地塞米松治疗枪弹伤致兔开放性骨缺损合并海水浸泡的实验研究  

Dexamethasone in the treatment of open bone defect caused by gunshot combined with seawater immersion in rabbits

作　　者：陈肖松 张淦 刘胜杰 马武秀 陈聪聪 吴成如 CHEN Xiao-song;ZHANG Gan;LIU Sheng-jie;MA Wu-xiu;CHEN Cong-cong;WU Cheng-ru(Department of Orthopedics,the 901st Hospital of the Joint Logistics Support Force of PLA,Hefei,Anhui,230031,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇一医院骨一科,安徽合肥230031 [2]中国人民解放军联勤保障部队第九〇一医院骨二科,安徽合肥230031

出　　处：《颈腰痛杂志》2022年第4期469-472,477,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：2018年军队后勤科研项目(编号:CLB18J059)。

摘　　要：目的探讨静脉注射地塞米松治疗海水环境下枪弹伤致兔开放性骨缺损的效果。方法将56只日本大耳家兔随机分为A、B两组。制作火器伤致兔股骨开放性骨缺损合并海水浸泡模型,A组作为空白对照,彻底清创后,行骨折切开复位钢板内固定术;B组为地塞米松治疗组,行同样的手术后,静脉注射地塞米松(5 mg/kg)。通过影像学分析、组织学等观察,比较各组损伤修复情况。结果①伤道周围软组织观察,伤后1 d、3 d、1周、2周、4周时,A组的丙二醛(malondialdehyde,MDA)含量均显著高于B组(P<0.05),A组超氧化物歧化酶(superoxide dismutase,SOD)活性均显著低于B组(P<0.05);8、12周时,两组的MDA含量以及SOD活性已趋于相近(P>0.05)。②影像学观察,伤后12周两组达骨性愈合,但髓腔均未完全再通。骨折区骨痂灰度值测量,伤后4、8、12周时,两组差异均无统计学意义(P>0.05)。③组织学观察,伤后1天,A组动物伤道周围部分肌纤维断裂,变性坏死,间质轻度水肿,血管淤血,各区均有不同程度的炎细胞浸润。B组标本炎症反应、水肿程度及范围方面均较A组减轻。伤后12周时,两组骨折区大部分为混合骨痂,其中仍可见软骨细胞,并可见少量炎症细胞浸润,无明显区别。结论静脉注射地塞米松治疗海水浸泡兔火器伤导致的开放性骨缺损,早期可减轻受损组织的炎症反应及再灌注损伤,但中远期对于骨缺损的愈合无明显促进作用。Objective To investigate the effect of dexamethasone in the treatment of open bone defect caused by gunshot combined with seawater immersion in rabbits.Methods A totoal of 56 rabbits were randomly divided into group A and group B.The open bone defect model of rabbit femur caused by gunshot combined with seawater immersion was made.Group A was used as blank control.After debridement,open reduction and plate internal fixation were performed.Group B was treated with dexamethasone.After the same operation,dexamethasone(5 mg/kg)was injected intravenously.Through imaging analysis and histological observation,the repair of injury in each group was compared.Results①The content of malondialdehyde(MDA)in group A was significantly higher than that in group B(P<0.05),and the activity of superoxide dismutase(SOD)in group A was significantly lower than that in group B(P<0.05).At the 8th and 12th week,the MDA content and SOD activity of the two groups were similar(P>0.05).②Imaging observation showed that bone healing was achieved in both two groups at 12 weeks after injury,but the medullary cavity was not completely reopened.There was no significant difference between the two groups at 4,8 and 12 weeks after injury(P>0.05).③Histological observation showed that at one day after injury,some muscle fibers around the injury tract in group A were broken,denatured and necrotic,interstitial edema was mild,blood vessels were congested,and inflammatory cells were infiltrated in various areas.The inflammatory reaction,edema degree and scope of group B were less than those of group A.At the 12th week after injury,most of the fracture areas in the two groups were mixed callus,in which chondrocytes were still visible,and a small amount of inflammatory cell infiltration was visible,with no significant difference.Conclusion Dexamethasone in the treatment of open bone defect in rabbits caused by gunshot in seawater soaked can reduce the inflammatory reaction and reperfusion injury of damaged tissue in the early stage,but it has no obviou

关 键 词：海水浸泡 枪弹伤 骨缺损 地塞米松 

分 类 号：R826.2[医药卫生—临床医学]