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目的：探讨踝关节骨折患者外周血中细胞因子水平与踝关节骨折严重程度及预后功能的相关性。方法：回顾性分析2022年6—12月86例踝关节骨折患者的临床资料，根据AO/OTA踝关节骨折分型将患者分为A型（腓骨骨折在胫腓联合以下）19例、B型（腓骨骨折经胫腓联合）38例、C型（腓骨骨折在胫腓联合以上）29例。采集患者年龄、性别、体重指数（BMI）、受伤方式、入院至手术时间、手术时长、术中出血量等一般资料，使用酶联免疫吸附法（ELISA）检测外周血中各项细胞因子水平。采用美国足踝外科协会（AOFAS）踝-后足功能评分量表评估预后踝关节功能情况，有效收集58例患者术后12个月的AOFAS踝-后足功能评分，其中AOFAS评分优组10例，AOFAS评分良组48例。分析58例患者外周血各项细胞因子水平与踝关节骨折严重程度及预后功能的相关性。结果：踝关节骨折患者外周血中的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)是影响骨折严重程度的相关因素（P<0.01），其中与IL-6水平相关性最强（r=0.811,P<0.01）。单因素分析结果显示，AOFAS评分优组患者的手术时长短于AOFAS评分良组，IL-6水平低于AOFAS评分良组，IL-10水平高于AOFAS评分良组，差异均有统计学意义（P均<0.05）。多因素分析结果显示，手术时长、IL-6和IL-10水平是影响踝关节骨折患者关节功能的独立危险因素（P<0.05）。结论：IL-6水平可作为评估踝关节骨折严重程度的重要指标。同时，IL-6水平是踝关节骨折预后的独立危险因素，IL-6水平升高提示长期预后关节功能恢复不佳，而IL-10水平升高则有利于关节功能恢复。
Abstract：Objective: To investigate the correlation between the cytokine levels in peripheral blood of patients with ankle fractures and the severity and prognosis of ankle fractures. Methods: The clinical data of 86 patients with ankle fractures from June to December 2022 were retrospectively analyzed. According to the AO/OTA classification of ankle fractures, 19 cases were categorized as type A(fibular fractures below the tibiofibular joint), 38 cases as type B(fibular fractures involving the tibiofibular joint), and 29 cases as type C(fibular fractures above the tibiofibular joint). General information such as age, gender, body mass index(BMI), injury mode, time from admission to operation, operation duration, and intraoperative blood loss was collected. Enzyme-linked immunosorbent assays(ELISAs) were used to measure cytokine levels in the peripheral blood. The American Orthopedic Foot & Ankle Society(AOFAS)Ankle-Hindfoot Scale was used to evaluate the prognosis of ankle function. A total of 58 cases were effectively evaluated with the AOFAS Ankle-Hindfoot Scale at 12 months postoperatively, including 10 cases in the excellent group and 48 cases in the good group.The correlation between the cytokine levels in peripheral blood of the 58 patients and the severity and prognosis of ankle fractures was analyzed. Results: Peripheral blood levels of interleukin(IL)-6, IL-8, IL-10, and tumor necrosis factor-alpha(TNF-α) in patients with ankle fractures were correlated with the fracture severity(P<0.01), with IL-6 exhibiting the strongest correlation(r=0.811, P<0.01).Univariate analysis revealed that patients in the excellent group had shorter surgical durations, lower IL-6 levels, and higher IL-10levels compared to those in the good group, with statistically significant differences(P<0.05). Multivariate analysis revealed that surgical duration, IL-6, and IL-10 were independent risk factors influencing joint function in patients with ankle fractures(P<0.05).Conclusions: Higher IL-6 levels in the peripheral blood correspond to more severe ankle fractures. IL-6 can serve as an important indicator for evaluating the fracture severity. Additionally, the IL-6 concentration is an independent risk factor for the prognosis of ankle fractures. Elevated IL-6 levels indicate poor long-term prognosis for joint function recovery, while elevated IL-10 levels are beneficial for joint function recovery.
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]盛学鑫,张明师,周子斐,等.踝关节骨折严重程度及预后功能与细胞因子水平的相关性分析[J].中华骨与关节外科杂志,2024,17(04):354-360.
基金信息:
国家重点研发计划“常见病多发病防治研究”重点专项（2022YFC2504304）;; 国家自然科学基金（82372395）;; 上海市科技创新行动计划项目（21ZR1450000）;; 上海市促进产业高质量发展专项（人工智能专题）计划（2023-GZ1-RGZN-01037）