Inflammatory Cytokine Response Following Acute Tibial Plateau Fracture
Inflammatory Cytokine Response Following Acute Tibial Plateau Fracture
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DOI：
10.2106/jbjs.n.00200
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发表时间：
2015-03-18
影响因子：
5.3
通讯作者：
Higgins, Thomas F.
中科院分区：
文献类型：
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作者：
Haller, Justin M.;McFadden, Molly;Higgins, Thomas F.
背景：本研究的目的是评估急性胫骨平台骨折后人类滑液中炎性细胞因子的浓度。我们的假设是关节内骨折后的炎症反应会升高，高能量损伤后的炎症反应会比低能量损伤后的炎症反应更大。方法：2011年12月至2013年6月，我们前瞻性地纳入了45例急性胫骨平台骨折患者。对受伤和未受伤的膝关节进行滑液抽吸。20名需要外固定器后延迟固定的患者在两个手术过程中都进行了抽吸。IL-2、IL-4、IL-6、IL-7、IL-8、IL-10、IL-12(P70)、IL-13、IL-17A、肿瘤坏死因子-α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)、结果：45例患者年龄20~60岁，平均42岁。其中24例为低能量损伤，21例为高能量胫骨平台损伤。在IL-1b、IL-6、IL-8、IL-10、IL-1RA和单核细胞趋化蛋白-1的浓度方面，受伤和未受伤的膝关节之间有显著差异(P<；0.001)。在高能量损伤和低能量损伤之间，滑液细胞因子浓度没有明显差异。伤后3~21d(平均9.5d)，伤侧膝关节IL-10(p<；0.001)、IL-1RA(p=0.002)、IL-6(p<；0.001)、IL-8(p<；0.001)和单核细胞趋化蛋白-1(p=0.002)水平明显高于健侧膝关节。在高能量损伤和低能量损伤之间，炎性细胞因子浓度没有明显差异。第二次抽吸时滑液中IL-10、IL-8、IL-6、IL-1RA和MCP-1浓度持续升高。
Background: The objective of the present study was to evaluate human synovial fluid for inflammatory cytokine concentrations following acute tibial plateau fracture. Our hypothesis was that there would be an elevated inflammatory response following intra-articular fracture, and that the inflammatory response would be greater after high-energy compared with low-energy injuries.Methods: Between December 2011 and June 2013, we prospectively enrolled forty-five patients with an acute tibial plateau fracture. Synovial fluid aspirations were performed on the injured and uninjured knees. Twenty patients who required an external fixator followed by delayed fixation underwent aspiration at both surgical procedures. The concentrations of interferon-gamma (IFN-gamma), interleukin-1 beta (IL-1 beta), interleukin-1 receptor antagonist (IL-1RA), IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12(p70), IL-13, IL-17A, tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein-1 beta (MIP-1 beta) were quantified with use of multiplex assays.Results: The forty-five patients had an average age of forty-two years (range, twenty to sixty years). There were twenty-four low-energy and twenty-one high-energy tibial plateau injuries. There was a significant difference between injured and uninjured knees (p < 0.001) with regard to concentrations of IL-1b, IL-6, IL-8, IL-10, IL-1RA, and MCP-1. There was not a detectable difference in synovial fluid cytokine concentrations between high and low-energy injuries. The concentrations of IL-10 (p < 0.001), IL-1RA (p = 0.002), IL-6 (p < 0.001), IL-8 (p < 0.001), and MCP-1 (p = 0.002) were significantly greater in the injured knee than in the uninjured knee at the second aspiration, at a mean of 9.5 days (range, three to twenty-one days) after the initial injury.Conclusions: There was a significant local inflammatory response following acute tibial plateau fracture. There was not a detectable difference in inflammatory cytokine concentration between high and low-energy injuries. Synovial fluid concentrations of IL-10, IL-8, IL-6, IL-1RA, and MCP-1 remained elevated at the second aspiration.