摘要
目的探讨胫骨骨折髓内钉固定患者围术期血清Ⅰ型胶原氨基端末肽(NTX)、碱性磷酸酶(ALP)、人胰岛素生长因子-1(IGF-1)的变化对术后骨不连的预测价值。方法湖北省随州市中心医院(湖北医药学院附属随州医院)2015年1月-2017年1月收治71例胫骨骨折患者,其中男性38例,女性33例;年龄21~65岁,平均37.8岁。均采用髓内钉固定治疗。分析患者术前、术后1、4周的血清NTX、ALP、IGF-1水平,记录2015年1月-2018年1月患者骨不连发生情况,并比较有骨不连患者与无骨不连患者围手术期血清NTX、ALP、IGF-1水平,用受试者工作绘制特征(ROC)曲线分析各指标对术后骨不连的预测价值。结果71例患者术后1、4周血清NTX、ALP及IGF-1水平均高于术前,差异有统计学意义(P<0.05),术后1年内骨不连发生率为21.13%(15/71)。术前,术后1、4周有骨不连的患者血清NTX、ALP及IGF-1水平均低于无骨不连者(P<0.05)。ROC曲线显示,胫骨骨折髓内钉患者术前,术后1、4周血清NTX、ALP及IGF-1水平对术后骨不连均有一定预测价值,其中术后4周血清NTX、ALP及IGF-1联合曲线下面积高于术后1周及术前(P<0.05)。结论胫骨骨折髓内钉固定患者围术期血清NTX、ALP及IGF-1对术后骨不连有一定预测价值,可能为早期评估术后骨不连的参考指标,进一步指导临床治疗。
Objective To investigate the predictive value of changes of perioperative serum type I collagen amino N-telopeptide peptide(NTX),alkaline phosphatase(ALP)and human insulin growth factor-1(IGF-1)in patients with tibiofibular fractures treated by intramedullary nailing.Methods Totally 71 patients(38 males and 33 females aged 21-65 years)with tibiofibular fractures who were admitted to Suizhou Central Hospital of Hubei Province(Suizhou Hospital Affiliated to Hubei Medical College)from Jan.2015 to Jan.2017 and treated with intramedullary nailing were selected.The serum levels of NTX,ALP and IGF-1 before operation,and at 1 week and 4 weeks after operation were analyzed.The occurrence of nonunion in patients from Jan.2015 to Jan.2018 was recorded.The perioperative levels of serum NTX,ALP,and IGF-1 were compared between patients with nonunion and without nonunion.The predictive value of each index for postoperative nonunion was analyzed by the receiver’s work drawing characteristic(ROC)curve.Results The levels of serum NTX,ALP and IGF-1 in patients with tibial fractures at 1 week and 4 weeks after operation were higher than those before operation(P<0.05).The incidence of nonunion in patients with intramedullary nailing of 71 patients with tibiofibular fracture was 21.13%(15/71).The serum levels of NTX,ALP and IGF-1 in patients with nonunion before operation,at 1 week and 4 weeks after operation were lower than those without bone nonunion(P<0.05).The ROC curve showed that serum NTX,ALP and IGF-1 levels in patients with intramedullary nails for tibiofibular fractures had predictive value for postoperative nonunion after surgery.The area under the NTX,ALP and IGF-1 combined curve at 4 weeks after operation was higher than those before operation and at 1 week after surgery(P<0.05).Conclusion Perioperative serum NTX,ALP and IGF-1 in patients with humeral fracture treated by intramedullary nailing have certain predictive value for postoperative nonunion.It may be a reference index for early evaluation of postoperative nonun
作者
邓磊
张睿
黄朋
吕朝阳
DENG Lei;ZHANG Rui;HUANG Peng;LV Zhao-yang(Suizhou Affiliated Hospital of Hubei University of Medicine/Suizhou Central Hospital of Hubei Province,Suizhou,Hubei 441300,China)
出处
《创伤外科杂志》
2019年第9期654-658,共5页
Journal of Traumatic Surgery
关键词
胫骨骨折
骨不连
髓内钉
围手术期
血清
标志物
tibiofibular fracture
nonunion
intramedullary nail
perioperative period
serum
marker
