骨科损伤控制救治对四肢骨折患者血清骨代谢和炎症反应的影响
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摘要
为探究骨科损伤控制(damage control orthopaedics, DCO)救治对四肢骨折患者血清骨代谢及炎症反应的影响,本研究选取40例四肢骨折患者,随机分为治疗组和对照组,各20例。治疗组采用骨科损伤控制救治四肢骨折患者,对照组则采用常规骨折治疗方法。酶联免疫法检测试剂盒检测骨代谢指标:骨钙素(bone gla protein, BGP)、Ⅰ型前胶原羧基端前肽(propeptide carboxy-terminal procollagen, PICP)水平、血清碱性磷酸酶(alkaline phosphatase, ALP),骨愈合相关指标:可溶性细胞间粘附分子-1 (soluble intercellular adhesion molecule 1, s ICAM-1)、胰岛素样生长因子-1 (insulin like growth factor-1, IGF-1),以及炎症反应相关因子白细胞介素-1 (interleukin-1, IL-1)、白细胞介素-6 (interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-alpha, TNF-α);统计分析各组患者手术后疼痛程度以及肿胀程度评分。结果表明,骨科损伤控制治疗组的血清骨钙素(BGP)、Ⅰ型前胶原氨基酸末端前肽(PICP)水平、血清碱性磷酸酶(ALP)、可溶性细胞间粘附分子-1 (sICAM-1)和胰岛素样生长因子-1 (IGF-1)水平明显高于对照组;炎症反应因子IL-1、IL-6和TNF-α水平明显低于对照组;骨科损伤控制救治可明显降低四肢骨折患者术后的疼痛程度以及肿胀程度评分。综上所述,骨科损伤控制救治可明显提高四肢骨折患者血清骨代谢和骨愈合水平、降低炎症反应、疼痛以及肿胀程度。
In order to explore the effect of damage control orthopedics on serum bone metabolism and inflammatory response in patients with limb fractures. 40 cases of limb fractures were randomly divided into treatment group and control group, 20 cases in each group. The treatment group was treated by injury control orthopedics,while the control group was treated by conventional fracture treatment. Bone gla protein(BGP), type Ⅰ propeptide carboxy-terminal procollagen(PICP), serum alkaline phosphatase(ALP), soluble intercellular adhesion molecule 1(sICAM-1), insulin-like growth factor-1(IGF-1), and inflammatory response-related factors interleukin-1(IL-1),interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) were detected by ELISA. The results presented that the levels of serum BGP, PICP, ALP, s ICAM-1 and IGF-1 in the treatment group were significantly higher than those in the control group. The inflammatory response factors IL-1, IL-6 and TNF-alpha in the treatment group were significantly lower than those in the control group. Injury control orthopedic treatment can significantly reduce postoperative pain and swelling scores in patients with limb fractures. In conclusion, damage control orthopedic treatment could significantly improve serum bone metabolism and bone healing, reduce inflammation, pain and swelling in patients with limb fractures.
In order to explore the effect of damage control orthopedics on serum bone metabolism and inflammatory response in patients with limb fractures. 40 cases of limb fractures were randomly divided into treatment group and control group, 20 cases in each group. The treatment group was treated by injury control orthopedics,while the control group was treated by conventional fracture treatment. Bone gla protein(BGP), type Ⅰ propeptide carboxy-terminal procollagen(PICP), serum alkaline phosphatase(ALP), soluble intercellular adhesion molecule 1(sICAM-1), insulin-like growth factor-1(IGF-1), and inflammatory response-related factors interleukin-1(IL-1),interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) were detected by ELISA. The results presented that the levels of serum BGP, PICP, ALP, s ICAM-1 and IGF-1 in the treatment group were significantly higher than those in the control group. The inflammatory response factors IL-1, IL-6 and TNF-alpha in the treatment group were significantly lower than those in the control group. Injury control orthopedic treatment can significantly reduce postoperative pain and swelling scores in patients with limb fractures. In conclusion, damage control orthopedic treatment could significantly improve serum bone metabolism and bone healing, reduce inflammation, pain and swelling in patients with limb fractures.
