胫骨远端髓内钉与锁定接骨板对胫骨远端粉碎性骨折患者围术期应激状态的影响比较

Comparison on the influence of distal intramedullary nail of tibia and locking proximal humerus plate for stress state of perioperative period of patients with distal comminuted fracture of tibia

目的:观察及比较胫骨远端髓内钉与锁定接骨板对胫骨远端粉碎性骨折患者围术期应激状态的影响情况。方法:选取56例胫骨远端粉碎性骨折患者,采用数表法将其随机分为胫骨远端髓内钉组(28例)和锁定接骨板组(28例),比较两组患者术前及术后1 d、3 d、5 d和7 d的应激激素、炎性应激及疼痛应激血清指标。结果:术前两组患者的应激激素皮质醇(Cor)、血管紧张素-Ⅱ(Ang-Ⅱ)及去甲肾上腺素(NE),炎性应激降钙素原(PCT)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8);疼痛应激前列腺素E_2(PGE_2)、缓激肽(BK)及P物质(SP)比较,差异均无统计学意义;而术后1 d、3 d和5 d胫骨远端髓内钉组的应激激素Cor、Ang-Ⅱ和NE均低于锁定接骨板组,其差异有统计学意义(t=5.642,t=6.123,t=6.781,t=7.254,t=7.165,t=8.034,t=5.963,t=6.520,t=6.637;P<0.05);炎性应激指标PCT、IL-6及IL-8均低于锁定接骨板组,其差异有统计学意义(t=5.643,t=5.579,t=6.871,t=7.353,t=7.642,t=6.456,t=5.950,t=6.227,t=9.820;P<0.05);术后1 d、3 d、5 d和7 d胫骨远端髓内钉组的疼痛应激血清指标PGE_2、BK及SP均低于锁定接骨板组,两组比较差异均有统计学意义(t=8.4522,t=6.137,t=6.250,t=7.146,t=7.257,t=6.564,t=6.541,t=5.985,t=5.620,t=7.631,t=9.243,t=9.941;P<0.05)。结论:胫骨远端髓内钉对胫骨远端粉碎性骨折患者围术期应激状态的影响明显好于锁定接骨板,胫骨远端髓内钉的临床应用价值较高。

Objective： To observe and compare the influence situation of distal intramedullary nail of tibia and locking proximal humerus plate for stress state of perioperative period of patients with distal comminuted fracture of tibia. Methods： 56 patients with distal comminuted fracture of tibia were selected and all of them were randomly divided into distal intramedullary nail of tibia group （28 cases） and locking proximal humerus plate group （28 cases）, and then series of serum indexes included the stress hormones, inflammatory stresses and pain stresses before the operation and at first, third, fifth and seventh day after the operation between the two groups were compared, respectively. Results： The differences of stress hormones （Cor, Ang-Ⅱ and NE）, inflammatory stresses （PCT, IL-6 and IL-8） and pain stresses （PGE2, BK and SP） pre-operation between the two groups were no significant. While the stress hormones （Cor, Ang-Ⅱ and NE） at the 1d, 3d and 5d post operation of distal intramedullary nail of tibia group were significantly lower than those of locking proximal humerus plate group （t=5.642, t=6.123, t=6.781, t=7.254, t=7.165, t=8.034, t=5.963, t=6.520, t=6.637, P〈0.05）, respectively. And the inflammatory stress indexes （PCT, IL-6 and IL-8） at the 1d, 3d and 5d post operation of distal intramedullary nail of tibia group were significantly lower than those of locking proximal humerus plate group （t=5.643, t=5.579, t=6.871, t=7.353, t=7.642, t=6.456, t=5.950, t=6.227, t=9.820, P〈0.05）, respectively. Besides, the pain stress indexes （PGE2, BK and SP） at the 1d, 3d, 5d and 7d post operation of distal intramedullary nail of tibia group were significantly lower than those of locking proximal humerus plate group （t=8.4522, t=6.137, t=6.250, t=7.146, t=7.257, t=6.564, t=6.541, t=5.985, t=5.620, t=7.631, t=9.243, t=9.941, P〈0.05）, respectively. Conclusion： The influence of distal intramedullary nail of tibia for the stress state of perioperative period of patients with distal comminuted fracture of tibia is significantly better than that of locking proximal humerus plate. Therefore, it＇s clinical application value is higher.