术前尿钙排泄量对骨质疏松性椎体压缩性骨折患者术后骨折延迟愈合的影响

Effect of preoperative urinary calcium excretion on delayed fracture healing in patients with osteoporotic vertebral compression fracture

目的:探讨术前尿钙排泄量对骨质疏松性椎体压缩性骨折(OVCF)患者术后骨折延迟愈合的影响。方法:前瞻性选择2022年8月至2023年5月收治的OVCF患者作为研究对象,所有患者拟行经皮椎体成形术。术前测定24 h尿钙水平,计算24 h尿钙排泄量,术后随访3个月,根据骨折愈合情况将患者分为延迟组与非延迟组。比较两组患者基线资料、骨密度T值和术前24 h尿钙、24 h尿钙排泄量,采用Pearson相关性检验分析术前24 h尿钙、24 h尿钙排泄量与骨密度T值的相关性,采用logistic回归分析检验骨密度T值和术前24 h尿钙、24 h尿钙排泄量对术后骨折延迟愈合的影响,绘制受试者操作特征(ROC)曲线分析术前24 h尿钙、24 h尿钙排泄量对术后骨折延迟愈合的预测价值。结果:共纳入185例OVCF患者作为研究对象,男31例,女154例;年龄57~73岁,平均(65.2±3.6)岁;术后均随访3个月,185例患者中发生骨折延迟愈合的32例作为延迟组,延迟愈合率为17.3%。延迟组患者骨密度T值低于非延迟组,术前24 h尿钙、24 h尿钙排泄量高于非延迟组,差异有统计学意义(P<0.05)。经Pearson相关性检验发现,术前24 h尿钙、24 h尿钙排泄量均与OVCF患者骨密度T值呈负相关(r=-0.230,P=0.025;r=-0.178,P=0.015)。经logistic回归分析发现,术前24 h尿钙>7.920(mmol/L·24 h),术前24 h尿钙排泄量>3.220(mg/kg·24 h)是OVCF患者术后骨折延迟愈合的危险因素(OR=1.824,P<0.001;OR=4.093,P<0.001);骨密度T值>-2.7是OVCF患者术后骨折延迟愈合的保护因素(OR=0.180,P=0.040)。ROC曲线显示,术前24 h尿钙、24 h尿钙排泄量对OVCF患者术后骨折延迟愈合具有一定的预测价值[曲线下面积(AUC)=0.719、0.768]。结论:OVCF患者术后骨折延迟愈合可能受术前尿钙排泄量影响,重视患者术前尿钙排泄量对减少OVCF患者术后骨折延迟愈合具有积极意义。

Objective:To explore the effect of preoperative urinary calcium excretion on delayed fracture healing in patients with osteoporotic vertebral compression fracture(OVCF).Methods:The OVCF patients admitted to the hospital from August 2022 to May 2023 were prospectively selected,and all patients planned to undergo percutaneous vertebroplasty.The 24 h urinary calcium was measured before operation and 24 h urinary calcium excretion was calculated.The patients were followed up for 3 months after operation and divided into delayed group and non-delayed group according to the fracture healing.The baseline data,bone mineral density T value,24 h urinary calcium and 24 h urinary calcium excretion of the two groups were compared.Pearson correlation test was used to analyze the correlation between 24 h urinary calcium,24 h urinary calcium excretion and bone mineral density T value.logistic regression analysis was used to examine the effects of bone mineral density T value,24 h urine calcium and 24 h urine calcium excretion on delayed fracture healing after operation.The receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of 24 h urinary calcium before operation and 24 h urinary calcium excretion on delayed fracture healing after operation.Results:Totally 185 OVCF patients were included as the study subjects,including 31 males and 154 females,with the mean a ge of(65.2±3.6)years(range,57-73 years).After 3 months of follow-up,there were 32 cases of delayed union in 185 patients,and the delayed union rate was 17.3%.The bone mineral density T value of the patients in the delayed group was lower than that in the non delayed group,and the preoperative 24 h urinary calcium and the urinary calcium excretion 24 hours before operation was higher than that in the non-delayed group,with a statistical significant difference(P<0.05).Pearson correlation test showed that 24 h urinary calcium and 24 h urinary calcium excretion were all negatively correlated with bone mineral density T value of OVCF patients(r=-0.230,P=0.025;r=-0.178,P=0.015).Logistic regression analysis showed that preoperative 24 h urinary calcium 7.920 mmol/L·24 h and 24 h urinary calcium excretion 3.220 mg/kg·24 h were risk factors for delayed fracture healing in OVCF patients(OR=1.824,P<0.001;OR=4.093,P<0.001).Bone mineral density T value-2.7 was a protective factor for delayed fracture healing in OVCF patients(OR=0.180,P=0.040).ROC curve showed that 24 h urinary calcium and 24 h urinary calcium excretion have certain predictive value on the delayed fracture healing of OVCF patients(area under curve=0.719,0.768).Conclusions:Postoperative delayed fracture healing in OVCF patients may be affected by preoperative urinary calcium excretion,and paying attention to preoperative urinary calcium excretion has positive significance in reducing the delayed fracture healing in OVCF patients.