| BackgroundFracture is a common disease of surgical department, especially according with the development of economy and the accelerated pace of life, the traffic accident became one of the most common causes of the fracture. Fracture nonunion, also known as delayed union or bone nonunion, is refered that bone nonunion continued after 9 months of fracture,or bone nonunion in more than 3 months continuous observation after fracture. Fracture nonunion often caused the joint movement disorder and gave great pain and economic burden to patints.It has been a hot research poit in the field of fracture. According to literature reports, the occurrence rate of fracture nonunion is 2.5-10%.The probability of fracture nonunion in different individuals is varied greatly. There were correlations between fracture nonunion and healing or not,age, sex, endocrine,nutritional status, blood vessels and nerve injury, braking conditions, infection and so many factors.Diabetes mellitus is an important risk factor among these factors. Transforming growth factor beta 1(TGF-?1) is one of the important cytokines in the body.It has the effect of boosting wound repairing, and it is possible to promote fracture union. Hyperbaric oxygen therapy and rat nerve growth factor are currently being used to treat fracture union in clinical trials. There was no report of effect of hyperbaric oxygen therapy and nerve growth factor on TGF-?1 and fracture union in fracture patients with diabetes mellitus. ObjectiveTo explore effect of hyperbaric oxygen therapy and nerve growth factor on TGF-?1 and fracture healing in fracture patients with diabetes mellitus. MethodsThe patients with traumatic upper limb long bone fracture were observed. Patients were divided into 3 groups by whether merged with diabetes and treatment methods: group A(n=116) were patients with diabetes mellitus and who were treated by restoration, fixation and functional exercise, control blood glucose, nutritional support and other conventional treatment were implemented. Group B(n=102) were patients with diabetes mellitus and who were treated by normal treatment mentioned above and in addition to high pressure oxygen therapy(1 times per day, 21 days per month,and contimous for 3 months) and muscle injection rat nerve growth factor(1 days of 18ug/ days,and contimous for for 3 months).Group C(n=96) were patients without diabetes mellitus who were treated by normal treatment. Preoperative and postoperative periodic testing of serum TGF-?1 level and continuous for 2 months. Fracture healing situation were diagnosed by X rays in continuous 10 months. Observation index inconcuded:(1) the levels of serum TGF-?1 in the 3 groups in before treatment, 2 weeks, 1 month and 2 months after treatment.(2) Fracture healing situation were studied in 10 months after treatment. Outcomes(1) Serum TGF-?1 levels in 3 groups were elevated at the second week after surgery, peaked in the first month and return to the base level in the second month.The basic and peak values of serum TGF-?1 levels in 3 groups were significantly different, which showed that group A<group B< group C.(2) The rate of fracture nonunion and delayed union in group A was higher than group B and group C,while there were no significant differences between group B and group C. Conclusions(1) Fracture healing cituation in diabetic patients is bad than those without diabetes.(2) Early hyperbaric oxygen therapy and rat nerve growth factor can promote the fracture healing rate in diabetic patients, which may attributed to increasing of serum level of TGF- ?1. |
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