碱性磷酸酶在踝关节骨折后创伤性骨性关节炎患者血清中的变化及对踝关节功能恢复的影响

Change in serum ALP levels in patients with traumatic osteoarthritis after ankle fracture and their effect on ankle functional recovery

摘要:

目的 探讨碱性磷酸酶（ALP）在踝关节骨折后创伤性骨性关节炎（PTOA）患者血清中的水平变化及其对踝关节功能恢复的影响。方法 选取2020年1月—2023年12月在丽水市人民医院接受踝关节骨折手术治疗的78例患者，根据术后1年的X射线检查判断是否发生PTOA，并分为PTOA组（36例）和非PTOA组（42例）。比较两组患者一般资料、手术方式、术后并发症、术后1年的美国足踝学会踝后足评分（AOFAS）和血清ALP水平。采用Pearson相关分析和多元线性回归模型分析血清ALP水平与AOFAS的相关性和影响因素。结果 PTOA组年龄、BMI、骨折类型、骨折位移、骨折关节面受累程度均高于非PTOA组（P <0.05）。两组患者性别构成、手术方式比较，差异均无统计学意义（P >0.05）。PTOA组术后感染、并发症总发生率均高于非PTOA组（P <0.05）。PTOA组术后1年AOFAS高于非PTOA组（P <0.05）。PTOA组术前与术后1年血清ALP的差值高于非PTOA组（P <0.05）。Pearson相关性分析结果显示，血清ALP水平、年龄、BMI、骨折类型、骨折位移、骨折关节面受累程度和术后并发症与AOFAS均呈负相关（r =-0.623、-0.412、-0.321、-0.278、-0.356、-0.389、-0.467，均P <0.05）。多元线性一般回归分析结果显示：血清ALP水平、年龄和术后并发症是AOFAS的独立影响因素（b =-0.512、-0.234、-0.278，均P <0.05）。结论 踝关节骨折后PTOA患者血清ALP水平升高，且与AOFAS呈负相关，提示ALP可能参与PTOA的发生、发展，也可能作为PTOA的预测指标和治疗靶点。

Abstract:

Objective To investigate the changes in serum alkaline phosphatase (ALP) levels in patients with traumatic osteoarthritis (PTOA) after ankle fracture and their effect on ankle functional recovery.Methods The 78 patients who received surgical treatment for ankle fracture in our hospital from January 2020 to December 2023 were selected. They were divided into a PTOA group (n = 36) and a non-PTOA group (n = 42) based on whether they had PTOA or not according to X-ray images 1 year after surgery. The general characteristics, surgical methods, postoperative complications, the American Orthopedic Foot and Ankle Score (AOFAS) and serum ALP levels 1 year after surgery were compared between the two groups. Pearson correlation analysis and multiple linear regression analysis were used to investigate the correlations between serum ALP levels and AOFAS scores and their influencing factors.Results The age, body mass index (BMI), fracture severity, degree of fracture displacement, and degree of involvement of the fractured articular surface in the PTOA group were significantly higher than those in the non-PTOA group (P < 0.05). There was no difference in the sex composition and surgical methods between the two groups (P > 0.05). The incidence of postoperative infections and the overall incidence of complications in the PTOA group were higher than those in the non-PTOA group (P < 0.05). The AOFAS score 1 year after surgery in the PTOA group was lower than that in the non-PTOA group (P < 0.05). The difference of serum ALP levels before and 1 year after surgery in the PTOA group was higher than that in the non-PTOA group (P < 0.05). Pearson correlation analysis indicated that serum ALP levels, age, BMI, fracture severity, degree of fracture displacement, degree of involvement of the fractured articular surface and postoperative complications were all negatively correlated with the AOFAS scores (r =-0.623, -0.412, -0.321, -0.278, -0.356, -0.389, and -0.467, all P < 0.05). The multiple linear regression analysis revealed that serum ALP levels, age, and postoperative complications were independent factors affecting AOFAS scores (b =-0.512, -0.234 and -0.278, all P < 0.05).Conclusions The serum level of ALP is increased in PTOA patients after ankle fracture and is negatively correlated with AOFAS scores, suggesting that ALP may be involved in the occurrence and development of PTOA and serve as a predictor and therapeutic target for PTOA.