探讨维生素D冲击治疗对创伤后慢性骨髓炎危重患者骨代谢标志物、骨密度的调控作用。

回顾性分析2021年6月至2024年5月期间扬州市第三人民医院收治的创伤后慢性骨髓炎危重患者80例作为研究对象，本研究采用病例对照研究，其中男性46例，女性34例；年龄35~66岁[（52.95±2.61）岁]。根据治疗方法分为观察组及对照组，每组各40例。对照组给予苯唑西林、克林霉素等抗菌治疗，观察组在对照组的基础上给予维生素D冲击治疗，两组患者均治疗6个月。比较两组患者恢复情况，治疗3、6个月骨代谢标志物[骨钙素（OC）、Ⅰ型胶原羧基端肽（CTX-Ⅰ）]、骨密度、白细胞计数（WBC）和红细胞沉降率（ESR），比较治疗期间不良反应发生率。

同组治疗前比较，两组患者治疗3、6个月OC水平均显著升高，CTX-Ⅰ水平均显著降低，差异均有统计学意义（P<0.05）；与同组治疗3个月比较，两组患者治疗6个月OC水平进一步升高，CTX-Ⅰ水平进一步下降，差异均有统计学意义（P<0.05）。治疗3个月观察组OC水平高于对照组，CTX-Ⅰ水平低于对照组，差异有统计学意义（P<0.05）；治疗6个月观察组OC水平仍高于对照组，CTX-Ⅰ水平仍低于对照组，差异有统计学意义（P<0.05）。两组患者治疗3、6个月骨密度水平均较本组治疗前显著升高（P<0.05）；且两组患者治疗6个月骨密度水平高于本组治疗3个月，差异有统计学意义（P<0.05）。治疗3、6个月观察组骨密度均高于对照组，差异有统计学意义（P<0.05）。与同组治疗前相比，两组患者治疗3个月、治疗6个月WBC、ESR水平均显著降低（P<0.05）；与同组治疗3个月比较，两组患者治疗6个月WBC、ESR水平进一步下降，差异有统计学意义（P<0.05）。治疗3、6个月观察组WBC、ESR水平均低于对照组，差异有统计学意义（P<0.05）。

对于危重创伤后慢性骨髓炎患者给予维生素D冲击治疗有较好的效果，可改善骨代谢标志物、骨密度。

To explore the regulatory effect of vitamin D pulse therapy on bone metabolism markers and bone mineral density in critical patients of chronic osteomyelitis after trauma.

A retrospective analysis was conducted on 80 critically ill patients with post-traumatic chronic osteomyelitis admitted to the Third People's Hospital of Yangzhou City from June 1, 2021 to May 2024. This study used a case-control study sampling, with 46 males and 34 females; The age ranged from 35 to 66 years old, with an average of (52.95±2.61) years. According to the treatment method, the patients were divided into an observation group and a control group, with 40 cases in each group. The control group received antibacterial treatments such as benzylpenicillin and clindamycin, while the observation group received vitamin D shock therapy in addition to the control group. Both groups were treated for 6 months. Compare the recovery status of two groups, including bone metabolism markers [osteocalcin (OC), type I collagen carboxy terminal peptide (CTX-I)], bone density, white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) after 3 months and 6 months of treatment, and compare the incidence of adverse reactions during treatment.

Compared with the baseline before treatment, the levels of OC significantly increased and CTX-I levels significantly decreased at 3 and 6 months after treatment in both patient groups, with statistically significant differences (P<0.05); compared with 3 months of treatment in the same group, OC levels further increased and CTX-I levels further decreased at 6 months after treatment in both patient groups, and the differences were statistically significant (P<0.05). At 3 months after treatment, the observation group had higher OC level and lower CTX-I level than the control group (P<0.05); at 6 months after treatment, the observation group still showed higher OC level and lower CTX-I level relative to the control group, with statistically significant differences (P<0.05). The bone mineral density of both groups was significantly elevated at 3 and 6 months after treatment compared with the baseline before treatment (P<0.05), and the bone mineral density at 6 months after treatment was higher than that at 3 months after treatment in the same group (P<0.05); the observation group presented higher bone mineral density than the control group at both 3 and 6 months after treatment (P<0.05). In addition, the levels of WBC and ESR were markedly reduced at 3 and 6 months after treatment in both patient groups when compared with pretreatment levels (P<0.05), and further decreased at 6 months after treatment compared with 3 months after treatment within each group (P<0.05); the observation group had lower WBC and ESR levels than the control group at 3 and 6 months after treatment, with statistically significant differences (P<0.05)

Vitamin D shock therapy has a good effect on critically ill cases of chronic osteomyelitis after trauma, which can improve bone metabolism markers and bone density.