[1]金华,颜夏卫.血清25-羟基维生素D与胰岛素样生长因子-1水平对桡骨远端骨折内固定术后预后的影响[J].中医正骨,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-羟基维生素D与胰岛素样生长因子-1水平对桡骨远端骨折内固定术后预后的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年08期
页码:
14-19,36
栏目:
临床研究
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:
金华; 颜夏卫
台州骨伤医院,浙江 温岭 317500
Author(s):
JIN Hua; YAN Xiawei
Taizhou Orthopedics Hospital,Wenling 317500,Zhejiang,China
关键词:
桡骨骨折;  腕损伤;  骨折固定术; 内;  预后;  羟基胆骨化醇类;  胰岛素样生长因子-Ⅰ
Keywords:
radius fractures;  wrist injuries;  fracture fixation; internal;  prognosis;  hydroxycholecalciferols;  insulin-like growth factor I
摘要:
目的:探讨血清25-羟基维生素D[25-hydroxy vitamin D,25(OH)D]、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平对桡骨远端骨折内固定术后预后的影响。方法:以2020年1月至2022年6月在台州骨伤医院接受同一组医生完成的切开复位钢板螺钉内固定手术治疗的桡骨远端骨折患者为研究对象。收集患者的年龄、性别、致伤原因、骨折AO分型、受伤至手术时间、手术入路、术中复位情况、术后开始锻炼时间、优势手及合并同侧其他骨折等一般资料。随访观察患侧腕关节情况,依据Gartland和Werley腕关节评分标准对患侧腕关节进行评分,≤8分为预后良好,≥9分为预后不良。分别于术前、术后1周、术后4周、术后6周时,采用电化学发光法检测血清25(OH)D水平,采用ELISA法检测血清IGF-1水平。根据术后6个月时患侧腕关节情况将纳入病例分为预后良好组和预后不良组。比较2组患者一般资料和手术前后血清25(OH)D、IGF-1水平,分析影响预后的因素,评价血清25(OH)D、IGF-1水平对预后不良的预测价值。结果:①一般结果。共纳入98例患者,预后良好组68例,预后不良组30例。2组患者骨折AO分型的组间差异有统计学意义(χ2=11.575,P=0.003)。②血清25(OH)D、IGF-1水平检测结果。术后第4周和术后第6周时,预后不良组血清25(OH)D、IGF-1水平均低于预后良好组[(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桡骨远端骨折内固定术后预后不良的影响因素分析结果。术后第4周时血清25(OH)D、IGF-1水平是桡骨远端骨折内固定术后预后不良的影响因素(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水平对桡骨远端骨折内固定术后预后不良的预测价值评价结果。术后第4周时血清25(OH)D、IGF-1水平分别预测及二者联合预测桡骨远端骨折内固定术后预后不良的受试者操作特征曲线下面积分别为0.812(P=0.000)、0.785(P=0.000)、0.906(P=0.000),灵敏度分别为67.6%、57.4%、83.8%,特异度分别为80.0%、93.3%、86.7%,2项指标的临界值分别为21.99 nmol·L-1、267.32 ng·mL-1。结论:术后第4周时血清25(OH)D、IGF-1水平对桡骨远端骨折内固定术后预后不良有一定预测价值。
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