骨肽注射液在下肢骨折患者术后应用对骨折愈合的影响及其机制

Effect of bone peptide injection on fracture healing in patients with lower limb fracture and its mechanism

目的探讨下肢骨折患者使用骨肽注射液对骨折愈合效果的影响及其作用机制。方法回顾性分析洛阳正骨医院骨科2015年1月—2016年6月采取切开复位内固定治疗的120例胫骨骨折患者,其中60例术后采用常规治疗措施(常规组)、60例患者术后加用骨肽注射液治疗(治疗组)。常规组男性40例,女性20例;年龄41~78岁,平均55.4岁,其中左侧32例、右侧28例,骨折后至手术时间平均(2.2±1.8)d。治疗组男性37例,女性23例;年龄39~79岁,平均54.6岁,其中左侧30例、右侧30例,骨折至手术时间平均(2.5±1.5)d。比较两组平均骨折愈合时间、术后VAS评分、肿胀程度评分以及相关血清学指标。结果治疗组平均骨折愈合时间(9.8±2.0)周显著短于常规组(10.7±2.2)周(P<0.05);治疗组在术后3、7、14d的VAS评分(4.41±1.30、2.96±0.88、2.21±0.59)、肿胀程度评分(2.25±0.48、1.53±0.36、0.82±0.26)均显著低于常规组(5.60±1.48、3.72±1.09、3.08±0.77)、(2.19±0.52、1.90±0.40、1.15±0.33),P<0.05;术后28d,治疗组的血清碱性磷酸酶(ALP)(98.9±14.6)U/L、骨钙素(BGP)(3.81±0.72)μg/L、骨保护素(OPG)(26.4±5.9)pmol/L、Ⅰ型胶原羧基端肽(PICP)(144.8±19.0)μg/L显著高于常规组[(90.2±11.7)U/L、(3.08±0.76)μg/L、(22.9±5.1)pmol/L、(122.0±18.5)μg/L],P<0.05,Ⅰ型胶原羧基端肽β特殊序列(β-CTX)(0.37±0.09)ng/mL显著低于常规组(0.46±0.11)ng/mL(P<0.05);术后3、7d,治疗组的血清白细胞介素-2(IL-2)[(9.22±2.44)μg/L、(4.84±1.88)μg/L]、白细胞介素-6(IL-6)[(76.2±20.1)μg/L、(54.9±18.5)μg/mL]、肿瘤坏死因子-α(TNF-α)[(440.8±97.2)ng/mL、(330.8±69.5)ng/mL]均低于常规组[(10.98±2.87)μg/L、(7.20±2.09)μg/L、(84.0±24.8)μg/L、(61.0±19.3)μg/mL、(498.1±114.8)ng/mL、(380.7±77.6)ng/mL],P<0.05。结论下肢骨折患者使用骨肽注射液有利于减轻术后炎症反应、肿痛程度,有利于促进骨折愈合。

Objective To investigate the effect of bone peptide injection on fracture healing in patients with lower limb fracture and its mechanism. Methods Clinical data of 120 cases of tibial fractures was retrospectively analyzed,who were treated with open reduction and internal fixation in Department of Orthopedics of Luoyang BoneSetting Hospital from Jan. 2015 to Jun. 2016. Among them,60 cases were treated with conventional treatment（ conventional group） and 60 cases were treated with bone peptide injection（ treatment group） after operation. In the conventional group,there were 40 males and 20 females,aged 41-78 years,with an average of 55. 4 years,including 32 cases on the left side and 28 cases on the right side. The average operation time after fracture was（ 2. 2 ±1. 8） days. In the treatment group,there were 37 males and 23 females,aged 39-79 years,with an average of 54. 6 years,including 30 cases on the left side and 30 cases on the right side. The average operation time after fracture was（ 2. 5 ± 1. 5） days. The average fracture healing time,postoperative VAS score,swelling degree score and related serological indicators were compared between the two groups. Results The mean fracture healing time in the treatment group was（ 9. 8 ± 2. 0） weeks,which was significantly shorter than that in the conventional group of（ 10. 7± 2. 2） weeks（ P〈0. 05）. The VAS scores（ 4. 41 ± 1. 30,2. 96 ± 0. 88,2. 21 ± 0. 59） and swelling degree scores（ 2. 25 ± 0. 48,1. 53 ± 0. 36,0. 82 ± 0. 26） on the 3 rd,7 th,and 14 th days after operation in the treatment group were all significantly lower than those in the conventional group（ 5. 60 ± 1. 48,3. 72 ± 1. 09,3. 08 ± 0. 77）,（ 2. 19 ±0. 52,1. 90 ± 0. 40,1. 15 ± 0. 33,P〈0. 05）; At 28 days after operation,the blood ALP was（ 98. 9 ± 14. 6） U/L,BGP was（ 3. 81 ± 0. 72） μg/L,OPG was（ 26. 4 ± 5. 9） pmol/L,and PICP was（ 144. 8 ± 19. 0） μg/L in the treatment group,which were significantly higher than in the conventional group（（ 90. 2 ± 11. 7） U/L,（ 3. 08 ± 0. 76）μg/L,（ 22. 9 ± 5. 1） pmol/L,（ 122. 0 ± 18. 5） μg/L,P〈0. 05）. β-CTX was（ 0. 37 ± 0. 09） ng/mL in the treatment group,which was significantly lower than that of（ 0. 46 ± 0. 11） ng/mL in the conventional group（ P〈0. 05）;At 3 and 7 days after operation,serum IL-2 levels in treatment group were（ 9. 22 ± 2. 44） μg/L,（ 4. 84 ± 1. 88） μg/L,respectively; IL-6 was（ 76. 2 ± 20. 1） μg/mL,（ 54. 9 ± 18. 5） μg/mL,respectively; and TNF-α was（ 440. 8 ±97. 2） ng/mL,330. 8 ± 69. 5） ng/mL,respectively; these indexes were lower than in the conventional group（ 10. 98 ± 2. 87） μg/L,（ 7. 20 ± 2. 09） μg/L,（ 84. 0 ± 24. 8） ng/mL,（ 61. 0 ± 19. 3） μg/mL,（ 498. 1 ± 114. 8）ng/mL,（ 380. 7 ± 77. 6） ng/mL（ P〈0. 05）. Conclusion The use of bone peptide injection in patients with lower extremity fractures will help reduce postoperative inflammatory reactions,swelling,and help promote fracture healing.