目的 分析前交叉韧带(anterior cruciate ligament,ACL)损伤术后患者的骨密度和骨代谢标记物特点及其相关影响因素.方法 选取 2022 年 7 月至 2023 年 7 月,于我科住院行康复治疗的 ACL 损伤术后患者作为观察组,选取同期健康体检人员作为对照组.回顾性采集两组人员临床数据,包括骨密度、腰椎 T 值、股骨颈 T 值、骨代谢标记物、年龄、性别、体质量指数(body mass index,BMI)及吸烟饮酒情况,并比较组间差异,将观察组按照受伤时长不同分层对比临床数据组间差异,并将骨密度与临床指标间进行相关性分析,进一步探究骨密度下降的危险因素.结果 两组骨密度、腰椎 T 值、股骨颈 T 值差异有统计学意义(P<0.05),年龄、BMI、吸烟饮酒情况、25-羟维生素 D3、全段甲状旁腺激素、Ⅰ 型胶原氨基末端前肽(procollagen type Ⅰ N-terminal propeptide,PINP)差异无统计学意义(P>0.05);根据受伤时长不同,将观察组患者分为 4 组(<3 个月、3～6 个月、6～12 个月、>12 个月),组间比较除 PINP 差异有统计学意义外(P<0.05),其它临床指标差异均无统计学意义(P>0.05);以观察组患者骨密度检查结果(骨量正常、骨量低下、骨质疏松)为因变量,与其它临床指标进行相关性分析,结果显示骨密度下降与年龄之间存在显著正相关关系(r = 0.237,P<0.05),与骨钙素、β-异构化 Ⅰ 型原交联羧基端肽(beta crosslaps,β-CTX)数值之间存在显著的负相关关系(r =-0.376,P<0.01;r =-0.242,P<0.05).结论 ACL 损伤患者较正常人群存在较为普遍的骨密度下降情况,不同受伤时长分组患者中骨密度检查结果差异无统计学意义,反映破骨细胞活动的 PINP 随受伤时间增长呈现显著性波动变化.年龄、骨钙素和 β-CTX是骨量下降的显著危险因素.
An analysis of bone mineral density and bone metabolic markers for patients with anterior cruciate ligament reconstruction
Objective To analyze the characteristics of bone mineral density(BMD)and bone metabolism markers and their related factors in postoperative patients with anterior cruciate ligament(ACL)injury.Methods Postoperative patients with ACL injury who were hospitalized in our department and underwent rehabilitation treatment from July 2022 to July 2023 were selected as the observation group,and healthy persons who had medical checkups in the same period were selected as the control group.Clinical data including BMD,lumbar spine T-value,femoral neck T-value,bone metabolism markers,age,gender,body mass index(BMI),smoking and alcohol consumption were collected retrospectively to compare the differences between the two groups.The observation group was stratified according to the duration of injury for comparison of differences of clinical data.Meanwhile,correlation analysis was performed between BMD and clinical indicators to further explore the risk factors for BMD decline.Results The differences in BMD,lumbar spine T-value,and femoral neck T-value between the two groups were statistically significant(P<0.05).Differences in age,BMI,smoking,drinking,25-hydroxyvitamin D3,whole-segment parathyroid hormone,and procollagen type Ⅰ N-terminal propeptide(PINP)were not statistically significant(P>0.05).The patients in the observation group were divided into 4 groups(<3 months,3-6 months,6-12 months,and>12 months)according to the duration of injury,and the comparison between the two groups was statistically significant except for the difference in PINP(P<0.05).The differences of other clinical indicators were not statistically significant(P>0.05).The results of BMD examination(normal bone mass,low bone mass,osteoporosis)of the patients in the observation group were used as the dependent variable,and correlation analysis was conducted with other clinical indicators.The results showed that there was a significant positive correlation between decreased bone mineral density and age(r = 0.237,P<0.05),and a significant negative correlation with the values of osteocalcin and beta-isomerized type Ⅰ pro-crosslinked carboxy-terminal peptide(beta crosslaps,beta-CTX)(r =-0.376,P<0.01;r =-0.242,P<0.05).Conclusions There is a more generalized decrease in BMD in patients with ACL injury than in the normal population,and there is no significant difference in the results of BMD examination in patients of different injury duration subgroups.PINP,which reflects osteoclast activity,shows significant fluctuating changes with the increase of injury duration.Age,osteocalcin and β-CTX are significant risk factors for bone loss.
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