高压氧联合神经生长因子局部注射对骨质疏松性骨折延迟愈合患者血清黏附因子及微循环指标表达的影响

Effect of hyperbaric oxygen combined with local injection of nerve growth factor on the expression of serum adhesion factor and microcirculation in patients with delayed union of osteoporotic fractures

目的研究高压氧联合神经生长因子局部注射对骨质疏松性骨折延迟愈合患者血清黏附因子及微循环指标表达的影响。方法选取骨质疏松性骨折有延迟愈合患者84例,分为对照组和观察组各42例。两组均行常规治疗。观察组除此之外,进行高压氧疗,并在骨折周围肌肉注射鼠神经生长因子。比较两组患者骨折愈合情况,同时比较两组治疗前后血液流变学指标(红细胞聚集指数、血浆黏度、红细胞刚性指数),血清黏附因子[血清人可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)]及骨形态发生蛋白-2(bone morphogenetic protein-2,BMP-2)水平,转化生长因子(transforming growth factor β1,TGF-β1)、胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)、血小板衍生生长因子(platelet derived growth factor,PDGF)水平及OPG/RANKL蛋白表达。结果治疗后1、2、3个月及6个月,观察组骨折愈合率均显著高于对照组,差异具有统计学意义( P <0.05)。治疗后,观察组患者的红细胞聚集指数、血浆黏度、红细胞刚性指数水平均明显优于对照组,差异具有统计学意义( P <0.01);观察组sICAM-1、BMP-2、sVCAM-1水平显著高于对照组,差异具有统计学意义( P <0.01);观察组TGF-β1、IGF-1及PDGF水平显著高于对照组,差异具有统计学意义( P <0.01);观察组OPG/RANKL蛋白表达显著高于对照组,差异具有统计学意义( P <0.05)。结论高压氧联合神经生长因子局部注射能够显著改善骨质疏松性骨折延迟愈合患者血清黏附因子及微循环指标,促进骨折愈合,值得在临床推广。

Objective To study the effect of hyperbaric oxygen combined with local injection of nerve growth factor on the expression of serum adhesion factor and microcirculation in patients with delayed union of osteoporotic fractures. Methods Eight-four osteoporotic fracture cases with delayed healing were divided into control group and observation group, with 42 cases in each group. Patients in both groups received routine therapy. In addition, patients in the observation group received hyperbaric oxygen therapy and intramuscular injection of nerve growth factor (NGF) around the fracture. The fracture healing between the two groups was compared. The hemorheology indexes (erythrocyte aggregation index and plasma viscosity), erythrocyte rigidity index, serum adhesion factor [serum soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1)], bone morphogenetic protein-2 (BMP-2), and the protein expressions of transforming growth factor (TGF-β1), insulin-like growth factor-1 (IGF-1), platelet derived growth factor (platelet derived growth factor-PDGF), and OPG/RANKL before and after the treatment were compared. Results At 1 month, 2 months, 3 months, and 6 months after the treatment, the fracture healing rate in the observation group was significantly higher than that in the control group ( P <0.05). After treatment, the erythrocyte aggregation index, plasma viscosity, and erythrocyte rigidity index in the observation group were significantly higher than those in the control group ( P < 0.01). The levels of sICAM-1, BMP-2, and sVCAM-1 in the observation group were significantly higher than those in the control group ( P < 0.01). The levels of TGF-β1, IGF-1, and PDGF in the observation group were significantly higher than those in the control group ( P <0.01). The expression of OPG/RANKL protein in the observation group was significantly higher than that in the control group ( P <0.05). Conclusion Local injection of hyperbaric oxygen combined with nerve growth factor significantly improves serum adhesion factor and microcirculation index in patients with delayed union of osteoporosis fracture, and promotes fracture healing, which is worthy to apply in the clinic.