-2(BMP-2)and runt-related transcription factor 2(Runx2)levels in patients with osteoporotic vertebral compression fractures(OVCF)for delayed healing after surgery

作　　者：王金龙 冯大军 周全 WANG Jinlong;FENG Dajun;ZHOU Quan(Department of Orthopedics,Affiliated Huaian Hospital of Xuzhou Medical University,Huai'an Jiangsu 223002,China;Department of Orthopedics,Hongze District People's Hospital,Huai'an City,Huai'an Jiangsu 223100,China)

机构地区：[1]徐州医科大学附属淮安医院骨科,江苏淮安223002 [2]淮安市洪泽区人民医院骨科,江苏淮安223100

出　　处：《新疆医科大学学报》2024年第6期836-842,共7页Journal of Xinjiang Medical University

基　　金：江苏省自然科学基金面上项目(BK20201153)。

摘　　要：目的探讨骨质疏松性椎体压缩性骨折(Osteoporotic vertebral compressibility fracture,OVCF)患者血清骨形态发生蛋白-2(Bone morphogenetic protein-2,BMP-2)、核心结合因子2(Runt-related transcription factor 2,Runx2)水平对术后骨折延迟愈合的预测价值。方法选取2020年1月-2023年4月徐州医科大学附属淮安医院骨科收治的260例OVCF患者为研究对象,均采用经皮椎体成形术(Percutaneous vertebroplasty,PVP)或椎体后凸成形术(Percutanous kyphoplasty,PKP)治疗,根据术后3个月骨折愈合情况分延迟愈合组、正常愈合组。分析OVCF患者术后骨折延迟愈合的影响因素及血清BMP-2,Runx2水平对术后骨折延迟愈合的预测价值。绘制决策曲线和临床影响曲线,评价血清BMP-2,Runx2水平对术后骨折延迟愈合的价值。结果260例患者术后无失访,22例出现骨折延迟愈合,发生率为8.46%(22/260)。延迟愈合组年龄、吸烟比率、合并糖尿病比率、合并甲状腺疾病比率、有椎体裂隙征比率大于正常愈合组,骨密度T值、术前和术后3个月血清BMP-2,Runx2水平小于正常愈合组,差异有统计学意义(P<0.05)。合并糖尿病、有椎体裂隙征是OVCF患者术后骨折延迟愈合的独立危险因素,骨密度T值、BMP-2,Runx2是OVCF患者术后骨折延迟愈合的独立保护因素(P<0.05)。BMP-2,Runx2联合预测OVCF患者术后骨折延迟愈合对应AUC值为0.856。阈值在0.10~0.63范围内,BMP-2,Runx2联合评估模型评估OVCF患者术后骨折延迟愈合的净受益率优于单独检测。在阈值概率为0.26时,被该模型划分入高风险的人数与真阳性人数基本达成一致。结论OVCF患者血清BMP-2,Runx2水平降低,二者联合检测对术后骨折延迟愈合具有较高的预测效能。Objective To investigate the predictive value of serum bone morphogenetic protein-2(BMP-2)and runt-related transcription factor 2(Runx2)levels in patients with osteoporotic vertebral compressibility fracture(OVCF)for delayed healing after surgery.Methods A total of 260 OVCF patients admitted to the hospital from January 2020 to April 2023 were selected as the research subjects.All patients were trea-ted with percutaneous vertebroplasty(PVP)or percutaneouskyphoplasty(PKP),and the patients were di-vided into a delayed healing group and a normal healing group based on the status of fracture healing at 3 months postoperatively.The influencing factors of delayed fracture healing in OVCF patients and the pre-dictive value of serum BMP-2 and Runx2 levels for delayed fracture healing were analyzed.Decision curves and clinical impact curves were plotted to evaluate the value of serum BMP-2 and Runx2 levels in predic-ting delayed fracture healing postoperatively.Results Among the 260 patients in the study group,there were no lost follow-ups.Delayed fracture healing occurred in 22 patients,with an incidence rate of 8.46%(22/260).The delayed healing group had a higher proportion of patients with older age,smoking,diabe-tes,thyroid disease and vertebral cleft sign than the normal healing group.Additionally,the bone mineral density T-score,preoperative and 3-month postoperative serum BMP-2 and Runx2 levels were lower in the delayed healing group compared to the normal healing group(P<0.05).Having diabetes and the presence of vertebral cleft sign were independent risk factors for delayed fracture healing in OVCF patients postop-eratively,while bone mineral density T-score,BMP-2 and Runx2 were independent protective factors for delayed fracture healing in OVCF patients postoperatively(P<0.05).The AUC value of BMP-2 and Runx2 combined in predicting delayed fracture healing in OVCF patients postoperatively was 0.856.With-in the threshold range of 0.10 to 0.63,the net benefit rate of the combined assessment model of BMP-2 and Runx2

关 键 词：骨质疏松性椎体压缩性骨折 骨形态发生蛋白-2 核心结合因子2 术后骨折延迟愈合 

分 类 号：R684[医药卫生—骨科学]