引文
Frouzan A.,Masoumi K.,Delirroyfard A.,Mazdaie B.,and Bagherzadegan E.,2017,Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients,Electron Physician,9(8):5092-5097
Haffner-Luntzer M.,Liedert A.,and Ignatius A.,2015,Mechanobiology and bone metabolism:Clinical relevance for fracture treatment,Unfallchirurg,118(12):1000-1006
Haller J.M.,Marchand L.,Rothberg D.L.,Kubiak E.N.,and Higgins T.F.,2017,Inflammatory cytokine response is greater in acute tibial plafond fractures than acute tibial plateau fractures,J.Orthop.Res.,35(12):2613-2619
Hu Y.L.,Guan S.Y.,Wang G.Q.,Hu S.C.,and Yu B.,2015,Clinical study of effect of placental peptide injection on prevention of postoperative infections in limb fractures patients,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),(10):2294-2296(胡涌亮,管四炎,王国庆,胡顺才,余斌,2015,胎盘多肽注射液对四肢骨折术后感染预防效果的临床研究,中华医院感染学杂志,(10):2294-2296)
Morgenstern M.,Vallejo A.,McNally M.A.,Moriaty T.,Ferguson J.,Nijs S.,and Metsmakers W.J.,2018,The effect of local antibiotic prophylaxis when treating open limb fractures:A systematic review and meta-analysis,Bone Joint Res.,7(7):447-456
Popescu G.I.,Lupescu O.,Nagea M.,and Patru C.,2013,Diagnosis and treatment of limb fractures associated with acute peripheral ischemia,Chirurgia(Bucur),108(5):700-705
Shen J.,Yao R.,Jing M.,et al.,2018,Sinomenine regulates inflammatory response and oxidative stress via nuclear fac-tor kappa B(NF-κB)and NF-E2-related factor 2(Nrf2)signa ing pathways in ankle fractures in children,Med.Sci.Monit.24:6649-6655
Tsuchie H.,Miyakoshi N.,Iba K.,Kasukawa Y.,Nozaka K.Dohke T.,Kosukegawa I.,Aizawa T.,Maekawa S.,Abe H.Takeshima M.,Tomite T.,Segawa T.,Ouchi K.,Kinoshita H.,Suzuki M.,Yamashita T.,and Shimada Y.,2018,The effects of teriparatide on acceleration of bone healing following atypical femoral fracture:comparison between daily and weekly administration,Osteoporos Int.,2018
Wang X.L.,Zhu X.P.,Ji D.X.,Wang J.,Zhai R.H.,Li P.,and Yang X.F.,2018,Beneficial effect of traditional Chinese medicine fumigation"Bone-healing Powder"in postoperative pain and recovery of neurological function of traumatic thoracolumbar spine fractures:a case-control study,Medicine(Baltimore),97(35):e11983
Wang Y.Z.,and Ma J.,2009,Theory and clinical application of damage control in orthopaedics,Zhonghua Chuangshang Guke Zazhi(Chinese Journal of Orthopaedic Trauma),11(8):777-779(王耀宗,马军,2009,骨科损伤控制的理论与临床应用,中华创伤骨科杂志,11(8):777-779)
Yang R.W.,Zhang M.L.,Li L.,Yao X.L.,Liu Ro.J.,and Guo Y.Y.,2006,Determination of bone metabolism markers in patients with osteoporosis,diabetes mellitus,hyperthyroid and rheumatoid arthritis,Jianyan Yixue(Laboratory Medicine),21(4):355-357(杨汝文,张曼丽,李雷,姚小苓,刘荣均,郭燕云,2006,骨代谢标志检测在骨质疏松,糖尿病,甲状腺功能亢进及类风湿性关节炎中的应用,检验医学,21(4):355-357)
Zhao Z.J.,Chu Y.C.,Liu M.Z.,Jiang B.,Du J.Y.,and Cai S.J.,2013,The damage control orthopedics strategy and its application in the treatment of pelvic fractures in pre-hospital emergency department and hospital settings,Zhongguo Jiaoxing Waike Zazhi(Orthopedic Journal of China),21(20):2019-2024(赵资坚,邹育才,刘梦璋,江标,杜建业,蔡史健,2013,骨盆骨折院前急救和院内救治的损伤控制策略应用体会,中国矫形外科杂志,21(20):2019-2024)
