Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany.
Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany.
Front Immunol. 2024 Oct 23;15:1476009. doi: 10.3389/fimmu.2024.1476009. eCollection 2024.
Open reduction and fixation are the standard of care for treating mandibular fractures and usually lead to successful healing. However, complications such as delayed healing, non-union, and infection can compromise patient outcomes and increase healthcare costs. The initial inflammatory response, particularly the response involving specific CD8 T cell subpopulations, is thought to play a critical role in healing long bone fractures. In this study, we investigated the role of these immune cell profiles in patients with impaired healing of mandibular fractures.
In this prospective study, we included patients with mandibular fractures surgically treated at Charité - Universitätsmedizin Berlin, Germany, between September 2020 and December 2022. We used follow-up imaging and clinical assessment to evaluate bone healing. In addition, we analyzed immune cell profiles using flow cytometry and quantified cytokine levels using electrochemiluminescence-based multiplex immunoassays in preoperative blood samples.
Out of the 55 patients enrolled, 38 met the inclusion criteria (30 men and 8 women; mean age 32.18 years). Radiographic evaluation revealed 31 cases of normal healing and 7 cases of incomplete consolidation, including 1 case of non-union. Patients with impaired healing exhibited increased levels of terminally differentiated effector memory CD8 T cells (T) and a higher T to regulatory T cell (T) ratio, compared with those with normal healing.
Our analysis of mandibular fracture cases confirms our initial hypothesis derived from long bone fracture healing: monitoring the T to T ratio in preoperative blood can be an early indicator of patients at risk of impaired bone healing. Radiologic follow-up enabled us to detect healing complications that might not be detected by clinical assessment only. This study highlights the potential of individual immune profiles to predict successful healing and may form the basis for future strategies to manage healing complications.
切开复位和内固定是治疗下颌骨骨折的标准治疗方法，通常可实现成功愈合。然而，并发症如延迟愈合、不愈合和感染会影响患者的预后并增加医疗保健成本。初始炎症反应，特别是涉及特定 CD8 T 细胞亚群的反应，被认为在长骨骨折愈合中发挥关键作用。在这项研究中，我们研究了这些免疫细胞特征在下颌骨骨折愈合受损患者中的作用。
在这项前瞻性研究中，我们纳入了 2020 年 9 月至 2022 年 12 月在德国柏林 Charité - Universitätsmedizin 接受下颌骨骨折手术治疗的患者。我们使用随访影像学和临床评估来评估骨愈合情况。此外，我们使用流式细胞术分析免疫细胞谱，并使用基于电化学发光的多重免疫分析测定术前血液样本中的细胞因子水平。
在纳入的 55 名患者中，38 名符合纳入标准（30 名男性和 8 名女性；平均年龄 32.18 岁）。影像学评估显示 31 例正常愈合和 7 例愈合不完整，包括 1 例不愈合。与正常愈合患者相比，愈合不良患者的终末分化效应记忆 CD8 T 细胞（T）水平升高，且 T 细胞与调节性 T 细胞（T）的比值更高。
我们对下颌骨骨折病例的分析证实了我们从长骨骨折愈合中得出的初始假设：监测术前血液中的 T 细胞与 T 细胞比值可以作为预测骨愈合不良风险的早期指标。影像学随访使我们能够检测到仅通过临床评估可能无法检测到的愈合并发症。这项研究强调了个体免疫谱预测成功愈合的潜力，并可能为未来管理愈合并发症的策略提供基础。
