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[1]金華,顏夏衛(wèi).血清25-羥基維生素D與胰島素樣生長因子-1水平對橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后的影響[J].中醫(yī)正骨,2023,35(08):14-19,36.
　JIN Hua,YAN Xiawei.Effects of serum levels of 25-hydroxy vitamin D and insulin-like growth factor-1 on prognosis after internal fixation for distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(08):14-19,36.
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血清25-羥基維生素D與胰島素樣生長因子-1水平對橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年08期
頁碼:
14-19,36
欄目:
臨床研究
出版日期:
2023-08-20

文章信息/Info

Title:
Effects of serum levels of 25-hydroxy vitamin D and insulin-like growth factor-1 on prognosis after internal fixation for distal radius fractures
作者:
金華; 顏夏衛(wèi)
臺州骨傷醫(yī)院,浙江 溫嶺 317500
Author(s):
JIN Hua; YAN Xiawei
Taizhou Orthopedics Hospital,Wenling 317500,Zhejiang,China
關(guān)鍵詞:
橈骨骨折;  腕損傷;  骨折固定術(shù); 內(nèi);  預(yù)后;  羥基膽骨化醇類;  胰島素樣生長因子-Ⅰ
Keywords:
radius fractures;  wrist injuries;  fracture fixation; internal;  prognosis;  hydroxycholecalciferols;  insulin-like growth factor I
摘要:
目的:探討血清25-羥基維生素D[25-hydroxy vitamin D,25(OH)D]、胰島素樣生長因子-1(insulin-like growth factor-1,IGF-1)水平對橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后的影響。方法:以2020年1月至2022年6月在臺州骨傷醫(yī)院接受同一組醫(yī)生完成的切開復(fù)位鋼板螺釘內(nèi)固定手術(shù)治療的橈骨遠(yuǎn)端骨折患者為研究對象。收集患者的年齡、性別、致傷原因、骨折AO分型、受傷至手術(shù)時間、手術(shù)入路、術(shù)中復(fù)位情況、術(shù)后開始鍛煉時間、優(yōu)勢手及合并同側(cè)其他骨折等一般資料。隨訪觀察患側(cè)腕關(guān)節(jié)情況,依據(jù)Gartland和Werley腕關(guān)節(jié)評分標(biāo)準(zhǔn)對患側(cè)腕關(guān)節(jié)進(jìn)行評分,≤8分為預(yù)后良好,≥9分為預(yù)后不良。分別于術(shù)前、術(shù)后1周、術(shù)后4周、術(shù)后6周時,采用電化學(xué)發(fā)光法檢測血清25(OH)D水平,采用ELISA法檢測血清IGF-1水平。根據(jù)術(shù)后6個月時患側(cè)腕關(guān)節(jié)情況將納入病例分為預(yù)后良好組和預(yù)后不良組。比較2組患者一般資料和手術(shù)前后血清25(OH)D、IGF-1水平,分析影響預(yù)后的因素,評價血清25(OH)D、IGF-1水平對預(yù)后不良的預(yù)測價值。結(jié)果:①一般結(jié)果。共納入98例患者,預(yù)后良好組68例,預(yù)后不良組30例。2組患者骨折AO分型的組間差異有統(tǒng)計學(xué)意義(χ2=11.575,P=0.003)。②血清25(OH)D、IGF-1水平檢測結(jié)果。術(shù)后第4周和術(shù)后第6周時,預(yù)后不良組血清25(OH)D、IGF-1水平均低于預(yù)后良好組[(25.47±6.06)nmol·L-1,(16.54±3.92)nmol·L-1,t=7.405,P=0.000;(36.42±7.10)nmol·L-1,(16.94±3.84)nmol·L-1,t=14.117,P=0.000;(292.36±58.64)ng·mL-1,(216.45±43.76)ng·mL-1,t=6.346,P=0.000;(402.75±66.48)ng·mL-1,(228.34±46.59)ng·mL-1,t=13.011,P=0.000]。③橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后不良的影響因素分析結(jié)果。術(shù)后第4周時血清25(OH)D、IGF-1水平是橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后不良的影響因素(β=-0.172,P=0.001,OR=0.842; β=-0.217,P=0.003,OR=0.805)。④血清25(OH)D、IGF-1水平對橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后不良的預(yù)測價值評價結(jié)果。術(shù)后第4周時血清25(OH)D、IGF-1水平分別預(yù)測及二者聯(lián)合預(yù)測橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后不良的受試者操作特征曲線下面積分別為0.812(P=0.000)、0.785(P=0.000)、0.906(P=0.000),靈敏度分別為67.6%、57.4%、83.8%,特異度分別為80.0%、93.3%、86.7%,2項指標(biāo)的臨界值分別為21.99 nmol·L-1、267.32 ng·mL-1。結(jié)論:術(shù)后第4周時血清25(OH)D、IGF-1水平對橈骨遠(yuǎn)端骨折內(nèi)固定術(shù)后預(yù)后不良有一定預(yù)測價值。
Abstract:
