CT定量参数在四肢骨折延迟愈合中表达及预测价值

Expression and Predictive Value of CT Quantitative Parameters in Delayed Healing of Limbs Fractures

目的探讨CT定量参数在四肢骨折延迟愈合中表达及诊断价值。方法前瞻性选取我院收治的300例四肢骨折患者(2020年5月至2023年5月),统计术后16周骨折延迟愈合情况,并根据骨折延迟愈合情况分组,比较2组CT定量参数、细胞间隙连接蛋白43(Cx43)、骨形成蛋白2(BMP-2),Pearson相关系数分析两者间相关性,绘制受试者工作特征曲线(ROC)及曲线下面积(AUC)分析预测效能。结果(1)术后16周,300例四肢骨折患者共8例失访,42例延迟愈合,发生率为14.38%;(2)术后2周、6周、8周,延迟组BMD、BSICSA、BSICSMI及血清Cx43、BMP-2表达均低于正常组(P<0.05);(3)Pearson相关系数显示,术后8周,四肢骨折延迟愈合患者BMD、BSICSA、BSICSMI与BMP-2、Cx43呈显著正相关(P<0.05);(4)术后2周、6周、8周,BSICSA+BSICSMI+BMD预测四肢骨折延迟愈合效能(AUC:0.914、0.926、0.937)近似于BMP+Cx43(AUC:0.898、0.916、0.925),其中术后8周三者联合预测效能最大。结论CT定量参数(BSICSA、BMD、BSICSMI)在四肢骨折延迟愈合患者中呈低表达,三者联合预测效能高,有助于临床医师制定个性化防治措施,减少四肢骨折延迟愈合风险。

Objective To investigate the expression and diagnostic value of CT quantitative parameters in delayed healing of limbs fractures.Methods A total of 300 patients with limb fracture admitted to Our hospital May(2020 to May 2023)were prospectively selected to statistically analyze the delayed healing of fractures 16 weeks after surgery,and grouped according to the delayed healing of fractures.The quantitative parameters of CT,gap connexin 43(Cx43)and bone morphogenetic protein 2(BMP-2)of the two groups were compared.Pearson correlation coefficient was used to analyze the correlation between the two,and the predictive efficiency of receiver operating characteristic curve(ROC)and area under curve(AUC)analysis was plotted.Results(1)At 16 weeks after operation,8 cases of 300 patients with limb fracture were lost to follow-up,42 cases were delayed healing(14.38%).(2)The expression of BMD,BSICSA,BSICSMI and serum Cx43 and BMP-2 in delayed group were lower than those in normal group at 2,6 and 8 weeks after surgery(P<0.05);(3)Pearson correlation coefficient showed that BMD,BSICSA and BSICSMI were significantly positively correlated with BMP-2 and Cx43 in patients with delayed limb fracture healing at 8 weeks after surgery(P<0.05).At 2,6 and 8 weeks after surgery,BSICSA+BSICSMI+BMD predicted delayed healing of limb fractures(AUC:0.914,0.926,0.937),which was similar to BMP+Cx43(AUC:0.898,0.916,0.925),and the combined prediction of BSICSA+BSICSMI+BMD was the most effective at 8 weeks after surgery.Conclusion Quantitative CT parameters(BSICSA,BMD,BSICSMI)are low expression in patients with delayed union of limbs fractures,and the combined prediction of the three parameters is high,which is helpful for clinicians to develop personalized prevention and treatment measures to reduce the risk of delayed union of limbs fractures.