摘要
目的了解老年髋部骨折患者术后血骨转换生化标志物的变化规律,并比较股骨颈骨折髋关节置换和股骨粗隆间骨折髓内钉内固定术后血骨转换标志物的异同。方法纳入髋部骨折患者50例,其中女性37例,男性13例;股骨粗隆间骨折髓内钉内固定21例,股骨颈骨折髋关节置换29例;明确骨折日期、手术日期,检测术前、术后血清1型前胶原氨基末端前肽(N-propeptide of type 1 collagen,P1NP)、1型胶原羧基末端肽交联(C-terminal crosslinking telopeptides of type 1 collagen,CTX)、骨钙素(osteocalcin,OC)、25羟维生素D(25 hydroxy vitamin D,25OHD)的水平以及骨密度。结果老年髋部骨折术前两种髋部骨折的骨转换标志物均未见明显差异,骨折术后30~60 d时骨转换标记物均有明显上升,P1NP、CTX及OC分别由术前的41.9(29.6,44.9)μg/L、0.57(0.38,0.67)μg/L和13.9(10.5,14.3)μg/L上升至134.0(110.7,57.0)μg/L、0.84(0.69,1.00)μg/L和21.6(16.8,28.6)μg/L;80~120 d时P1NP和CTX已经下降,分别下降至102.0(72.3,126.8)μg/L和0.69(0.55,0.82)μg/L;OC在80~120 d时仍为上升趋势,为24.3(18.6,26.5)μg/L。老年髋部骨折患者术后P1NP变化性别差异无统计学意义(P=0.871),术后30~60 d P1NP比基线升高3~4倍,80~120 d时比基线升高2~3倍。老年髋部骨折患者术后P1NP/CTX比值的变化骨折类型差异无统计学意义(P=0.468),两种典型骨折术后30~60 d时P1NP/CTX比基线升高2.5倍,80~120 d比基线升高2倍。结论老年髋部骨折的骨转换标志物变化不同并受许多因素影响,但观察P1NP不必考虑性别不同,观察P1NP/CTX比值可不必顾虑骨折类型术式之间的差异。
Objective To evaluate the changes of bone turnover markers during the healing process after surgery of hip fractures in old patients by comparing the markers between hip replacement for femoral neck fracture group and intramedullary nailing fixation for intertrochanteric fracture group.Methods A total of 50 elderly cases with hip fractures were selected,including 37 females and 13 males,29 hip replacement for femoral neck fracture and 21 intramedullary nailing fixation for intertrochanteric fracture.Serum levels of N-propeptide of type 1 collagen(P1NP),C-terminal crosslinking telopeptides of type 1 collagen(CTX),osteocalcin(OC),and 25 hydroxy vitamine D(25OHD)were investigated.Bone mineral density(BMD)was measured with dual energy X-ray absorptiometry(DXA).Results Within 1 week after injury and before operation,bone turnover markers had no obvious difference between patients with hip replacement for femoral neck fracture and intramedullary nailing fixation for intertrochanteric fracture,which were significantly increased at 30 to 60 days after surgery.P1NP,CTX and OC were increased from 41.9(29.6,44.9)μg/L,0.57(0.38,0.67)μg/L,13.9(10.5,14.3)μg/L to 134.0(110.7,157.0)μg/L,0.84(0.69,1.00)μg/L,21.6(16.8,28.6)μg/L respectively.P1NP and CTX were declined at 80 to 120 days,from baseline to 102.0(72.3,126.8)μg/L and 0.69(0.55,0.82)μg/L respectively.while OC keep increasing at 80 to 120 days,was 24.3(18.6,26.5)μg/L.There was no gender difference in the changes of P1NP in the elderly patients with hip fracture after operation(P=0.871).P1NP was 3-4 times higher than the baseline at 30-60 days and 2-3 times higher than the baseline at 80-120 days after operation.There was no fracture difference in the changes of P1NP/CTX ratio in the elderly patients with hip fracture after operation(P=0.468).P1NP/CTX was 2.5 times higher than the baseline at 30-60 days and 2.0 times higher than the baseline at 80-120 days after operation.Conclusion The changes of bone turnover markers of hip fracture in the elderly are different and affected by many factors,while we can ignore the gender difference in the observation of P1NP;and calculate the ratio of P1NP/CTX disregard the differences between fracture types and operation methods.
作者
李新萍
李晓玉
杨明辉
朱仕文
吴新宝
张萍
LI Xin-ping;LI Xiao-yu;YANG Ming-hui;ZHU Shi-wen;WU Xin-bao;ZHANG Ping(Department of Cadre Health Care, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing 100035, China;Department of Orthopedic Trauma, Beijing Jishuitan Hospital,the Fourth Medical College of Peking University, Beijing 100035,China)
出处
《中华骨质疏松和骨矿盐疾病杂志》
CSCD
北大核心
2020年第3期198-205,共8页
Chinese Journal Of Osteoporosis And Bone Mineral Research
基金
北京市医院管理局科研培育项目(PX2019015)
北京市保健委科研课题(京19-17号)。
关键词
骨质疏松
老年髋部骨折
骨转换标志物
骨密度
osteoporosis
elderly hip fracture
bone turnover marker
bone mineral density
