Liu De-Quan, Lu Yi, Wang Man-Yi
Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Wai Ke Za Zhi. 2004 Jun 22;42(12):741-5.
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.
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.
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.
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.
探讨手术后即刻一些细胞因子及其他免疫标志物的表达情况、股骨钉内固定对全身免疫的影响，并试图区分扩髓与非扩髓交锁髓内钉之间的差异。
59例急性股骨骨折患者，其中男性55例，女性4例，平均年龄32.1岁，根据损伤严重度评分（ISS）分为2组。所有患者均采用闭合复位髓内钉固定。第1组，扩髓23例，非扩髓23例；第2组，扩髓7例，非扩髓6例。于术前24小时、术后1小时、24小时、48小时采集静脉血样本。采用酶联免疫吸附测定法检测血清肿瘤坏死因子（TNF）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）。采用蛋白分析仪检测C反应蛋白（CRP）。我们还从22名健康未受伤志愿者采集静脉样本作为对照组。
术后所有免疫标志物均升高，IL-6、IL-8、IL-10在术后1小时开始升高，24小时达到峰值，然后下降，但48小时时未降至正常水平。TNF和CRP在术后24小时升高，然后在48小时下降。所有介质均显著高于对照组（<0.05）。在第1组和第2组的扩髓与非扩髓患者之间，虽然扩髓股骨钉组（RFN）的TNF、IL-6、IL-8、IL-10和CRP水平有高于非扩髓股骨钉组（URFN）的趋势，但除术后24小时RFN组血清IL-10释放量高于URFN组外（P = 0.047），未发现显著差异。2例患者发生全身炎症反应综合征（SIRS），但其标志物与未出现SIRS症状的患者无显著差异。
对于损伤不太严重的患者，使用髓内钉治疗会使炎症介质在更高水平再次释放，但很快会被自身免疫平衡，因此髓内钉不会造成严重损害。扩髓与非扩髓钉之间未发现显著差异。但IL-10的变化表明，在髓内钉固定后，尤其是扩髓钉固定后，当患者损伤更严重时，RFN与URFN之间抗炎介质水平的差异会更明显。在此情况下，RFN会加重免疫抑制。
