扩髓与非扩髓型股骨髓内针术后免疫因子释放水平的研究

目的通过检测部分免疫介质的释放水平,探讨在应用髓内针治疗股骨干骨折术后早期对机体免疫功能的影响.方法选择股骨干闭合骨折患者59例,男55例,女4例,平均年龄32.1岁,按伤情分为轻伤组(n=43)和中度伤组(n=16),采取闭合复位带锁髓内针固定治疗.轻伤组扩髓23例、非扩髓23例,中度伤组扩髓7例、非扩髓6例,分别于术前24 h和术后1、24、48 h通过ELISA法检测患者血中TNF、IL-6、IL-8、IL-10的水平,通过蛋白分析测定CRP的水平;同时选取22例健康志愿者作为正常对照组.结果轻、中度创伤患者术后各炎症指标均较术前有所上升;IL-6、IL-8、IL-10在术后1 h呈上升趋势,术后24 h达到高峰,术后48 h 三种因子水平均开始下降,但尚未恢复正常;TNF、CRP术后1 h仍较术前有所下降,但在术后24 h均出现明显上升,到术后48 h再次回落;轻伤与中度伤组不同时段的免疫指标均与对照组有明显差异(P《0.05).不同伤情患者扩髓后各免疫指标均高于非扩髓者,但除中度伤组中IL-10在术后24 h有差异显著性意义(P=0.047)外,其它指标差异均无显著性意义(P》0.05). 2例患者术后出现SIRS,观察发现与非SIRS患者相比各项免疫指标并无显著差别.结论对于轻、中度创伤患者,髓内针会造成机体免疫介质再次大量释放,但经机体免疫调节后不会产生严重的影响;不同方式髓内针固定对术后早期机体的免疫系统的影响没有显著的差异,但以IL-10为代表的免疫抑制因子很可能随着伤情的加重在应用髓内针,尤其是扩髓型髓内针时出现短期内大量释放,从而加重机体的免疫抑制.

Research on the expression of some immune markers after reamed and unreamed femoral nailing

OBJECTIVE: To investigate on the expression of some cytokines and other immunity makers right after the operation, the effect of femoral nailing on systemic immunity and sought to differentiate any differences between reamed and unreamed IMN. METHODS: Fifty-nine patients presenting with acute femoral fractured including 55 male and 4 female, 32.1 years old on average, are divided into 2 group depend on ISS. All patients were treated by close reduction and intramedullary nail for fixation. In group 1, 23 reamed and 23 unreamed; in group 2, 7 reamed and 6 unreamed. Venous blood samples were taken at 24 hr pre-operationally, and 1 hr, 24 hr, 48 hr post operationally. Serum TNF, IL-6, IL-8, IL-10 were measured by enzyme-linked immunosorbent assay. CRP was measured by protein assay apparatus. We also collected venous samples from 22 healthy uninjured volunteers, which formed control group. RESULTS: All immune marks were elevated post operation, for IL-6, IL-8, IL-10, this elevation began at 1 hr after operation, reached to the peak at 24 hr, and then down but never to the normal at 48 hr. For TNF and CRP, the level were raised at 24 hr, and then fallen at 48 hr. All mediators were raised significantly above the control group (< 0.05). Between reamed and unreamed patients both in group 1 and group 2, Although there was a trend towards higher levels of TNF, IL-6, IL-8, IL-10 and CRP in RFN than in the URFN, no significant difference was found except that there was a greater release of serum IL-10 in RFN than in URFN at 24 hr post operation (P = 0.047). Two patients have become SIRS, but the markers have shown no significant difference with those that have no SIRS symptoms. CONCLUSIONS: To the patient not injured severely, using IMN for treatment will make the inflammatory mediators re-released on higher level than normal, which will be balanced by immunity itself soon, so IMN won't make any damage severely. And no significant difference were found between reamed and unreamed nail. But the changing of IL-10 show us that after IMN, especially the reamed nailing, the level of anti-inflammatory mediators will show the difference more apparently between RFN and URFN while the patient got injured more severely. Under this condition, the RFN will aggravate the restrain of immunity.