Conversion from external fixator to intramedullary nail causes a second hit and impairs fracture healing in a severe trauma model
Conversion from external fixator to intramedullary nail causes a second hit and impairs fracture healing in a severe trauma model
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DOI：
10.1002/jor.22242
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发表时间：
2013-03-01
影响因子：
2.8
通讯作者：
Ignatius, Anita
中科院分区：
文献类型：
--
作者：
Recknagel, Stefan;Bindl, Ronny;Ignatius, Anita
在多发性创伤患者中，二次击打已知会增强创伤后全身炎症反应，从而增加多器官功能障碍的风险。根据损伤控制骨科外科原则，骨折最初使用外部固定器治疗，一旦患者的免疫状态被认为是稳定的，就用内部接骨器取代。最近，我们发现在整个愈合过程中，严重的创伤会损害外固定支架稳定的骨折愈合。问题出现了，改用髓内钉是否会增加第二次击打时的炎症反应，导致进一步损害骨愈合。Wistar大鼠接受了由外固定器稳定的股骨截骨术。与此同时，一半的大鼠接受了额外的胸部创伤。4d后，两组大鼠各有一半更换外固定器为髓内钉。通过测定血清补体C5a水平评价炎症反应。骨折愈合通过三点弯曲、多层螺旋CT和组织形态计量学进行判定。胸部创伤组在第2次手术干预后6、24、72h C5a浓度显著升高。40天后，改用髓内钉显著降低了骨痂的弯曲硬度，但在有或没有胸部创伤的大鼠之间没有显著差异。47天后，与单纯外固定治疗的动物相比，接受转换的大鼠的弯曲刚性仍然下降，特别是在合并钝性胸部创伤的情况下。结果表明，多发伤后二次打击的积累可能会导致骨折愈合结果的恶化。(C)2012年骨科研究会。由威利期刊公司出版，《矫形外科杂志》2013年第31期：465471期
In poly-traumatic patients, second hits are known to potentiate the posttraumatic systemic inflammatory response, thus increasing the risk of multi-organ dysfunction. In accordance with damage control orthopaedic surgery principles, fractures are initially treated with external fixators, which are replaced by internal osteosynthesis once the immunological status of the patient is considered stable. Recently, we demonstrated that a severe trauma impaired the healing of fractures stabilized by external fixation during the entire healing period. The question arose, whether switching to intramedullary nailing increases the inflammatory response in terms of a second hit, leading to a further impairment of bone healing. Wistar rats received a femoral osteotomy stabilized by an external fixator. Simultaneously half of the rats underwent an additional thoracic trauma. After 4 days, the external fixator was replaced by an intramedullary nail in half of the rats of the two groups. The inflammatory response was evaluated by measuring serum C5a levels. Fracture healing was determined by three-point-bending, mu CT, and histomorphometry. The thoracic trauma significantly increased C5a concentrations 6, 24, and 72?h after the second surgical intervention. After 40 days, conversion to intramedullary nailing considerably decreased the flexural rigidity of the callus, with no significant differences between rats with or without thoracic trauma. After 47 days, flexural rigidity in rats subjected to conversion remained decreased compared to animals solely treated by external fixation, particularly in combination with blunt chest trauma. The results indicate that accumulation of second hits after multiple injuries could lead to aggravation of the fracture healing outcome. (C) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 465471, 2013