神经生长因子在合并颅脑损伤的股骨干骨折修复中的意义

Significance of expression of nerve growth factor in femoral shaft fracture combined with traumatic brain injury

目的 探讨合并颅脑损伤的股骨干骨折患者血清中神经生长因子（NGF）的变化及其对骨折愈合的影响.方法 选择广西省柳州市人民医院骨科自2002年7月至2008年7月收治的新鲜闭合性股骨干骨折患者64例,其中伴有颅脑损伤（混合损伤组）32例,不伴有其他损伤（单纯骨折组）32例.所有患者依病情选择切开复位内固定或带锁髓内钉固定术治疗.采用双抗体夹心ELISA法检测患者伤后第1、7、14、21天血清NGF的水平,分析混合损伤组患者伤后第1天血清NGF水平与骨折临床愈合时间的相关性并比较2组患者的骨折临床愈合时间.结果 与单纯骨折组比较,混合损伤组各时间点的NGF水平均较高,差异有统计学意义（P＜0.05）;2组患者血清NGF水平均呈现出先升后降的趋势,第14天达高峰,差异有统计学意义（P＜0.05）.混合损伤组的骨折临床愈合时间[（62.88±5.99）d]要比单纯骨折组[（82.47±3.07）d]短,差异有统计学意义（t=-16.473,P=0.000）;混合损伤组患者的骨折临床愈合时间与伤后第1天的血清NGF水平呈负相关关系（r=-0.966,P=0.000）.结论 合并颅脑损伤的骨折患者伤后血清NGF水平增高,骨折临床愈合时间缩短,可能是促进骨折修复的因素之一.

Objective To explore the relationship between fracture healing and level variation of nerve growth factor （NGF） in the serum of patients with femoral shaft fracture combined with traumatic brain injury. Methods Sixty-four patients with femoral shaft fracture were divided into simple fracture group （n=32） and composited injured group （fracture combined with traumatic brain injury, n=32）. Treatments like open reduction and internal fixation, or fixation with unreamed tibial nail were performed according to the patient＇s condition. Two-site enzyme-linked immunosorbent assy （ELISA） was employed to detect the serum level of NGF 1, 7, 14 and 21 d after injury; and correlation analysis of clinical healing time of fracture and serum level of NGF was performed on the 1 d of injury in the composited injured group. The clinical healing time of fracture between the 2 groups were compared.Results The clinical healing time in the composited injured group （62.88±5.99） was shorter than that in the simple fracture group （82.47±3.07, t=-16.473, P=0.000）; and there was a high negative correlation between the clinical healing time of fracture and serum level of NGF on the 1^st d of injury in the composited injured group（r=-0.966, P=0.000）. The serum level of NGF in the composited injured group was higher than that in the simple group at each time points （P〈0.05）, and the serum level of NGF in the 2 groups peaked on the 14th d of injury; and decreased gradually. Conclusion Serum level of NGF increases in the early phase in patients with femoral shaft fracture combined with traumatic brain injury and remains at a high level for the first 2 weeks, which may play an important role in promoting fracture healing.