股骨颈骨折患者空心钉内固定术后血清一氧化氮、内皮素-1及血管内皮生长因子的变化及其与股骨头坏死的关系

Changes in serum NO, ET-1, and VEGF after cannulated screw fixation in patients with femoral neck fractures and their relationship with femoral head necrosis.

作者信息

Li Ziqiang, Wang Huanxi, Cao Tingwei, Du Kewei

机构信息

Department of Orthopedics, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.

出版信息

Front Physiol. 2025 Jul 23;16:1603323. doi: 10.3389/fphys.2025.1603323. eCollection 2025.

DOI:10.3389/fphys.2025.1603323

PMID:40771454

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12325288/

Abstract

BACKGROUND

Femoral head necrosis (FHN) is one of the most serious complications in patients with femoral neck fractures (FNF) after cannulated screw fixation. Therefore, it is critical to predict the occurrence of FHN.

METHODS

FHN was diagnosed through clinical symptoms and imaging examinations. The serum levels of nitric oxide (NO), endothelin-1 (ET-1), and vascular endothelial growth factor (VEGF) in FNF patients were measured preoperatively and on postoperative days 3 and 5 using Enzyme-linked immunosorbent assay. The predictive value of NO, ET-1, and VEGF was evaluated using receiver operating characteristic curve analysis. The odds ratio (OR) for the risk factors of FHN was analyzed using multivariate logistic analysis.

RESULT

The serum levels of NO and VEGF decreased post-surgery in patients with FNF, with a more pronounced decrease in those who subsequently developed FHN, whereas patients who did not develop FHN showed no significant changes in these levels. Conversely, the serum level of ET-1 increased after surgery in FNF patients, with a marked rise in those who experienced FHN, while no significant change was observed in patients without FHN. ROC analysis indicated that serum levels of NO, ET-1, and VEGF have predictive value for FHN occurrence in FNF patients, with the highest predictive accuracy observed on day 5 post-surgery (Serum NO had the AUC (95% CI) of 0.74 (0.67-0.81), 0.70 (0.62-0.78) for ET-1 and 0.73 (0.65-0.80) for VEGF, p < 0.001 for all). Operation time after fracture ≥48 h, Garden classification of III and IV, Panwels classification of III, Serum ET-1 at 3 days post operation >75.24 pg/mL were independent risk factors for FHN occurrence but Serum NO at 3 days post operation >35.98 nmol/mL, Serum NO at 5 days post operation >33.62 nmol/mL, Serum VEGF at 5 days post operation >66.45 pg/mL were protective factors.

CONCLUSION

In patients with FNF who developed FHN, serum levels of NO and VEGF were reduced, while ET-1 levels were elevated, compared to those who did not develop FHN. Furthermore, on day 5 post-surgery, these three markers provided the strongest predictive value for the occurrence of FHN in FNF patients.

摘要

背景

股骨头坏死（FHN）是空心螺钉固定术后股骨颈骨折（FNF）患者最严重的并发症之一。因此，预测FHN的发生至关重要。

方法

通过临床症状和影像学检查诊断FHN。采用酶联免疫吸附测定法在术前以及术后第3天和第5天测量FNF患者血清中一氧化氮（NO）、内皮素-1（ET-1）和血管内皮生长因子（VEGF）的水平。使用受试者工作特征曲线分析评估NO、ET-1和VEGF的预测价值。采用多因素逻辑分析分析FHN危险因素的比值比（OR）。

结果

FNF患者术后血清NO和VEGF水平下降，随后发生FHN的患者下降更明显，而未发生FHN的患者这些水平无显著变化。相反，FNF患者术后血清ET-1水平升高，发生FHN的患者显著升高，而未发生FHN的患者无显著变化。ROC分析表明，血清NO、ET-1和VEGF水平对FNF患者FHN的发生具有预测价值，术后第5天预测准确性最高（血清NO的AUC（95%CI）为0.74（0.67 - 0.81），ET-1为0.70（0.62 - 0.78），VEGF为0.73（0.65 - 0.80），所有p < 0.001）。骨折后手术时间≥48小时、Garden III级和IV级、Pauwels III级、术后3天血清ET-1>75.24 pg/mL是FHN发生的独立危险因素，但术后3天血清NO>35.98 nmol/mL、术后5天血清NO>33.62 nmol/mL、术后5天血清VEGF>66.45 pg/mL是保护因素。