高压氧治疗海水浸泡火器伤兔股骨骨缺损的疗效观察

Effect of hyperbaric oxygen on the open bone defect of limbs caused by firearm wound in seawater

目的 观察高压氧治疗海水浸泡火器伤所致兔股骨开放性骨缺损的疗效。方法 实验实施时间2020年7月至2021年5月。84只新西兰兔采用随机数字表法分成对照组和高压氧组。制作海水浸泡火器伤所致肢体开放性骨缺损模型,对照组彻底清创后,行骨折切开复位钢板内固定术;高压氧组彻底清创后,行骨折切开复位钢板内固定术,连续高压氧治疗7 d。通过X线摄片、定量PCR法、HE染色及生物力学分析评价各组治疗效果。结果 血管内皮生长因子(VEGF) mRNA各组各个时间段均有表达,与对照组相比,高压氧组术后1 d[(2.97±0.25)比(2.39±0.24)]、3 d[(4.12±0.38)比(3.65±0.30)]、1周[(4.83±0.23)比(4.36±0.39)]、2周[(5.89±0.40)比(5.04±0.36)]、4周[(4.21±0.42)比(5.04±0.36)],差异有统计学意义(P<0.05);术后8周、12周,两组VEGF mRNA表达,差异无统计学意义(P>0.05)。影像学观察:术后2周两组未见明显骨组织影,钢板及螺钉在位。术后4周两组骨缺损区有薄云状骨痂阴影,阴影区域高压氧组>对照组,钢板及螺钉在位。术后8周对照组骨组织阴影增强,高压氧组达骨性愈合,髓腔未完全再通,钢板及螺钉在位。术后12周,对照组达骨性愈合,但髓腔部分再通,钢板及螺钉在位;高压氧组皮质连续性好,髓腔再通,基本完成修复,钢板及螺钉在位。Lane-Sandhu放射学评分,与对照组相比,高压氧组术后4周[(4.17±0.75)分比(2.83±0.98)分]、8周[(7.67±1.63)分比(5.67±0.82)分]、12周[(10.17±1.47)分比(7.83±1.17)分],差异有统计学意义(P<0.05);术后2周,两组Lane-Sandhu放射学评分,差异无统计学意义(P>0.05)。组织学观察:术后第12周,两组大量板层骨形成,对照组髓腔部分再通,高压氧组髓腔再通。生物力学分析:对照组最大负荷(195.97±11.70)N<高压氧组最大负荷(239.75±10.76)N,差异有统计学意义(P<0.05)。结论 高压氧具有促进海水浸泡火器伤致骨缺损愈合的作用。

Objective To observe the effect of hyperbaric oxygen on the open bone defect of limbs caused by firearm wound in seawater.Methods The experiment was performed from July 2020 to May 2021.Eighty-four New Zealand rabbits were randomly assigned into control group and hyperbaric oxygen group.The model of the open bone defect of limbs caused by firearm wound in seawater was made.After thorough debridement,open reduction of fracture was performed with plate internal fixation in control group,while open reduction,internal fixation and continuous hyperbaric oxygen treatment for 7 days were performed in hyperbaric oxygen group.Xray radiography,quantitative PCR,HE staining and biomechanical analysis were used to evaluate the therapeutic effect of each group.Results Vascular endothelial growth factor(VEGF)mRNA was expressed in each group at all time periods.There were statistically significant differences between control group and hyperbaric oxygen group at postoperative 1 d[(2.97±0.25)vs.(2.39±0.24)],3 d[(4.12±0.38)vs.(3.65±0.30)],1 week[(4.83±0.23)vs.(4.36±0.39)],2 weeks[(5.89±0.40)vs.(5.04±0.36)],4 weeks[(4.21±0.42)vs.(5.04±0.36)](P<0.05);There was no significant difference in VEGF mRNA expression between the two groups at 8 weeks and 12 weeks postoperatively(P>0.05).Imaging observation results showed that two weeks after surgery,no obvious bone shadow was found in both groups,and plates and screws were present.Four weeks after surgery,thin cloud-shaped callus shadows were found in the bone defect area of control group and hyperbaric oxygen group,and the shadow area of control group was bigger than that of hyperbaric oxygen group,plates and screws in position.Eight weeks after the operation,the bone shadow of control group was enhanced,and the bone healing of hyperbaric oxygen group was achieved.The medullary cavity was not completely recanalized,and the plates and screws were in place.Twelve weeks after operation,osseous union was achieved in control group,the medullary cavity was partially recanalized,and the plates and screws were in place.In hyperbaric oxygen group,the cortical continuity was good,the medullary cavity was recanted,the re‐pair was basically completed,and the plates and screws were in place.Significant differences were found between control group and hy‐perbaric oxygen group in Lane-Sandhu radiological score at postoperative 4 weeks[(4.17±0.75)vs.(2.83±0.98)],8 weeks[(7.67±1.63)vs.(5.67±0.82)],12 weeks[(10.17±1.47)vs.(7.83±1.17)](P<0.05);Lane-sandhu radiological scores at 2 weeks after surgery showed no significant difference between the two groups(P>0.05).Histological observation results showed that at the 12th week after surgery,large amounts of lamellar bone formed in both groups,and the medullary cavity was partially recanalized in control group and recanalized in hyperbaric oxygen group,respectively.Biomechanical analysis results showed that maximum load[(195.97±11.70)N]in control group was lower than the maximum load[(239.75±10.76)N]in hyperbaric oxygen group,and the difference was statistically significant(P<0.05).Conclusion Hyperbaric oxygen therapy promotes the healing of the open bone defect of limbs caused by firearm wound in seawater.