Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair.
Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair.
复制标题
DOI：
10.1097/bot.0000000000002307
复制
发表时间：
2022-02-01
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
--
作者：
在一项对孤立性胫骨平台骨折患者的前瞻性纵向研究中，使用一种新的、经过验证的生物测定法来监测X胶原分解产物的血清浓度。X胶原蛋白是软骨内修复过程中软软骨愈伤组织向骨转化过程中的标志性细胞外基质蛋白。先前的临床前和临床研究表明，在长骨骨折后，胶原X生物标志物（CXM）的生物测定水平明显达到峰值。一级学术创伤设施。36例;孤立性胫骨平台骨折。(3)闭合治疗，内固定（暂时/最终），切开复位内固定。胶原X血清生物标志物水平（CXM生物测定）。22名男性和14名女性（平均年龄：46.3岁；22.6-73.4岁，SD 13.3）入选（16例单髁骨折和20例双髁骨折）。25例（72.2%）采用手术治疗，其中12例（33.3%）采用固定治疗。CXM的峰值在性别和年龄之间没有差异。患者的峰值表达接近1000 pg/mL（平均：男性986.5 pg/mL, SD 369；女性953.2 pg/mL, SD 576）。治疗方案、使用外固定架或骨折严重程度对CXM峰值没有影响（Schatzker）。采用外固定（P = 0.05）或分期切开复位内固定（P = 0.046）治疗的患者表现出严重的延迟峰。初步分析表明，骨折后CXM峰值较强，与之前的临床前和临床研究一致，但分期固定延迟了这一峰值。这可能表示构造加载延迟的后果。进一步的验证需要更大的队列和长期随访。X胶原蛋白可能提供一个机会，支持前瞻性介入研究测试新的骨科或固定技术。
To use a novel, validated bioassay to monitor serum concentrations of a breakdown product of collagen X in a prospective longitudinal study of patients sustaining isolated tibial plateau fractures. Collagen X is the hallmark extracellular matrix protein present during conversion of soft, cartilaginous callus to bone during endochondral repair. Previous preclinical and clinical studies demonstrated a distinct peak in collagen X biomarker (CXM) bioassay levels after long bone fractures. Level 1 academic trauma facility. Thirty-six patients; isolated tibial plateau fractures. (3) Closed treatment, ex-fix (temporizing/definitive), and open reduction internal fixation. Collagen X serum biomarker levels (CXM bioassay). Twenty-two men and 14 women (average age: 46.3 y; 22.6–73.4, SD 13.3) enrolled (16 unicondylar and 20 bicondylar fractures). Twenty-five patients (72.2%) were treated operatively, including 12 (33.3%) provisionally or definitively treated by exfix. No difference was found in peak CXM values between sexes or age. Patients demonstrated peak expression near 1000 pg/mL (average: male—986.5 pg/mL, SD 369; female—953.2 pg/mL, SD 576). There was no difference in peak CXM by treatment protocol, external fixator use, or fracture severity (Schatzker). Patients treated with external fixation (P = 0.05) or staged open reduction internal fixation (P = 0.046) critically demonstrated delayed peaks. Pilot analysis demonstrates a strong CXM peak after fractures commensurate with previous preclinical and clinical studies, which was delayed with staged fixation. This may represent the consequence of delayed construct loading. Further validation requires larger cohorts and long-term follow-up. Collagen X may provide an opportunity to support prospective interventional studies testing novel orthobiologics or fixation techniques.