【摘要】：背景與目的:骨科臨床實踐中合并腦外傷的骨折病人,骨痂生長快、數(shù)量多,甚至部分病人出現(xiàn)異位骨化的現(xiàn)象,近來已有大量文獻(xiàn)報道,對于該現(xiàn)象的探討已成為骨科研究的熱點。通過家兔腦外傷合并骨折及單純骨折的動物模型,動態(tài)測定家兔血清中下丘腦-垂體-性腺軸的激素水平變化并對骨折斷端病理切片的成骨細(xì)胞計數(shù)、直徑,觀察家兔腦外傷合并骨折愈合速度,通過數(shù)據(jù)分析,探討對骨折愈合影響的相關(guān)因素。方法:選取家兔40只,隨機(jī)分為2組,直線加速腦外傷合并尺骨骨折模型組(實驗組),單純標(biāo)準(zhǔn)尺骨骨折模型(對照組),每組各20只,兩組分別于致傷前1天、3天、1周取血,再于致傷后1天、3天、1周及2周取血,用直接發(fā)光法測定血清中黃體生成素(LH)、辜丸酮(T)、雌二醇(E2)、催乳素(PRL)、生長激素(GH)、卵泡刺激素(FSH)水平;于致傷后1-6周,每周隨機(jī)處死家兔子,每組各兩只,通過病理組織學(xué)檢查骨痂生長情況(觀察成骨細(xì)胞的數(shù)量、直徑的變化)。結(jié)果:1.血清激素測定結(jié)果在致傷后所有模型組(實驗組和對照組)家兔檢測血清激素均較傷前有明顯升高,在傷后3天,所有激素水平達(dá)到峰值,1周時血清激素水平開始下降,傷后2周時,所有激素均回落至傷前測定激素水,實驗組在致傷后激素水平均高于對照組。其中測定T、E2、GH激素水平在致傷后實驗組較對照組明顯升高,經(jīng)統(tǒng)計學(xué)分析P0.05,有統(tǒng)計學(xué)意義,余PRL、FSH、LH雖實驗組在致傷后均高于對照組,但經(jīng)統(tǒng)學(xué)計分析P0.05,無統(tǒng)計學(xué)意義。2.患肢骨痂測定結(jié)果在致傷后1-6周,每周成骨細(xì)胞計數(shù),實驗組均高于對照組,經(jīng)統(tǒng)計分析P0.05,有統(tǒng)計學(xué)意義,致傷后1到6周內(nèi),成骨細(xì)胞計數(shù)各組內(nèi)對比,成骨細(xì)胞無遞增性生長,經(jīng)統(tǒng)計學(xué)分析P0.05,無統(tǒng)計學(xué)意義;成骨細(xì)胞直徑測定,每周實驗組與對照組比較無明顯差異,經(jīng)統(tǒng)計學(xué)分析P0.05,無統(tǒng)計學(xué)意義,組內(nèi)對比,其測定值經(jīng)統(tǒng)計學(xué)分析P0.05,無統(tǒng)計學(xué)意義。結(jié)論:本實驗中,通過從血清激素水平及骨痂的病理學(xué)觀察,其結(jié)果表明:在腦外傷合并骨折的愈合中,多種下丘腦垂體激素明顯升高,并且參與了骨折愈合的這一過程,其分泌量的增高與骨折加速愈合相關(guān)。但在臨床中還有骨折不愈合的患者,必定還存在多種可抑制骨折愈合的因子存在,以及未知的體液因素,還需有待于進(jìn)一步研究、證實。
[Abstract]:Background & objective: in the clinical practice of orthopedics, the callus of fracture patients with brain trauma grows rapidly and has a large number of callus, and even some patients appear ectopic ossification phenomenon, which has been reported in a large number of literatures recently. The study of this phenomenon has become a hot spot in orthopedic research. The changes of hormone levels of hypothalamus-pituitary-gonadal axis in serum of rabbits were dynamically determined by the animal model of brain trauma complicated with fracture and simple fracture. The osteoblasts and diameters of pathological sections of broken end of fracture were counted. To observe the healing speed of brain injury complicated with fracture in rabbits, and to discuss the related factors of influencing fracture healing by data analysis. Methods: forty rabbits were randomly divided into two groups: the model group of linear accelerated brain injury combined with ulna fracture (experimental group) and the simple standard fracture of ulna model (control group) with 20 rabbits in each group. The two groups were divided into two groups: one day and three days before injury. 1 week blood was taken, and then blood was taken at 1 day, 3 days, 1 week and 2 weeks after injury. Serum luteinizing hormone (LH), Koo pill (T), estradiol (E2) and prolactin (PRL), growth hormone (GH), were determined by direct luminescence method. Follicle stimulating hormone (FSH) level; Rabbits were randomly killed at 1-6 weeks after injury with two rabbits in each group. The growth of callus was examined by histopathology (the number and diameter of osteoblasts were observed). The result is 1: 1. The levels of serum hormones in all the model groups (experimental group and control group) were significantly higher than those before injury. On the 3rd day after injury, the levels of all hormones reached the peak, and the serum hormone levels began to decrease at 1 week after injury. At 2 weeks after injury, all the hormones decreased to the levels of hormone water before injury, and the levels of hormones in the experimental group were higher than those in the control group. The level of GH in the experimental group was significantly higher than that in the control group after injury, and there was significant difference between the experimental group and the control group by statistical analysis (P 0.05). Although the level of PRL,FSH,LH in the experimental group was higher than that in the control group after injury, the level of GH in the experimental group was significantly higher than that in the control group. However, P0.05 was not statistically significant. The number of osteoblasts in the experimental group was higher than that in the control group at 1-6 weeks and every week after injury. There was significant difference in the number of osteoblasts between 1 and 6 weeks after injury by statistical analysis (P0.05), but within 1 to 6 weeks after injury, the number of osteoblasts in the experimental group was higher than that in the control group. Osteoblasts did not grow incrementally, and there was no statistical significance by statistical analysis (P0.05). There was no significant difference in the diameter of osteoblasts between the experimental group and the control group every week. There was no significant difference between the experimental group and the control group, but there was no significant difference between the experimental group and the control group. Conclusion: in this experiment, the serum hormone level and the pathological observation of callus showed that during the healing of traumatic brain injury with fracture, many kinds of hypothalamic pituitary hormones increased obviously, and participated in the process of fracture healing. The increase in secretion is associated with accelerated fracture healing. However, there must be many factors that can inhibit fracture healing and unknown humoral factors in the patients with nonunion, which need to be further studied and confirmed.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R683;R651.15

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