Gorter E A, Krijnen P, Schipper I B
Department of Surgery and Traumatology, Leiden University Medical Center, Leiden, The Netherlands.
J Clin Orthop Trauma. 2017 Jan-Mar;8(1):34-37. doi: 10.1016/j.jcot.2016.09.003. Epub 2016 Sep 23.
The effect of vitamin D on maintaining bone health is well researched and its role in the various metabolic stages of fracture healing has become evident, the clinical effects of a vitamin D deficiency in human fracture healing are less well described. Considering today's high prevalence of vitamin D deficiency, the aim of this present study was to investigate the effect of vitamin D status on human adult fracture healing.
The serum calcidiol concentration was measured in a cohort of adult patients with a fracture in the upper or lower extremity between September 2012 and October 2013. Deficient patients (serum calcidiol <50 nmol/L) were treated with vitamin D. Clinical and radiological consolidation was determined.
Vitamin D concentration was measured in 617 patients; 249 (40%) were vitamin D deficient, they subsequently received vitamin D supplements. In 141 patients with a deficiency vitamin D was measured again after 4 months; 111 patients (78.7%) were no longer vitamin D deficient, and 30 remained vitamin D deficient. In six patients of the entire cohort, a clinical delayed union was described. The incidence of delayed union was higher in the group that remained vitamin D deficient (9.7%) compared to the patients who were not initially deficient (0.3%) and those who were no longer deficient after supplementation (1.7%; < 0.001). The incidence of radiological delayed union did not differ between these three groups ( = 0.67).
The results of this research suggest that the vitamin D status at time of fracture affects fracture healing. Further research is needed to confirm these results.
维生素D对维持骨骼健康的作用已得到充分研究，其在骨折愈合各个代谢阶段的作用也已显现，但维生素D缺乏在人类骨折愈合中的临床影响描述较少。鉴于当今维生素D缺乏的高患病率，本研究旨在探讨维生素D状态对成人骨折愈合的影响。
对2012年9月至2013年10月期间上肢或下肢骨折的成年患者队列测定血清骨化二醇浓度。维生素D缺乏患者（血清骨化二醇<50 nmol/L）接受维生素D治疗。确定临床和影像学愈合情况。
对617例患者测定了维生素D浓度；249例（40%）维生素D缺乏，随后接受了维生素D补充剂。141例维生素D缺乏患者在4个月后再次测定；111例患者（78.7%）不再维生素D缺乏，30例仍维生素D缺乏。在整个队列的6例患者中，描述为临床延迟愈合。与最初不缺乏维生素D的患者（0.3%）和补充后不再缺乏维生素D的患者（1.7%；<0.001）相比，仍维生素D缺乏组的延迟愈合发生率更高（9.7%）。这三组之间影像学延迟愈合的发生率没有差异（=0.67）。
本研究结果表明骨折时的维生素D状态影响骨折愈合。需要进一步研究来证实这些结果。
