老年骨质疏松患者髋部骨折术前后骨转换生化标志物的变化

摘要

目的 了解老年骨质疏松患者髋部骨折术后骨转换生化标志物的变化规律,并比较骨代谢标志物在股骨颈骨折和股骨粗隆间骨折的异同.方法 收集在北京积水潭医院老年髋部骨折病房住院的髋部骨折患者138例,其中女性106例,男性32例;股骨粗隆间骨折68例,股骨颈骨折70例;明确骨折日期、手术日期,检测术前、术后血清碱性磷酸酶ALP(alkaline phosphatase,ALP)、1型前胶原氨基末端前肽(Npropeptide 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)、25羟维生素D(25 hydroxy vitamine D,25OHD)水平以及骨密度(bone mineral density,BMD).结果 (1)髋部骨折以女性居多;(2)骨折后1周内术前男性、女性之间,以及两种髋部骨折之间的骨代谢标志物均未见明显差异,骨折术后40～ 50 d骨代谢标志物均有明显上升;(3)股骨颈骨折人工股骨头置换术组和股骨粗隆间骨折髓内钉内固定组,术后40～ 50 d女性患者的P1NP上升约3倍,男性患者P1NP上升达到4倍左右;CTX及ALP上升幅度均在1.5倍左右;(4)在股骨颈骨折空心钉内固定组,P1NP上升约1.5倍,CTX变化不明显;(5)女性股骨颈骨折人工股骨头置换组中部分患者术后CTX呈下降趋势,与基线血磷水平呈负相关.结论 老年髋部骨折后骨代谢标志物的变化有一定规律,骨折类型不同会影响骨代谢标志物变化总体变化趋势,研究标志物变化规律有助于评估骨折术后骨愈合的进程.%Objective To evaluate the changes of bone turnover markers during the healing process after surgery of elderly hip fractures,by comparing the markers between femoral neck fractures and intertrochanteric fractures.Methods A total of 138 elderly cases with hip fractures were selected,including 106 females and 32 males,68 intertrochanteric fractures and 70 femoral neck fractures.Serum levels of alkaline phosphatase (ALP),N-propeptide of type 1 collagen (P1NP),C-terminal crosslinking telopeptides of type 1 collagen (CTX),and 25 hydroxy vitamine D (25OHD) were investigated.Bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA).Results The majority of hip fractures occurred in women.Within 1 week after injury and before operation,bone turnover markers had no obvious difference either between male and female patients or between patients with femoral neck fracture and intertrochanteric fracture,which were significantly increased at 40 to 50 days after surgery.In the groups of hemiarthroplasty for femoral neck fracture and intramedullary nailing for intertrocbanteric fracture,P1NP level increased about 3 times in females,4 times in males,CTX and ALP levels increased about 1.5 times at 40 to 50 days after surgery,compared with preoperative.In the group of cannulated screw for femoral neck fracture,P1NP level increased about 1.5 times,while CTX level changed mildly.Eight female patients received hemiarthroplasty for femoral neck fracture,with declining CTX level which was negatively correlated with baseline serum phosphate level.Better fracture healing might be expected in these patients during follow-up.Conclusions The changes of bone turn over markers have some specitic features in elderly hip fractures.Discrepancy existed between intertrochanteric fractures and femoral neck fractures.Although some individuals were different from the general trends,bone turnover markers played a role in evaluating hip fracture healing and risk of delayed union or nonunion.The meaning of bone turnover markers in evaluating bone healing was notable.