Karthick S R, Sen Ramesh Kumar, Gopinathan Nirmal Raj, Dhillon Mandeep Singh, Nada Ritambhra, Sharma R R
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Senior Director and Professor, Max Superspeciality Hospital, Mohali, India.
J Clin Orthop Trauma. 2020 Feb;11(Suppl 1):S86-S92. doi: 10.1016/j.jcot.2019.09.014. Epub 2019 Sep 16.
There are few studies in the literature that correlates the level of IL-6 with fat embolism syndrome (FES). But there is no conclusive correlative evidence of its specific relation to the establishment of FES. Also it is a proven fact that polytrauma due to its associated multiple long bone fracture and/or associated shock can predispose an individual to FES. By hypothesizing that polytrauma induces Fat Embolism in the animal; it was considered worthwhile to study the association of IL-6 in polytrauma induced Fat Embolism (FE) and to compare it with induced FE by injecting fatty acids in rabbits.
An animal study was conducted in 32 New Zealand white rabbits. The animals were divided into 3 groups: control, fat embolism and polytrauma group. We injected 6 ml of normal saline and 0.2 ml of linoleic acid in the control and fat embolism group respectively. In the polytauma group we created bilateral femur and tibial shaft factures which were stabilized with intramedullary K- wires. Blood was taken before and at 6, 12 and 24 h after the procedure to measure plasma IL-6 levels. The rabbits were euthanized at 24 h and lungs were removed and stained for fat globules.
All rabbits in the fat embolism group and around 72.22% rabbits in polytrauma group had fat embolism. The IL-6 levels were raised in all the groups reaching a peak at 6 h after procedure with a decline in the values at 12 h for polytrauma and fat embolism group. IL-6 in the control group was stationary after an initial raise at 6 h. There was no statistically significant difference seen among the groups (p value > 0.05) at 6 h.
IL-6 is not a specific marker to fat embolism per se or polytrauma who later develop complications like FES. Even though the recent literature says that IL-6 is an early marker of fat embolism, still the diagnosis of fat embolism syndrome is clinical only and can be supplemented by laboratory markers. None of the laboratory markers individually is good enough to predict the development of FES in an individual.
文献中很少有研究将白细胞介素-6（IL-6）水平与脂肪栓塞综合征（FES）相关联。但尚无确凿的相关证据表明其与FES的发生存在特定关系。此外，一个已被证实的事实是，多发伤因其伴有多处长骨骨折和/或相关休克，可使个体易患FES。通过假设多发伤可在动物体内诱发脂肪栓塞，研究IL-6在多发伤诱发的脂肪栓塞（FE）中的关联，并将其与通过向兔子注射脂肪酸诱发的FE进行比较被认为是有价值的。
对32只新西兰白兔进行了一项动物研究。将动物分为3组：对照组、脂肪栓塞组和多发伤组。我们分别在对照组和脂肪栓塞组中注射6毫升生理盐水和0.2毫升亚油酸。在多发伤组中，我们制造了双侧股骨和胫骨干骨折，并用髓内克氏针进行固定。在手术前以及手术后6、12和24小时采集血液，以测量血浆IL-6水平。在24小时时对兔子实施安乐死，并取出肺部进行脂肪球染色。
脂肪栓塞组的所有兔子以及多发伤组约72.22%的兔子发生了脂肪栓塞。所有组的IL-6水平均升高，在手术后6小时达到峰值，多发伤组和脂肪栓塞组在12小时时数值下降。对照组的IL-6在6小时初次升高后保持稳定。在6小时时，各组之间未见统计学显著差异（p值>0.05）。
IL-6本身并非脂肪栓塞或后来发生FES等并发症的多发伤的特异性标志物。尽管最近的文献称IL-6是脂肪栓塞的早期标志物，但脂肪栓塞综合征仍仅靠临床诊断，实验室标志物可作为补充。没有任何一个实验室标志物足以单独预测个体发生FES。
