2022 年第 8 期 第 17 卷

老年股骨干骨折患者加压钢板内固定术后血清鸢尾素及硫化氢水平与骨折愈合的关系

Relationship of serum irisin and hydrogen sulfide levels with fracture healing in elderly patients with femoral shaft fracture undergoing compression plate internal fixation

作者：张喻孟国林魏红红

英文作者：Zhang Yu Meng Guolin Wei Honghong

单位：空军军医大学第一附属医院骨科手术室，西安710000

英文单位：Orthopedic Operating Room First Affiliated Hospital of Air Force Medical University Xi′an 710000 China

关键词：股骨干骨折；鸢尾素；硫化氢；骨折愈合

英文关键词：Femoralshaftfracture;Irisin;Hydrogensulfide;Fracturehealing 

• 摘要：

• 目的 探讨老年股骨干骨折患者加压钢板内固定术后血清鸢尾素、硫化氢水平与骨折愈合的关系。方法 选取2019年1月至2021年1月空军军医大学第一附属医院骨科收治的115例行加压钢板内固定治疗的老年股骨干骨折患者。分别于术后1、4、8、12周检测血清鸢尾素、硫化氢水平，术后随访患者骨折愈合情况，随访时间至2021年10月，根据术后骨折愈合情况将患者分为不愈合组和正常愈合组。分析血清鸢尾素及硫化氢水平与老年股骨干骨折患者加压钢板内固定术后骨折不愈合的关系以及二者预测老年股骨干骨折患者加压钢板内固定术后骨折不愈合的价值。结果 3例患者失访，剩余分为不愈合组（13例）和正常愈合组（99例）。不愈合组术后血清鸢尾素、硫化氢水平随时间延长逐渐降低，正常愈合组鸢尾素、硫化氢水平则逐渐升高（均P＜0.05），不愈合组术后4、8和12周血清鸢尾素、硫化氢水平均低于正常愈合组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示年龄（比值比=2.989，95%置信区间：1.812～4.918）、术后12周血清鸢尾素水平（比值比=0.481,95%置信区间：0.327～0.708）、术后12周血清硫化氢水平（比值比=0.546，95%置信区间：0.392～0.761）与老年股骨干骨折患者加压钢板内固定术后骨折不愈合有关（均P＜0.01）。术后12周血清鸢尾素、硫化氢水平预测老年股骨干骨折患者加压钢板内固定术后骨折不愈合的曲线下面积分别为0.656、0.668，二者联合预测的曲线下面积为0.905，大于单一指标预测（Z=2.941、2.009, 均P＜0.05）。结论 老年股骨干骨折患者加压钢板内固定术后血清鸢尾素、硫化氢水平下降与骨折不愈合有关，可作为术后骨折愈合评估的预测指标。

• Objective To investigate the relationship of serum irisin and hydrogen sulfide(H2S) with fracture healing in elderly patients with femoral shaft fracture undergoing compression plate internal fixation. Methods From January 2019 to January 2021, 115 elderly patients with femoral shaft fracture were enrolled. They were treated with pressurized plate internal fixation from Department of Orthopedic, First Affiliated Hospital of Air Force Medical University. Levels of serum irisin and H2S were detected at 1, 4, 8 and 12 weeks after surgery, respectively. Fracture healing of patients was followed-up until October 2021. According to the fracture healing, patients were divided into nonunion group and normal healing group. The relationship of serum irisin and H2S levels with nonunion of fracture after compression plate internal fixation in elderly patients with femoral shaft fracture, and the value of serum irisin and H2S levels in predicting nonunion of fracture were analyzed. Results Three patients were lost to follow-up, and other were divided into nonunion group(13 cases) and normal union group(99 cases). The postoperative levels of serum irisin and H2S in the nonunion group gradually decreased with time, while the levels in the normal union group gradually increased(all P<0.05). The levels of serum irisin and H2S in the nonunion group were lower than those in the normal union group at 4, 8 and 12 weeks after operation (all P<0.05). Multivariate Logistic regression analysis showed that age（odds ratio=2.989, 95% confidence interval: 1.812-4.918）, level of serum irisin 12 weeks after operation（odds ratio=0.481, 95% confidence interval: 0.327-0.708） and level of serum H2S 12 weeks after operation（odds ratio=0.546, 95% confidence interval: 0.392-0.761） were related to fracture nonunion after compression plate internal fixation in elderly patients with femoral shaft fracture (all P<0.01). The areas under the curve predicted by levels of serum irisin and H2S 12 weeks after surgery were 0.656 and 0.668 for fracture nonunion after compression plate internal fixation in elderly patients with femoral shaft fracture. The area under the curve predicted by combined irisin and H2S was 0.905, which was greater than that measured by single index(Z=2.941, 2.009, both P<0.05). Conclusion The decrease of serum irisin and H2S levels in elderly patients with femoral shaft fracture after compression plate internal fixation is related to fracture nonunion, which can be used as a predictive index of fracture union evaluation.