张恒 邓学德

【摘要】 目的：探究阿法骨化醇輔助经皮微创内固定治疗四肢骨折的临床效果。方法：选择2017年7月—2022年12月在山东国欣颐养集团枣庄中心医院治疗的86例四肢骨折患者，应用随机数字表法将其分为对照组（经皮微创内固定）及观察组（阿法骨化醇联合经皮微创内固定），各43例。对比两组临床疗效、视觉模拟评分法（VAS）评分、Fugl-Meyer评测法（FMA）评分、肿胀评分、骨代谢产物[血清碱性磷酸酶（ALP）、骨保护素（OPG）、骨钙素（BGP）、骨形态发生蛋白-2（BMP-2）、胰岛素样生长因子-1（IGF-1）、血管内皮生长因子（VEGF）]水平、愈合进程指标（骨痂量、骨痂密度、骨痂边缘、愈合优良率）。结果：对照组总有效率低于观察组，差异有统计学意义（P<0.05）。术后4周，两组VAS、肿胀评分均降低，FMA评分均升高，且观察组改善优于对照组，差异均有统计学意义（P<0.05）。术后4周，两组ALP、OPG、BGP、BMP-2、IGF-1、VEGF水平均升高，且观察组均高于对照组，差异均有统计学意义（P<0.05）。术后4周，两组骨痂量、骨痂密度、骨痂边缘评分均升高，对照组均低于观察组，差异均有统计学意义（P<0.05）。观察组愈合优良率高于对照组，差异有统计学意义（P<0.05）。结论：阿法骨化醇辅助经皮微创内固定治疗四肢骨折，可促进患者骨折愈合，降低疼痛程度，改善肢体功能，机制与上调血清骨代谢因子水平有关。

【关键词】 阿法骨化醇 经皮微创内固定 四肢骨折 血清碱性磷酸酶 骨保护素

Effect of Alfacalcidol Assisted Percutaneous Minimally Invasive Internal Fixation on Extremity Fractures and Its Influence on ALP and OPG Levels/ZHANG Heng， DENG Xuede. //Medical Innovation of China， 2024， 21（07）： 0-019

[Abstract] Objective： To investigate the clinical effect of Alfacalcidol assisted percutaneous minimally invasive internal fixation in the treatment of extremity fractures. Method： A total of 86 patients with extremity fractures treated in Shandong Guoxin Health Care Group Zaozhuang Central Hospital from July 2017 to December 2022 were selected and divided into control group （percutaneous minimally invasive internal fixation） and observation group （Alfacalcidol combined percutaneous minimally invasive internal fixation） by random number table method， with 43 cases in each group. The clinical efficacy， visual analogue scale （VAS） score， Fugl-Meyer assessment （FMA） score， swelling score， bone metabolites [serum alkaline phosphatase （ALP）， osteoprotectin （OPG）， bone glaprotein （BGP）， bone morphogenetic protein-2 （BMP-2）， insulin-like growth factor-1 （IGF-1）， vascular endothelial growth factor （VEGF）] levels， healing process indicators （callus volume， callus density， callus margin， excellent rate of healing） were compared between the two groups. Result： The total effective rate of control group was lower than that of observation group， the difference was statistically significant （P<0.05）. 4 weeks after surgery， VAS and swelling scores decreased and FMA scores increased in both groups， and the improvement in the observation group were better than those in the control group， the differences were statistically significant （P<0.05）. 4 weeks after surgery， the levels of ALP， OPG， BGP， BMP-2， IGF-1 and VEGF were increased in both groups， and the observation group were higher than those of the control group， the differences were statistically significant （P<0.05）. 4 weeks after surgery， callus volume， callus density and callus margin scores were increased in both groups， and the control group were lower than those of the observation group， the differences were statistically significant （P<0.05）. The excellent rate of healing in the observation group was higher than that of control group， the difference was statistically significant （P<0.05）. Conclusion： Alfacalcidol assisted percutaneous minimally invasive internal fixation for limb fractures can promote fracture healing， reduce the degree of pain and improve limb function in patients， and the mechanism is related to upregulation of serum bone metabolic factor levels.

[Key words] Alfacalcidol Percutaneous minimally invasive internal fixation Extremity fracture Serum alkaline phosphatase Osteoprotegerin

First-author's address： Department of Traumatic Orthopedics， Shandong Guoxin Health Care Group Zaozhuang Central Hospital， Zaozhuang 277000， China

doi：10.3969/j.issn.1674-4985.2024.07.004

作为临床常见骨折类型—四肢骨折，大多因为外伤、暴力、高空坠落等所致，是一种发生率较高的骨折类型[1-2]。在患者发生四肢骨折后，临床常采用固定手术治疗，通过手术固定对骨折位置生理结构进行重建，促进患者肢体功能恢复。因此，手术固定方式对四肢骨折患者而言意义显著。微创经皮内固定因对患者损伤较小，利于患者恢复，且术后并发症较少被广泛应用在治疗四肢骨折中[3]。但手术均具有创伤性，如何促进患者骨折愈合，成为临床研究重点。阿法骨化醇具有抑制骨吸收、促进骨基质蛋白合成功效[4-5]。但当前，临床对阿法骨化醇辅助经皮微创内固定治疗四肢骨折研究较少。基于此，本文旨在探究阿法骨化醇辅助经皮微创内固定治疗四肢骨折临床效果，以期为临床促进四肢骨折愈合提供最佳治疗方案，现报道如下。……