Andermahr Jonas, Elsner Andreas, Brings Angela Elisabeth, Hensler Thorsten, Gerbershagen Hans, Jubel Axel
Clinic of Trauma, Hand, Reconstructive Surgery, University of Cologne, Köln, Germany.
J Neurotrauma. 2006 May;23(5):708-20. doi: 10.1089/neu.2006.23.708.
Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessive bone healing (EH = hypertrophic callus formation and/or heterotopic ossification). Polytrauma patients are often attributed higher rates of delayed fracture union. This study compares 182 total fractures in 29 isolated polytrauma patients (POLY) and 48 patients after TBI and polytrauma (TBI+POLY), examining the clinical parameters of EH versus delay. A subset of 28 patients (13 TBI+POLY, 15 POLY) underwent serological testing for the following bone turnover parameters: carboxy-terminal extension peptide of type 1 procollagen (P1CP), pyridinolene cross-linked carboxy-terminal telopeptide (1CTP), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and basic fibroblast growth factor (bFGF). There were higher rates of delayed union in the POLY patients (45% vs. 23%) and EH in the TBI+POLY patients (33% vs. 17%) (not significant = NS). More delayed unions were observed in diaphyseal fractures suffered by POLY (28%) than in TBI+POLY (15%) patients (NS). EH after pelvic fracture was apparent in 52% TBI+POLY and in 21% POLY fractures (NS). P1CP levels did not differ between the groups, but the collagen breakdown parameter 1CTP was significantly higher in the POLY group (p = 0.01-0.04). IGF-1 levels were below normal in both groups, and did not differ. IGFBP-3, an IGF-1-inhibiting and collagenase-3-activating protein, was significantly higher in POLY patients (p = 0.017-0.037). bFGF levels did not vary between groups. Increased serum levels of 1CTP and IGFBP-3 in POLY patients suggest that EH in TBI patients is secondary to decreased collagen breakdown rather than increased synthesis.
创伤性脑损伤（TBI）合并骨骼损伤的患者过度骨愈合（EH，即肥大性骨痂形成和/或异位骨化）的发生率增加。多发伤患者的骨折延迟愈合率通常较高。本研究比较了29例单纯多发伤患者（POLY）和48例TBI合并多发伤患者（TBI+POLY）的182处骨折，研究EH与延迟愈合的临床参数。28例患者（13例TBI+POLY，15例POLY）的一个亚组接受了以下骨转换参数的血清学检测：I型前胶原羧基末端延长肽（P1CP）、吡啶啉交联羧基末端肽（1CTP）、胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白-3（IGFBP-3）和碱性成纤维细胞生长因子（bFGF）。POLY患者的延迟愈合率较高（45%对23%），TBI+POLY患者的EH发生率较高（33%对17%）（无显著性差异=NS）。POLY患者骨干骨折的延迟愈合（28%）比TBI+POLY患者（15%）更常见（NS）。骨盆骨折后的EH在52%的TBI+POLY患者和21%的POLY骨折患者中明显（NS）。两组间P1CP水平无差异，但POLY组的胶原降解参数1CTP显著更高（p=0.01-0.04）。两组的IGF-1水平均低于正常，且无差异。IGFBP-3是一种抑制IGF-1并激活胶原酶-3的蛋白，在POLY患者中显著更高（p=0.017-0.037）。两组间bFGF水平无变化。POLY患者血清1CTP和IGFBP-3水平升高表明，TBI患者的EH继发于胶原降解减少而非合成增加。
