BACKGROUND: The aim of this study was to investigate the value of serum transforming growth factor-431 (TGF-431), insulin-like growth factor-1 (IGF-1), malondialdehyde (MDA) and superoxide dismutase (SOD) levels in predicting ischemic necrosis of femoral head (ANFH) patients with femoral neck fracture after platelet rich plasma (PRP) combined with internal fixation. METHODS: The clinical data of 670 patients with femoral neck fracture treated by PRP combined with internal fixation in our hospital from March 2016 to March 2020 were retrospectively analyzed. The general data of the patients and the levels of TGF-431, IGF-1, MDA and SOD serum were analyzed, and the incidence of ANFH was analyzed after 12 months of postoperative follow-up. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum TGF-431, IGF-1, MDA, SOD levels on postoperative ANFH, and multivariate logistic regression was used to analyze the independent influencing factors of postoperative ANFH. RESULTS: All 670 patients were successfully treated with PRP combined with internal fixation. All patients were followed-up for 12 months. Among them, 20 cases (2.99%) were lost to follow-up, and 650 cases were finally included. During the follow-up period, 35 patients (5.38%) developed ANFH and were included in the ANFH group. The remaining 615 patients (94.62%) did not develop ANFH and were included the non ANFH group. In ANFH group, BMI>25.00 kg/m2, garden type III-IV, C-grade proportion of fracture reduction quality, serum TGF-431, MDA and SOD levels were significantly higher than those in non ANFH group (P<0.05), and serum IGF-1 levels were significantly lower than those in non ANFH group (P<0.05). The serum levels of TGF-431, IGF-1, MDA and SOD had a certain predictive effect on postoperative ANFH, and the area under the curve was 0.812, 0.780, 0.755 and 0.764, respectively. The results of logistic regression analysis showed that BMI>25.00 kg/m2, garden type III-IV of fracture, grade C of fracture reduction quality and serum levels of TGF-431, IGF-1, MDA and SOD were independent risk factors for ANFH (P<0.05). CONCLUSIONS: TGF-431, IGF-1, MDA and SOD have high diagnostic efficacy for ANFH after PRP combined with internal fixation of femoral neck fracture, and they are independent risk factors for ANFH.