Haffner-Luntzer M.,Liedert A.,and Ignatius A.,2015,Mechanobiology and bone metabolism:Clinical relevance for fracture treatment,Unfallchirurg,118(12):1000-1006
Haller J.M.,Marchand L.,Rothberg D.L.,Kubiak E.N.,and Higgins T.F.,2017,Inflammatory cytokine response is greater in acute tibial plafond fractures than acute tibial plateau fractures,J.Orthop.Res.,35(12):2613-2619
Hu Y.L.,Guan S.Y.,Wang G.Q.,Hu S.C.,and Yu B.,2015,Clinical study of effect of placental peptide injection on prevention of postoperative infections in limb fractures patients,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),(10):2294-2296(胡涌亮,管四炎,王国庆,胡顺才,余斌,2015,胎盘多肽注射液对四肢骨折术后感染预防效果的临床研究,中华医院感染学杂志,(10):2294-2296)
Morgenstern M.,Vallejo A.,McNally M.A.,Moriaty T.,Ferguson J.,Nijs S.,and Metsmakers W.J.,2018,The effect of local antibiotic prophylaxis when treating open limb fractures:A systematic review and meta-analysis,Bone Joint Res.,7(7):447-456
Popescu G.I.,Lupescu O.,Nagea M.,and Patru C.,2013,Diagnosis and treatment of limb fractures associated with acute peripheral ischemia,Chirurgia(Bucur),108(5):700-705
Shen J.,Yao R.,Jing M.,et al.,2018,Sinomenine regulates inflammatory response and oxidative stress via nuclear fac-tor kappa B(NF-κB)and NF-E2-related factor 2(Nrf2)signa ing pathways in ankle fractures in children,Med.Sci.Monit.24:6649-6655
Tsuchie H.,Miyakoshi N.,Iba K.,Kasukawa Y.,Nozaka K.Dohke T.,Kosukegawa I.,Aizawa T.,Maekawa S.,Abe H.Takeshima M.,Tomite T.,Segawa T.,Ouchi K.,Kinoshita H.,Suzuki M.,Yamashita T.,and Shimada Y.,2018,The effects of teriparatide on acceleration of bone healing following atypical femoral fracture:comparison between daily and weekly administration,Osteoporos Int.,2018
Wang X.L.,Zhu X.P.,Ji D.X.,Wang J.,Zhai R.H.,Li P.,and Yang X.F.,2018,Beneficial effect of traditional Chinese medicine fumigation"Bone-healing Powder"in postoperative pain and recovery of neurological function of traumatic thoracolumbar spine fractures:a case-control study,Medicine(Baltimore),97(35):e11983
Wang Y.Z.,and Ma J.,2009,Theory and clinical application of damage control in orthopaedics,Zhonghua Chuangshang Guke Zazhi(Chinese Journal of Orthopaedic Trauma),11(8):777-779(王耀宗,马军,2009,骨科损伤控制的理论与临床应用,中华创伤骨科杂志,11(8):777-779)
Yang R.W.,Zhang M.L.,Li L.,Yao X.L.,Liu Ro.J.,and Guo Y.Y.,2006,Determination of bone metabolism markers in patients with osteoporosis,diabetes mellitus,hyperthyroid and rheumatoid arthritis,Jianyan Yixue(Laboratory Medicine),21(4):355-357(杨汝文,张曼丽,李雷,姚小苓,刘荣均,郭燕云,2006,骨代谢标志检测在骨质疏松,糖尿病,甲状腺功能亢进及类风湿性关节炎中的应用,检验医学,21(4):355-357)
Zhao Z.J.,Chu Y.C.,Liu M.Z.,Jiang B.,Du J.Y.,and Cai S.J.,2013,The damage control orthopedics strategy and its application in the treatment of pelvic fractures in pre-hospital emergency department and hospital settings,Zhongguo Jiaoxing Waike Zazhi(Orthopedic Journal of China),21(20):2019-2024(赵资坚,邹育才,刘梦璋,江标,杜建业,蔡史健,2013,骨盆骨折院前急救和院内救治的损伤控制策略应用体会,中国矫形外科杂志,21(20):2019-2024)