Szczesny Grzegorz, Olszewski Waldemar L, Gorecki Andrzej
Department of Surgical Research, Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
Lymphat Res Biol. 2005;3(3):137-45. doi: 10.1089/lrb.2005.3.137.
Closed bone fractures, and torn muscles and tendons are "internal wounds". What kind of reaction do they evoke in the local and systemic immune system? Cellular debris of damaged tissue and extravasated blood cells are removed by scavenger cells. They are transported via lymphatics to the lymph nodes. There elimination of self antigens takes place. Clinically, no enlargement of lymph nodes is observed after closed fractures and soft tissue damage. The question arises whether there is really no enlargement of regional lymph nodes, in other words, no reaction to damaged cell antigens. This question was studied by using lymphoscintigraphy to visualize lymphatics and lymph nodes draining the site of closed bone fracture. The lymphoscintigraphic pictures of two groups of patients, those with a rapid noncomplicated healing of leg fractures, and those with protracted healing and undergoing surgical reconstructions, were evaluated. The surface area of lymphatic pathways and inguinal lymph nodes on the injured and contralateral normal limb were measured. Enlarged superficial lymphatics and inguinal lymph nodes were found in limbs with healed bone fractures, and decreased inguinal lymph nodes and visualization of deep lymphatics and popliteal nodes in the majority of patients with nonhealing fractures. There was a lack of correlation between age of patients, duration of healing, and surgical interventions and the lymphoscintigraphic changes. These findings suggest that the fracture gap tissue is a dominant source of signals to the lymph nodes, releasing cellular and humoral regulatory factors. Taken together, there is a strong immune reaction of lymph node to the fracture, although it cannot be recognized clinically.
闭合性骨折以及肌肉和肌腱撕裂属于“内伤”。它们在局部和全身免疫系统中会引发何种反应？受损组织的细胞碎片和外渗的血细胞由吞噬细胞清除。它们通过淋巴管被输送到淋巴结。在那里会发生自身抗原的清除。临床上，闭合性骨折和软组织损伤后未观察到淋巴结肿大。问题在于区域淋巴结是否真的没有肿大，换句话说，对受损细胞抗原是否没有反应。通过使用淋巴闪烁造影术来可视化引流闭合性骨折部位的淋巴管和淋巴结，对这个问题进行了研究。评估了两组患者的淋巴闪烁造影图像，一组是腿部骨折快速顺利愈合的患者，另一组是愈合延迟并接受手术重建的患者。测量了受伤肢体和对侧正常肢体上淋巴通路和腹股沟淋巴结的表面积。在骨折已愈合的肢体中发现浅表淋巴管和腹股沟淋巴结肿大，而在大多数骨折不愈合的患者中，腹股沟淋巴结减小，深部淋巴管和腘窝淋巴结显影。患者年龄、愈合持续时间、手术干预与淋巴闪烁造影变化之间缺乏相关性。这些发现表明骨折间隙组织是向淋巴结发出信号的主要来源，释放细胞和体液调节因子。综上所述，淋巴结对骨折存在强烈的免疫反应，尽管在临床上无法识别。
