股骨颈骨折患者内固定术后血清25(OH)D_(3)、骨代谢水平对骨折愈合情况的预测价值分析

Analysis of the predictive value of serum 25(OH)D_(3) and bone metabolism on fracture healing after internal fixation in patients with femoral neck fractures

目的探讨股骨颈骨折患者内固定术后血清25羟维生素D_(3)[25(OH)D_(3)]、骨代谢水平与骨折不愈合或畸形愈合的关系及预测价值分析。方法选取我院2020年1月至2022年2月于我院行内固定术治疗的173例(共纳入185例,其中173例完成随访)股骨颈骨折患者为研究对象,术后随访12个月,根据骨折愈合情况分为骨折愈合组(141例)、骨折不愈合或畸形愈合组(32例)。比较两组临床资料及术后1周血清25(OH)D_(3)、骨代谢指标[骨保护素(OPG)、骨钙素(BGP)、碱性磷酸酶(ALP)],分析血清25(OH)D_(3)水平与骨代谢指标的相关性,Logistic回归分析股骨颈骨折内固定术患者骨折不愈合或畸形愈合的影响因素,受试者工作特征曲线(ROC)分析血清25(OH)D_(3)、骨代谢指标水平联合检测对股骨颈骨折内固定术患者骨折不愈合或畸形愈合的预测价值。结果两组间移位、骨折复位质量比较差异有统计学意义(P<0.05);骨折不愈合或畸形愈合组术后1周血清25(OH)D_(3)、OPG、BGP、ALP水平低于骨折愈合组(P<0.05);术后1周血清25(OH)D_(3)水平与OPG、BGP、ALP水平呈正相关(P<0.05);Logistic回归分析发现,移位是股骨颈骨折内固定术患者骨折不愈合或畸形愈合的危险因素,骨折复位质量(解剖复位)、术后1周血清25(OH)D_(3)水平(≥30 ng/mL)、OPG(>325.42 pg/mL)、BGP(>27.26μg/L)、ALP(>229.18 U/L)水平为保护因素(P<0.05);ROC分析结果显示,术后1周血清25(OH)D_(3)水平、OPG、BGP、ALP水平联合预测股骨颈骨折患者内固定术后骨折不愈合或畸形愈合的曲线下面积(AUC)为0.916,最佳预测敏感度、特异度分别为87.50%、85.11%。结论股骨颈骨折内固定术患者术后血清25(OH)D_(3)水平与OPG、BGP、ALP水平显著相关,联合检测在预测股骨颈骨折患者内固定术后骨折不愈合或畸形愈合风险方面具有较高效能。

Objective To investigate the relationship and predictive value of serum 25-hydroxy vitamin D_(3)[25(OH)D_(3)],bone metabolism levels,and non-union or malunion of femoral neck fractures in patients undergoing internal fixation surgery.Methods A total of 173 patients with femoral neck fractures who underwent internal fixation surgery in our hospital from January 2020 to February 2022(a total of 185 cases were included,of which 173 completed follow-up)were selected as the research subjects.All patients were followed up for 12 months after surgery and were divided into a fracture healing group(141 cases)and a non-union or malunion of fracture group(32 cases)based on the fracture healing status.Compare the clinical data and serum 25(OH)D_(3) levels or bone metabolism indicators one week after surgery of the two groups,and analyze the correlation between serum 25(OH)D_(3) levels and bone metabolism indicators,logistic regression analysis of the influencing factors of non-union or malunion of femoral neck fractures in patients undergoing internal fixation surgery,and the predictive value of combined detection of serum 25(OH)D_(3) and bone metabolism index levels in patients with femoral neck fractures undergoing internal fixation surgery for non-union or malunion of fractures using the receiver operating characteristic curve(ROC)analysis.Results There was a statistically significant difference in the quality of displacement and fracture reduction between the two groups(P<0.05);the serum levels of 25(OH)D_(3),OPG,BGP,and ALP in the non-union or malunion of fractures group were lower than those in the union group one week after surgery(P<0.05);the serum 25(OH)D_(3) levels were positively correlated with OPG,BGP,and ALP levels one week after surgery(P<0.05);logistic regression analysis found that displacement was a risk factor for non-union or malunion of femoral neck fractures in patients undergoing internal fixation surgery,while the quality of fracture reduction(anatomical reduction),serum 25(OH)D_(3) levels(≥30 ng/mL),OPG(>325.42 pg/mL),BGP(>27.26μg/L),and ALP(>229.18 U/L)were protective factors(P<0.05);the ROC analysis results showed that the combined prediction of serum 25(OH)D_(3) levels,OPG,BGP,and ALP levels at 1 week after surgery for non-union or malunion of femoral neck fractures in patients with internal fixation surgery had an area under the curve(AUC)of 0.916,the best predictive sensitivity and specificity were 87.50%and 85.11%,respectively.Conclusion The serum 25(OH)D_(3) levels in patients undergoing internal fixation for femoral neck fractures are significantly correlated with OPG,BGP,and ALP levels.Combined detection has high efficacy in predicting the risk of non-union or malunion of fractures in patients undergoing internal fixation for femoral neck fractures.