骨质疏松性胸腰椎骨折患者维生素D与血清骨转换指标及愈合延迟的相关性

Correlation of vitamin D with serum bone turnover markers and healing delay in patients with osteoporotic thoracolumbar vertebral fractures

目的探讨骨质疏松性胸腰椎骨折患者维生素D与血清骨转换指标及愈合延迟的相关性。方法2021年1月至2023年12月期间,募集120例在杭州市富阳中医骨伤医院接受经皮椎体成形术(percutaneousvertebroplasty,PVP)治疗的骨质疏松性胸腰椎骨折患者进行研究。将患者按照随机数字表法分为对照组和观察组,对照组患者在PVP手术后不接受任何维生素D3的补充,观察组患者在PVP手术后口服维生素D3滴剂。对比两组患者维生素D、血清骨转换指标、骨密度水平的变化,两组患者骨折愈合情况,分析患者维生素D水平与血清骨转换指标及骨折愈合延迟的相关性。结果术后观察组患者25(OH)D水平(18.79±1.68 vs.16.38±1.27)、Ⅰ型前胶原氨基端延长肽(typeⅠprocollagenamino-terminal peptide,PINP)/β胶原降解产物(β-C-terminal telopeptide of type I collagen,β-CTX)水平(97.67±13.30 vs.76.09±11.82)高于对照组(均P<0.05)。术后观察组患者甲状旁腺激素(parathyroid parathyroid hormone,PTH)水平(49.12±6.22 vs.54.69±7.51)、PINP水平(28.12±3.17 vs.36.33±4.84)、β-CTX水平(0.29±0.02 vs.0.48±0.03)显著低于对照组(均P<0.05)。术后观察组患者L1-4(0.91±0.07 vs.0.84±0.06)、左侧股骨颈骨密度(0.83±0.06 vs.0.72±0.05)高于对照组(均P<0.05)。术后观察组维生素D水平(59.63±2.67 vs.16.14±3.18)高于对照组(P<0.05)。观察组患者Lane-Sandhu评分(11.20±1.85 vs.6.52±2.14)高于对照组(P<0.05)。观察组患者临床愈合时间(3.52±1.07 vs.9.86±2.15)和骨性愈合时间(6.84±1.21 vs.12.04±1.47)短于对照组(均P<0.05)。观察组愈合延迟患者比例(26.7%vs.10.0%)少于对照组(P<0.05)。患者维生素D水平与25(OH)D、PINP/β-CTX水平呈正相关,与PTH、PINP、β-CTX水平呈负相关。患者维生素D水平与临床愈合时间、骨性愈合时间呈负相关(均P<0.05)。正常愈合的患者维生素D水平(40.22±21.90 vs.29.67±20.51)高于愈合延迟患者(P<0.05)。结论在PVP术后骨质疏松性胸腰椎骨折患者应多摄入维生素D,提高血液中25(OH)D的水平,促进骨折的快速愈合,从而改善患者的康复情况。

Objective To investigate the correlation of vitamin D with serum bone turnover markers and healing delay in patients with osteoporotic thoracolumbar vertebral fractures.Methods From Jan.2021 to Dec.2023,120 patients treated with percutaneous vertebroplasty(PVP)for osteoporotic thoracolumbar vertebral fractures at our hospital were recruited for the study.The patients were randomly divided into a control group and an observation group.The patients in the control group did not receive any supplementation of vitamin D3 after PVP,while the patients in the observation group received oral vitamin D3 drops after PVP.The changes in vitamin D,serum bone turnover markers,and bone density levels were compared between the two groups,as well as the fracture healing status.The correlation between patients’vitamin D levels and serum bone turnover markers and delayed fracture healing was analyzed.Results After surgery,the observation group patients showed higher levels of 25(OH)D(18.79±1.68 vs.16.38±1.27)and typeⅠprocollagenamino-terminal peptide(PINP)/β-CTX(97.67±13.30 vs.76.09±11.82)compared to the control group(all P<0.05).After the surgery,the observation group's patients had significantly lower levels of PTH(49.12±6.22 vs.54.69±7.51),PINP(28.12±3.17 vs.36.33±4.84)andβ-CTX(0.29±0.02 vs.0.48±0.03)compared to the control group(all P<0.05).The observation group's L1-4(0.91±0.07 vs.0.84±0.06)and left femoral neck bone density(0.83±0.06 vs.0.72±0.05)were higher than the control group(all P<0.05).The observation group’s vitamin D level(59.63±2.67 vs.16.14±3.18)was higher than the control group(P<0.05).The Lane-Sandhu scores of the patients in the observation group(11.20±1.85 vs.6.52±2.14)were higher than those in the control group(P<0.05).The clinical healing time(3.52±1.07 vs.9.86±2.15)and bone healing time(6.84±1.21 vs.12.04±1.47)of the patients in the observation group were shorter than those in the control group(all P<0.05).The proportion of patients with delayed healing in the observation group(26.7%vs.10.0%)was lower than that in the control group(P<0.05).The level of vitamin D in patients was positively correlated with levels of 25(OH)D,PINP/β-CTX,and negatively correlated with levels of PTH,PINP,β-CTX.The level of vitamin D in patients was negatively correlated with clinical healing time and bone healing time(all P<0.05).The vitamin D level of patients with normal healing(40.22±21.90 vs.29.67±20.51)was higher than that of patients with delayed healing(P<0.05).Conclusion After PVP surgery,patients with osteoporotic thoracolumbar vertebral fractures should intake more vitamin D to raise the level of 25(OH)D in the blood,promoting rapid healing of the fractures and improving the patient’s recovery.