Chen Yunqiang, Ouyang Jiemiao, Chen Hong
Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
Evid Based Complement Alternat Med. 2023 Jan 31;2023:8498062. doi: 10.1155/2023/8498062. eCollection 2023.
The effect of pre-emptive analgesia plus early weight-bearing treadmill training (EWBTT) on healing and motor function recovery of femoral shaft fracture is not clear.
A total of 60 SD male rats were randomly allocated into 4 groups: group A (pre-emptive analgesia with EWBTT), group B (pre-emptive analgesia with delayed weight-bearing treadmill training, DWBTT), group C (pre-emptive analgesia with no weight-bearing), and group D (EWBTT with no pre-emptive analgesia). All rats were molded by internal fixation with Kirschner wire after right femoral shaft fracture. In groups A, B, and C, tramadol was intramuscularly injected 15 minutes before surgery. EWBTT was performed at day 1 postoperatively in groups A and D, and DWBTT was performed at day 14 postoperatively in group B. Oblique plate test was accomplished to assess hindlimb motor function recovery of rats in each group. Status of fracture healing was assessed through digital radiography (DR). Hematoxylin-eosin (HE) staining and immunohistochemistry of bone morphogenetic protein-2 (MBP-2) and vascular endothelial growth factor (VEGF) in callus were performed to explore fracture healing. The expression of BMP-2 and VEGF protein in quadriceps femoris muscle was detected by Western blot technique and mRNA expression of BMP-2 and VEGF in callus ascertained via reverse transcription-polymerase chain reaction (RT-PCR) technique.
For oblique plate test, rats in group A outperformed those in groups B and C at all time points after operation. DR image revealed that large numbers of callus growth, blurred fracture line, and obvious continuous callus passing through the fracture line can be found in group A at day 28 postoperatively, which is the best healing status among all groups. HE staining of callus confirmed the optimal effect of healing for rats in group A. VEGF and BMP-2 expression by immunohistochemistry showed a significantly higher positive score for callus in group A while those in group C being the lowest at all time points postoperatively. Significantly higher expression level of VEGF and BMP-2 protein was detected in quadriceps femoris muscle from group A, which exceeded those in all other groups at all time points. RT-PCR testing proved the highest expression of BMP-2 and VEGF mRNA in callus of rats from group A, significantly higher than those of other groups.
Both pre-emptive analgesia and EWBTT can effectively invoke the expression of VEGF and BMP-2 and promote recovery of hindlimb locomotor function in rats with femoral fracture, and the combination of them leads to more superior results.
超前镇痛联合早期负重跑步机训练（EWBTT）对股骨干骨折愈合及运动功能恢复的影响尚不清楚。
将60只SD雄性大鼠随机分为4组：A组（超前镇痛联合EWBTT）、B组（超前镇痛联合延迟负重跑步机训练，DWBTT）、C组（超前镇痛但不负重）、D组（EWBTT但无超前镇痛）。所有大鼠右侧股骨干骨折后均采用克氏针内固定造模。A、B、C组在手术前15分钟肌内注射曲马多。A组和D组在术后第1天进行EWBTT，B组在术后第14天进行DWBTT。进行斜板试验以评估各组大鼠后肢运动功能恢复情况。通过数字X线摄影（DR）评估骨折愈合情况。对骨痂进行苏木精-伊红（HE）染色以及骨形态发生蛋白-2（MBP-2）和血管内皮生长因子（VEGF）的免疫组织化学检测以探讨骨折愈合情况。采用蛋白质印迹技术检测股四头肌中BMP-2和VEGF蛋白的表达，通过逆转录-聚合酶链反应（RT-PCR）技术确定骨痂中BMP-2和VEGF的mRNA表达。
对于斜板试验，A组大鼠在术后所有时间点的表现均优于B组和C组。DR图像显示，术后第28天A组可见大量骨痂生长、骨折线模糊，有明显连续骨痂通过骨折线，这是所有组中愈合状态最佳的。骨痂的HE染色证实A组大鼠的愈合效果最佳。免疫组织化学检测显示，术后所有时间点A组骨痂的VEGF和BMP-2表达阳性评分显著更高，而C组最低。在A组股四头肌中检测到VEGF和BMP-2蛋白的表达水平显著更高，在所有时间点均超过其他所有组。RT-PCR检测证明A组大鼠骨痂中BMP-2和VEGF mRNA的表达最高，显著高于其他组。
超前镇痛和EWBTT均可有效激发VEGF和BMP-2的表达，并促进股骨骨折大鼠后肢运动功能的恢复，两者联合效果更佳。