Objective:To explore the effects of serum levels of 25-hydroxy vitamin D(25(OH)D)and insulin-like growth factor-1(IGF-1)on prognosis of patients who underwent internal fixation for treatment of distal radius fractures.Methods:The patients who underwent open reduction and plate-screws internal fixation for treatment of distal radius fractures by the same surgeons in Taizhou Orthopedics Hospital from January 2020 to June 2022 were selected as the subjects,and their information including age,gender,cause of injury,AO fracture classification,time from injury to surgery,surgical approach,intraoperative reduction,postsurgical exercises start time,dominant hands and combined other ipsilateral fractures was collected.The patients were followed up and the affected wrist was observed.The affected wrist was scored according to the Gartland-Werley wrist scoring criteria,and the prognosis was evaluated according to the scores.The score of≤8 points was classified as favorable prognosis,while the score of≥9 points as unfavorable prognosis.The serum levels of 25(OH)D and IGF-1 were detected by using electrochemiluminescence(ECL)method and ELISA method before the surgery and at postsurgical week 1,4 and 6 respectively.According to the prognosis of affected wrist at postsurgical month 6,the included patients were divided into favorable prognosis group and unfavorable prognosis group.The general data of patients and the presurgical and postsurgical serum levels of 25(OH)D and IGF-1 were compared between the 2 groups.Moreover,the factors influencing prognosis were analyzed,and the value of the serum levels of 25(OH)D and IGF-1 in predicting unfavorable prognosis was evaluated.Results:①Ninety-eight patients were enrolled in the study,68 cases in favorable prognosis group and 30 cases in unfavorable prognosis group.There was statistical difference in AO fracture classification between the 2 groups(χ2=11.575,P=0.003).②The serum levels of 25(OH)D and IGF-1 were lower in unfavorable prognosis group compared to favorable prognosis group at postsurgical week 4 and 6(25.47±6.06 vs 16.54±3.92 nmol/L,t=7.405,P=0.000; 36.42±7.10 vs 16.94±3.84 nmol/L,t=14.117,P=0.000; 292.36±58.64 vs 216.45±43.76 ng/mL,t=6.346,P=0.000; 402.75±66.48 vs 228.34±46.59 ng/mL,t=13.011,P=0.000).③The serum levels of 25(OH)D and IGF-1 at postsurgical week 4 were the factors influencing unfavorable prognosis after internal fixation for distal radius fractures(β=-0.172,P=0.001,OR=0.842; β=-0.217,P=0.003,OR=0.805).④The applied value of serum levels of 25(OH)D and IGF-1 at postsurgical week 4 in individual prediction or unified prediction of unfavorable prognosis after internal fixation for distal radius fractures was evaluated and analyzed by using receiver operating characteristic(ROC)curve; and the results showed that the areas under the ROC curves were 0.812(P=0.000),0.785(P=0.000)and 0.906(P=0.000); the sensitivities were 67.6%,57.4% and 83.8%; and the specificities were 80.0%,93.3% and 86.7% respectively; moreover,the critical values of the two indexes were 21.99 nmol/L and 267.32 ng/mL respectively.Conclusion:The serum levels of 25(OH)D and IGF-1 at postsurgical week 4 have a certain application value in prediction of unfavorable prognosis after internal fixation for distal radius fractures.

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更新日期/Last Update: 1900-01-01