CD62P、CD63及脂代谢指标与股骨颈骨折术后ANFH的相关性及其危险因素分析

Correlations between CD62P,CD63,lipid metabolism indexes and ANFH after femoral neck fracture operation and ANFH-related risk factors

目的分析血小板活动指标血小板表面P-选择素(CD62P)、溶酶体颗粒糖蛋白(CD63)、脂代谢异常与股骨颈骨折术后股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的相关性,并探讨术后ANFH的危险因素。方法对2015年2月至2019年4月我院收治的302例股骨颈骨折患者的临床资料进行回顾性分析,其中男155例、女147例。年龄51~89岁,平均(65.82±8.15)岁,骨折至手术时间42h^10天,平均(5.20±1.00)天。致伤原因:交通事故52例、意外摔倒211例、其它39例;Garden分型:Ⅰ型41例、Ⅱ型204例、Ⅲ型45例、Ⅳ型12例;复位方式:切开复位202例、闭合复位100例;固定方式:空心螺钉加压内固定203例、钢板内固定99例。统计ANFH的发生率,并分析术后CD62P、CD63、脂代谢异常与ANFH的关系及其危险因素。结果 ANFH发生率为12.58%;ANFH发生者术后CD62P、CD63水平均低于未发生者(P=0.000、0.000),而TC、LDLC水平均高于未发生者(P=0.000、0.000);年龄>80岁、骨折移位、GardenⅢ/Ⅳ型、骨折至手术时间>7天、术前牵引、术后CD62P、CD63偏低、术后TC、LDLC偏高、内固定物未取出均为ANFH发生的独立危险因素。结论股骨颈骨折术后有ANFH发生风险,且ANFH发生者术后CD62P、CD63水平偏低,TC、LDLC水平偏高,患者年龄>80岁、骨折移位等均可增加ANFH的发生风险。

Objective To analyze the correlations between the platelet surface P-selectin (CD62P),lysosomal granule glycoprotein (CD63),abnormal lipid metabolism and ANFH after femoral neck fracture operation,and to explore the risk factors of ANFH.Methods Clinical data of 302 cases after femoral neck fracture were analyzed retrospectively from February 2015 to April 2019,including 155 males and 147 females with an average age of (65.82±8.15) years.The mean time from fracture to operation was (5.20±1.00) days (range:42 h-10 d).Injury types:traffic accident 52 cases;accidental fall 211 cases;other 39 cases.Garden classification:41 cases were of type Ⅰ;204 cases of type Ⅱ;45 cases of type Ⅲ;12 cases of type Ⅳ.Reduction:open reduction in 202 cases;closed reduction in 100 cases.Fixation:203 cases were treated with cannulated screw;99 cases were treated with steel plates.The incidence of ANFH was evaluated.Clinical relations between CD62P,CD63,abnormal lipid metabolism and ANFH were analyzed,and the risk factors were investigated.Results The incidence of ANFH was 12.58%.Levels of CD62P and CD63 in patients with ANFH were lower than those without ANFH (P=0.000,0.000),while the levels of TC and LDLC were higher than those without ANFH (P=0.000,0.000).The age > 80 years,fracture displacement,Garden Ⅲ / Ⅳ,fracture to operation>7 d,preoperative traction,low postoperative CD62P,low postoperative CD63,high postoperative TC,high postoperative LDLC,internal fixation were independent risk factors of ANFH.Conclusions ANFH may occur after femoral neck fracture operation.Low levels of CD62P and CD63,high levels of TC and LDLC,and the age > 80 years will increase the risk of ANFH.