内外联合固定术治疗骨盆骨折的临床疗效及对血清IL-10、IL-13、TGF-β、TNF-α、IL-1β及IL-6水平的影响

Clinical efficacy of internal and external fixation for pelvic fractures and its effect on serum IL-10,IL-13, TGF-β, TNF-β, IL-1 β and IL-6 levels

目的探讨骨盆骨折患者采用内外联合固定术治疗的临床疗效及对血清白细胞介素-10(IL-10)、白细胞介素-13(IL-13)、转化生长因子-β(TGF-β)、肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)及白细胞介素-6(IL-6)水平的影响。方法 82例骨盆骨折患者,根据手术方法不同分为观察组(42例)和对照组(40例)。对照组给予传统切开复位内固定手术治疗,观察组给予经皮骶髂骨关节空心螺钉内固定联合支架外固定治疗。对比两组手术相关指标(手术时间、术中出血量、骨折愈合时间以及完全负重下地时间),记录两组术前和术后3 d及术后10 d血清IL-10、IL-13、TGF-β、TNF-α、IL-1β及IL-6水平,随访记录患者术后6、12个月的Majeed功能评分,统计患者临床疗效,并记录患者术后并发症发生情况。结果观察组术中出血量(152.35±30.73)ml少于对照组的(528.52±87.15)ml,手术时间(58.83±10.30)min、骨折愈合时间(18.45±3.24)周和完全负重下地时间(23.25±3.14)周均短于对照组的(106.36±15.61)min、(25.96±4.11)周和(28.24±4.16)周,差异具有统计学意义(t=26.315、16.349、9.213、6.150,P<0.05)。术后3 d,两组的血清IL-10、IL-13、TGF-β、TNF-α、IL-1β及IL-6水平均显著高于术前,但观察组低于对照组,差异具有统计学意义(P<0.05);术后10 d,两组的血清IL-10、IL-13、TGF-β、TNF-α、IL-1β及IL-6水平均显著低于术后3 d,且观察组低于对照组,差异具有统计学意义(P<0.05)。观察组术后6、12个月的Majeed功能评分分别为(68.24±8.24)、(75.26±5.24)分,均显著高于对照组的(59.54±8.17)、(65.37±6.35)分,差异具有统计学意义(t=4.799、7.708,P<0.05)。观察组优良率92.86%显著高于对照组的75.00%,差异具有统计学意义(P<0.05)。观察组术后并发症发生率4.76%显著低于对照组的20.00%,差异具有统计学意义(P<0.05)。结论对于骨盆骨折患者,给予经皮骶髂骨关节空心螺钉内固定联合支架外固定治疗效果明确,相对于传统的切开复位内固定手术而言,可显著缩短手术时间,减少术中失血量,促进患者术后的快速康复,对机体炎性应激作用小,术后并发症少,具有临床推广价值。

Objective To investigate the clinical efficacy of internal and external fixation for the treatment of patients with pelvic fractures and its effect on serum interleukin-10（IL-10）, interleukin-13（IL-13）, transforming growth factor-β（TGF-β）, tumor necrosis factor-α（TNF-α）, interleukin-1 β（IL-1 β）, and interleukin-6（IL-6）. Methods A total of 82 patients with pelvic fractures were divided by different surgical methods into observation group（42 cases） and control group（40 cases）. The control group received traditional open reduction and internal fixation for treatment, and the observation group received percutaneous internal fixation with sacroiliac joint hollow screw and external stent fixation. Comparison were made on surgical related indexes（operation time, intraoperative bleeding volume, fracture healing time and full weight-bearing time） between the two groups, and record were made on, the levels of serum IL-10, IL-13, TGF-β, TNF-α, IL-1 β and IL-6 of the two groups before and after 10 d of operation. The Majeed function score of patients at 6 and 12 months after operation was recorded, the clinical efficacy was counted, and the occurrence of postoperative complications were recorded. Results The observation group had less intraoperative bleeding volume as（152.35±30.73） ml than（528.52±87.15） ml in the control group, shorter operation time as（58.83±10.30） min, fracture healing time as（18.45±3.24） weeks and full weight-bearing time as（23.25±3.14） weeks than（106.36±15.61） min,（25.96±4.11） weeks and（28.24±4.16） weeks in the control group. Their difference was statistically significant（t=26.315, 16.349, 9.213, 6.150, P〈0.05）. In postoperative 3 d, both groups had obviously higher IL-10, IL-13, TGF-β, TNF-α, IL-1β and IL-6 level than before operation, but the observation group was lower than the control group. Their difference was statistically significant（P〈0.05）. In postoperative 10 d, both groups had obviously lower serum IL-10, IL-13, TGF-β, TNF-α, IL-1β and IL-6 level than those of postoperative 3 d, and the observation group was lower than the control group. Their difference was statistically significant（P〈0.05）. The observation group had Majeed function score of patients at 6 and 12 months after operation respectively as（68.24±8.24） and（75.26±5.24）points, which were obviously higher than（59.54±8.17） and（65.37±6.35） points in the control group, and their difference was statistically significant（t=4.799, 7.708, P〈0.05）. The observation group had obviously higher excellent rate as 92.86% than 75.00% in the control group, and the difference was statistically significant（P〈0.05）. The observation group had obviously lower incidence of postoperative complications as 4.76% than 20.00% in the control group, and the difference was statistically significant（P〈0.05）. Conclusion Combination of percutaneous internal fixation with sacroiliac joint hollow screw and external stent fixation shows remarkable effect for patients with pelvic fractures. Compared with the traditional open reduction and internal fixation, this method can shorten operation time significantly, reduce intraoperative bleeding volume, and promote patient’s rapid recovery after operation, with small body inflammatory stress and less postoperative complications. This method contains clinical promotion value.