血清OSTN、SII水平在老年股骨粗隆间骨折股骨近端防旋髓内钉术后的变化及其临床意义

Changes in serum OSTN and SII following PFNA in elderly patients with intertrochanteric fractures and their clinical significance

摘要:

目的 分析血清骨织素（OSTN）、全身免疫炎症指数（SII）水平在老年股骨粗隆间骨折股骨近端防旋髓内钉（PFNA）术后的变化及其临床意义。方法 回顾性分析2023年1月—2023年12月十堰市人民医院收治的92例老年股骨粗隆间骨折PFNA术患者的临床资料。术后随访2年，参照Harris髋关节功能评分，分为预后良好组（Harris评分 ≥80分）和预后不佳组（Harris评分 < 80分）。于术前、术后1 d及术后10个月检测患者血清OSTN及SII水平，观察其变化情况，并比较两组临床资料，分析股骨粗隆间骨折患者PFNA术后远期预后的影响因素，血清OSTN、SII水平对股骨粗隆间骨折患者PFNA术后远期预后的预测价值。结果 92例患者术前1 d、术后1 d及10个月的血清OSTN水平和SII比较，差异均有统计学意义（P < 0.05）；血清OSTN水平呈下降趋势，SII呈先升高再降低趋势。2年后随访，92例患者中有71例Harris评分 ≥ 80分。预后不佳组糖尿病率、重度骨质疏松占比及SII水平均高于预后良好组（P <0.05），术后1 d的OSTN水平低于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示：糖尿病［O^R=3.047（95% CI：1.060，8.758）］、重度骨质疏松［O^R=3.462（95% CI：1.239，9.674）］、OSTN低水平［O^R=0.056（95% CI：0.019，0.163）］及SII高水平［O^R=1.004（95% CI：1.001，1.007）］均为PFNA术后远期预后不佳的危险因素（P <0.05）。受试者工作特征曲线结果表明，血清OSTN联合SII预测股骨粗隆间骨折患者PFNA术后远期预后的曲线下面积为0.891（95% CI：0.835，0.967），敏感性为81.40%（95% CI：0.726，0.905），特异性为91.50%（95% CI：0.834，0.985）。结论 老年股骨粗隆间骨折患者PFNA术后血清OSTN水平下降，SII先升后降。两者联合可更好地预测PFNA术后远期预后，可通过其指导临床治疗，改善预后。

Abstract:

Objective To analyze the changes in serum osteocrin (OSTN) and systemic immune-inflammation index (SII) in elderly patients with intertrochanteric fractures after proximal femoral nail antirotation (PFNA) and their clinical significance.Methods The clinical data of 92 elderly patients with intertrochanteric fractures treated by PFNA at Shiyan People's Hospital from January 2023 to December 2023 were retrospectively analyzed. After 2 years of follow-up, the patients were divided into the good prognosis group (Harris Hip Score ≥ 80) and the poor prognosis group (Harris Hip Score < 80) based on the Harris Hip Score. Serum OSTN levels and the SII were determined 1 day before surgery, 1 day after surgery and 10 months after surgery to observe their changes, and the clinical data of the two groups were compared to analyze the factors affecting the long-term prognosis of patients with intertrochanteric fractures after PFNA. The predictive value of serum OSTN levels and the SII for the long-term prognosis of patients with intertrochanteric fractures after PFNA was also assessed.Results In the 92 patients, comparison of the serum OSTN levels and the SII at 1 day before surgery,1 day after surgery and 10 months after surgery showed significant differences (P < 0.05). The serum OSTN level showed a decreasing trend (P < 0.05), whereas the SII increased initially and subsequently declined (P < 0.05). Two years after the follow-up, 71 of the 92 patients had ≥ 80 points on the Harris Hip Score. The prevalence of diabetes mellitus, the proportion of severe osteoporosis and the SII in the poor prognosis group were higher than those in the good prognosis group (P < 0.05), and the serum OSTN level at 1 day after surgery was lower in the poor group than that in the good prognosis group (P < 0.05). The multivariable Logistic regression analysis revealed that diabetes mellitus [O^R = 3.047 (95% CI: 1.060, 8.758) ], severe osteoporosis [O^R = 3.462 (95% CI: 1.239, 9.674) ], low serum OSTN levels [O^R = 0.056 (95% CI: 0.019, 0.163) ] and high SII levels [O^R = 1.004 (95% CI: 1.001, 1.007) ] were risk factors for poor prognosis after PFNA surgery (P < 0.05). Receiver operating characteristic curve analysis demonstrated that the area under the curve of serum OSTN combined with SII in predicting the long-term prognosis of patients with intertrochanteric fractures after PFNA was 0.891 (95% CI: 0.835, 0.967), with the sensitivity being 81.40% (95% CI: 0.726, 0.905) and the specificity being 91.50% (95% CI: 0.834, 0.985).Conclusion In elderly patients with intertrochanteric fractures after PFNA, the serum OSTN level decreases and the SII rises before going down. The combination of the two indicators better predicts the long-term outcomes of patients after PFNA and may guide clinical management to improve prognosis.