摘要
目的观察红细胞沉降率(ESR)/C反应蛋白(CRP)对股骨颈骨折(FNF)内固定术后发生股骨头坏死(ONFH)的影响。方法纳入2019年1月至2020年6月郑州市骨科医院收治的FNF患者,均给予内固定手术治疗,术后随访2年。术前测定ESR、CRP水平,计算ESR/CRP,以ESR/CRP的25及75百分位数作为界限,将患者分为3组。采用Kaplan-Meier曲线分析不同ESR/CRP的FNF患者2年内ONFH的发生情况,采用Logistic回归分析ESR/CRP对FNF患者内固定术后发生ONFH的影响,绘制受试者工作特征(ROC)曲线,分析ESR/CRP对FNF患者内固定术后发生ONFH的预测价值。结果共纳入122例患者,患者术前ESR/CRP为96.42%(93.40%,99.23%)。术后2年发生ONFH 21例,发生率为17.21%;ESR/CRP<93.40%患者术后2年ONFH发生率低于ESR/CRP在93.40-99.23之间及>99.23%,差异有统计学意义(P<0.05)。发生组患者合并糖尿病占比、骨折Ⅲ型占比高于未发生组,术前CRP水平高于未发生组,ESR/CRP低于未发生组,差异有统计学意义(P<0.05)。经Logistic回归分析,合并糖尿病、骨折Garden分型Ⅲ型是FNF患者内固定术后发生ONFH的独立危险因素(OR>1,P<0.05),高ESR/CRP是其保护因素(OR<1,P<0.05)。ROC曲线显示,ESR/CRP预测术后发生ONFH的AUC>0.70,有一定预测价值。结论ESR/CRP是FNF患者内固定术后发生ONFH的影响因素,可作为预测患者术后发生ONFH的重要指标。
Objective To observe the effect of erythrocyte sedimentation rate(ESR)/C-reactive protein(CRP)on osteonecrosis of the femoral head(ONFH)after internal fixation of femoral neck fracture(FNF).Methods All FNF patients admitted to Zhengzhou Orthopedic Hospital from January 2019 to June 2020 were treated with internal fixation surgery and followed up for 2 years after surgery.The levels of ESR and CRP were measured before operation,and the ESR/CRP was calculated.The patients were divided into three groups with 25 and 75 Percentile of ESR/CRP as the boundary.Kaplan Meier curve was used to analyze the incidence of ONFH in FNF patients with different ESR/CRP within 2 years.Logistic regression was used to analyze the impact of ESR/CRP on ONFH occurrence in FNF patients after internal fixation surgery.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of ESR/CRP on ONFH occurrence in FNF patients after internal fixation surgery.Results A total of 122 patients were included in the study,The preoperative ESR/CRP ratio was 96.42%(93.40%,99.23%).ONFH occurred in 21 of 122 patients with FNF 2 years after operation,with an incidence of 17.21%.The incidence of ONFH 2 years after internal fixation in patients with ESR/CRP ratio<93.40%was lower than that in patients with ESR/CRP ratio between 93.40-99.23 and>99.23%,with a statistical significant difference(P<0.05).The proportion of patients with diabetes and fracture type III in the occurrence group was significantly higher than that in the non occurrence group,the preoperative CRP level was higher than that in the non occurrence group,and the ESR/CRP ratio was lower than that in the non occurrence group,with a statistical significant difference(P<0.05).Logistic regression analysis showed that the combination of diabetes and Garden type III fracture were independent risk factors for ONFH after internal fixation in FNF patients(OR>1,P<0.05),and high ESR/CRP ratio was the protective factor(OR<1,P<0.05).ROC curve showed that ESR/CRP ratio could predict AUC>0.70 of ONFH after operation,which had certain predictive value.Conclusion ESR/CRP ratio is an influential factor of ONFH in FNF patients after internal fixation,and can be used as an important indicator to predict ONFH in FNF patients after internal fixation.
作者
赵晓博
王顺利
史迎宾
喻斌
Zhao Xiao-bo;Wang Shun-li;Shi Ying-bin;Yu Bin(Bone tumor of Zhengzhou Orthopaedic Hospital,Department of Bone Disease,Zhengzhou 450000,henan Province,China)
出处
《罕少疾病杂志》
2023年第8期80-83,共4页
Journal of Rare and Uncommon Diseases
关键词
股骨颈骨折
股骨头坏死
红细胞沉降率
C反应蛋白
Femoral Neck Fracture
Osteonecrosis of the Femoral Head
Erythrocyte Sedimentation Rate
C-reactive Protein
