Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfallchirurgie und Orthopädie, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany.
Injury. 2011 Aug;42(8):758-64. doi: 10.1016/j.injury.2010.11.017. Epub 2010 Dec 17.
Radiological studies are the standard method to monitor fracture healing but they do not allow a timely assessment of bone healing. Biochemical markers react rapidly to changes in bone metabolism during fracture healing and could be an additional tool to monitor this process. The goal of this study was to observe changes in serum biomarkers and evaluate the possible differences in the serum levels of tartrate-resistant acid phosphatase 5b (TRACP 5b), total N-terminal propeptide of type I collagen (PINP), bone-specific alkaline phosphatase (BAP), and C-terminal cross-linking telopeptide of type I collagen (CTX) in patients with normal and delayed fracture healing. Several serum samples were collected for one year after the surgical treatment of long bone fractures in 248 patients. From this large pool, 15 patients with atrophic nonunion were matched to 15 patients with normal bone healing. Post-operative changes in osteological markers were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd weeks. The patients were followed both clinically and radiologically for the entire one-year duration of the study. In the first week, the absolute values of CTX decreased significantly (p=0.0164) in cases of delayed fracture healing. The relative values of TRACP 5b were significantly decreased at weeks 4 (p=0.0066) and 8 (p=0.0043). BAP and PINP levels decreased in the first week followed by an increase, but there were no significant differences in the absolute or relative values during the healing process in both patient groups. For the first time, we have demonstrated changes in serum concentrations of TRACP 5b, PINP, BAP, and CTX during normal and delayed fracture healing. Characteristic changes in systemic TRACP 5b and CTX levels could reflect the initial process of successful fracture healing and may be used in clinical practice to monitor the healing process. Furthermore, it could be very important for determining the beneficial effects of additional treatments such as ultrasound or BMPs in clinical trials.
放射学研究是监测骨折愈合的标准方法，但它们无法及时评估骨愈合情况。生化标志物对骨折愈合过程中骨代谢的变化反应迅速，可作为监测这一过程的额外手段。本研究的目的是观察血清生物标志物的变化，并评估在正常和延迟愈合的骨折患者中，抗酒石酸酸性磷酸酶 5b（TRACP 5b）、I 型胶原氨基端前肽（PINP）、骨碱性磷酸酶（BAP）和 I 型胶原 C 端交联肽（CTX）的血清水平可能存在的差异。对 248 例长骨骨折患者的手术治疗后一年采集了多个血清样本。从这个大样本中，我们匹配了 15 例萎缩性骨不连患者和 15 例正常骨愈合患者。在第 1、2、4、8、12 和 52 周监测骨标志物的术后变化。在整个研究的一年期间，对患者进行了临床和放射学随访。在骨折愈合延迟的情况下，第 1 周 CTX 的绝对值显著降低（p=0.0164）。第 4 周（p=0.0066）和第 8 周（p=0.0043）TRACP 5b 的相对值显著降低。BAP 和 PINP 的水平在第 1 周下降后上升，但在两组患者的愈合过程中，绝对和相对值均无显著差异。我们首次证明了正常和延迟骨折愈合过程中血清中 TRACP 5b、PINP、BAP 和 CTX 浓度的变化。系统 TRACP 5b 和 CTX 水平的特征变化可能反映了成功骨折愈合的初始过程，可用于临床实践监测愈合过程。此外，这对于确定超声或 BMP 等额外治疗的有益效果在临床试验中非常重要。
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