肱骨远端骨折愈合过程中的维生素 D 状态:临床观察

Andrea Celli, Piero Aloisi, Mattia Manelli, Ludovica Elena Celli, Luigi Celli
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引用次数: 0

摘要

背景:骨折愈合是一个复杂的生物过程,在骨折发生后很快就会开始。维生素 D 状态对维持骨骼健康的作用已得到公认,但维生素 D 缺乏对肱骨远端骨折愈合的临床影响却鲜有研究。本研究通过比较有或无骨折愈合影像学征兆的患者和对照组的维生素 D 血清浓度,探讨了维生素 D 在采用切开复位和双钢板固定术治疗的肱骨远端骨折(C2、C3)中的作用。我们的假设是,治疗 6 个月后各组患者的维生素 D 水平将有所不同:我们测量了一组 30 至 60 岁连续成年患者的维生素 D 血清水平。其中包括一组在研究前 6 个月在本诊所就诊的无骨折患者(对照组)和两组肱骨骨折患者,这些患者在 6 个月的随访中显示或未显示骨折愈合的放射学迹象:结果:有骨折愈合影像学表现的一组患者的维生素 D 平均浓度为 23.03 μg/L (±5.8),有延迟愈合影像学表现的一组患者的维生素 D 平均浓度为 9.30 μg/L (±2.60),而对照组的维生素 D 平均浓度为 26.15 μg/L (±11.76 μg/L)。骨折组之间、有骨折愈合影像学征兆组与对照组之间以及有延迟愈合影像学征兆组与对照组之间测得的维生素 D 浓度均有显著差异(P < 0.05):讨论:维生素 D 主要参与硬茧形成和重塑阶段。讨论:维生素 D 主要参与硬茧的形成和重塑阶段,它还具有影响骨折愈合早期阶段的多种功能。维生素 D 影响骨愈合的细胞过程,但其潜在机制仍有部分不清楚。在骨折患者入院时确定其维生素 D 状态,并开始补充维生素 D,同时定期检查,以促进巩固阶段的愈合,是非常有用的。虽然维生素 D 显然不是影响手术治疗肱骨远端骨折愈合的唯一因素,但其浓度很容易确定和管理。我们的数据表明,入院时应测定维生素 D 水平,浓度低的骨折患者应开始补充维生素 D。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vitamin D status in healing of distal humeral fractures: Clinical observations.

Background: Fracture healing is a complex biological process that begins soon after a fracture has occurred. Whereas the role of vitamin D status on the maintenance of bone health is well established, the clinical effects of vitamin D deficiency in the healing of distal humeral fractures are less well explored. This study examines the role of vitamin D serum levels in distal humeral fractures (C2, C3) managed with open reduction and double plate fixation, by comparing its concentration in patients with or without radiographic signs of fracture healing and in control subjects. Our hypothesis is that 6 months from treatment vitamin D levels will be different between the groups of patients.

Material and methods: We measured the vitamin D serum level in a cohort of consecutive adult patients aged 30 to 60 years. They included a group of subjects without fractures who were admitted to our clinic in the 6 months preceding the study (controls) and two groups of patients with humeral fractures who at 6-month follow-up showed or failed to show radiological signs of fracture healing.

Results: The mean vitamin D concentration was 23.03 μg/L (±5.8) in the group with radiographic signs of fracture healing, 9.30 μg/L (±2.60) in the group with radiographic signs of delayed union and 26.15 μg/L (±11.76 μg/L) in the control group. Significantly different (p < 0.05) concentrations were measured between the fracture groups, between the group with radiographic signs of fracture healing and the control group and between the group with radiographic signs of delayed union and the control group.

Discussion: Vitamin D is primarily involved in the stages of hard callus formation and remodelling. It also has several functions that affect the early stages of fracture healing. Vitamin D influences the cellular process of bone healing, although the underlying mechanism is still partly unclear. It would be useful to determine the vitamin D status of fracture patients at admission and to start supplementation, with periodic checks, to foster the consolidation phase. Although vitamin D is clearly not the only factor influencing the consolidation of a surgically treated distal humerus fracture, its concentration can easily be determined and managed. Our data suggest that vitamin D levels should be determined at admission and that fracture patients with low concentrations should be started on vitamin D supplementation.

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