2种固定方法治疗胫腓骨骨折对转化生长因子-β_1表达影响及疗效比较

Comparison of transforming growth factor-β_1 expression and therapeutic effects on tibia and fibular fracture with two different fixation methods

目的:检测加压钢板和交锁髓内钉固定胫腓骨骨折后(Transforming growth factor-β1,TGF-β1)表达的改变,评价2种治疗方式对骨折愈合的影响。方法:117例非严重胫腓骨骨折患者随机分组,分别采用加压钢板和交锁髓内钉固定治疗,采用ELISA法在手术治疗后1d、7d、30d和90d分别检测TGF-β1的含量,并和手术后30d时的临床疗效相比较。结果:手术治疗后7dTGF-β1含量较1d有所上升,而至术后30d到9d,TGF-β1含量又逐渐下降。同时间点2组间比较,加压钢板固定组TGF-β1含量均较交锁髓内钉固定组TGF-β1含量低(P<0.01)。术后3月时,加压钢板固定组疗效优良率77.6%,低于交锁髓内钉固定组的91.5%(χ2=4.366,P=0.037)。而2组的并发症发生率相当(χ2=0.068,P=0.794)。结论:交锁髓内钉固定治疗胫腓骨骨折优于加压钢板固定,TGF-β1表达的差异在其中起到一定的作用。

Objective：To detect the expression of TGF-β1 in tibia and fibula fracture with two methods of compression plate fixation and intramedullary nail fixation,and to evaluate their therapeutic effects.Methods：117 patients with non severe tibia and fibula fractures were separated into two groups.One group received pressurized plates fixation for treatment,the other received intramedullary nail fixation.On 1,7,30 and 90 days after surgery,TGF-β1 was detected by ELISA,and on 30 days after surgery the clinical efficacy were also assessed. Results：The TGF-β1 content increased on 7 days as compared with that on 1 days after surgery,and the TGF-β1 content gradually decreased at on 30 to 90 days after surgery.The TGF-β1 content in compression plate fixation group were lower than that in intramedullary nailing group every points of four days（P0.01）.The excellent efficacy was 77.6%in the compression plate fixation group 3 months after surgery,which was lower than 91.5%in the intramedullary nailing group（χ2=4.366,P=0.037）.But thecomplication rate in two groups was the same（χ2=0.068,P=0.794）.Conclusion：The interlocking intramedullary nail fixation for tibia and fibula fracture has a better clinical efficacy than compression plate fixation,and the increased TGF-β1 expression may play a important role.