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

Effects of serum levels of 25-hydroxy vitamin D and insulin-like growth factor-1 on prognosis after internal fixation for dist al radius fractures

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(χ^(2)=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。

Objective:To explore the flects of serum levels of 25-hydroxy viamin D(25(0H)D)and insulin-like growth factor-1(IGF-1)on prognosis of patients who underwent intemal fixation for treatment of distal radius fractures.Methods:The patients who under-went open reduction and plate-screws intemal fixation for treatment of distal radius fractures by the same surgons 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 frac-ture classification,time from injury to surgery,surgical approach,intraoperative reduction,postsurgical exercises start time,dominant hands and combined other ipsilatenal fractures was ollected.The patients were followed up and the afcted wrist was observed.The alected 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 unfavonable prognosis.The serum levels of 25(0H)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 afcted wrist at postsurgical monh 6,the included patients were divided into favorable prognosis group and unfavorable prognosis group.The general data of patients and the presurgical and postsurgical senum levels of 25(0H)D and IGF-1 were compared between the 2 groups.Moreover,the factors influencing prognosis were analyzed,and the value of the serum levels of25(OH)D and IGF-1 in predicting unfavornble prognosis was evalualed.Results:①Ninety-eight patients were enrolled in the study,68 cases in favornable prognosis group and 30 cases in unfavornable prognosis group.There was statistical difference in AO fracture classification between the 2 groups(χ^(2)=11.575,P=0.003).②The serum levels of 25(0H)D and IGF-1 were lower in unfavorable prog-nosis group compared to favorable prognosis group at postsurgical week 4 and 6(25.47+6.06 vs 16.54+3.92 nmoVL,t=7.405,P=0.000;36.42+7.10 vs 16.94土3.84 nmol/L,t=14.117,P=0.000;292.36+58.64 vs216.45士43.76 ng/mL,l=6.346,P=0.000;402.75+66.48 vs 228.34+46.59 ng/mL,l=13.011,P=0.000).③The serum levels of 25(0H)D and ICF-1 at postsurgical week 4 were the factors infuencing unfavorable prognosis after intemal fixation for distal radius fmactures(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 ICF-1 at postsurgical week 4 in individual prediction or unified prediction of unfavorable prognosis afer intemal fixation for distal radius fractures was evaluated and analyzed by using receiver operating chanacteris tie(ROC)curve;and the resuls 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 specifcities 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(0H)D and ICF-1 at postsurgical week 4 have a certain application value in prediction of unfavorable prognosis after in-temal fixation for distal radius fractures.