ABSTRACT
Objective:To investigate the relationship between serum fibroblast growth factor 21/23 level, trauma severity and prognosis in middle-aged and older adult patients with traumatic fracture.Methods:A total of 126 middle-aged and older adult patients with traumatic facture who received treatment in the Second People's Hospital of Lishui, China between June 2017 and June 2019 were included in the study group. Fifty healthy controls who concurrently received physical examination in the Second People's Hospital of Lishui were included in the control group. The study group was divided into five subgroups according to relevant criteria: mild, moderate, severe, poor prognosis and good prognosis. The levels of C-reactive protein (CRP), procalcitonin (PCT), FGF21 and FGF23 were measured.Results:On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62)μg/L,(52.10 ± 16.34) μg/L, respectively, and they were significantly higher than those in the control group [ (7.60 ± 2.61) mg/L, (0.30 ± 0.11) μg/L, (40.18 ± 10.33) μg/L, (30.11 ± 10.19) μg/L, t = 18.888, 17.750, 18.336, 11.032, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62) μg/L, (52.10 ± 16.34) μg/L, respectively, and they were significantly increased at 1 day [(21.59 ± 4.53) mg/L, (0.79 ± 0.22) μg/L, (83.85 ± 19.07) μg/L, (55.18 ± 16.55) μg/L, t = 3.72, 3.29, 1.56, 1.56, P < 0.05, P < 0.05, P = 0.122, P = 0.122] and 3 days after surgery [(23.15 ± 3.16) mg/L, (0.80 ± 0.24) μg/L, (88.11 ± 19.80) μg/L, (59.70 ± 16.07) μg/L, t = 6.65, 3.12, 3.59, 3.77, all P < 0.05] , and significantly decreased at 7 days after surgery [(14.35 ± 4.02) mg/L, (0.52 ± 0.16) μg/L, (50.06 ± 15.50) μg/L, (32.18 ± 12.52) μg/L, t = 8.31, 8.58, 13.77, 11.11, all P < 0.001]. On admission, there were significant differences in serum CRP, PCT, FGF23, FGF21 levels between mild, moderate and severe groups ( F = 25.087, 15.851, 15.831 and 12.645, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF21 levels in the poor prognosis group were significantly higher than those in the good prognosis group ( t = 5.757, 4.984, 3.189 and 4.006, all P < 0.001). The receiver operating characteristic curve (ROC) analysis results showed that serum CRP, PCT, FGF23, FGF21 levels in patients with traumatic fracture on admission had a certain value in the prediction of poor prognosis. Combined detection of these four indexes had the highest value, with AUC (0.95 CI) of 0.877 (0.783-0.982). Conclusion:Serum FGF21 and FGF23 levels have a certain value in the prediction of severity and prognosis of traumatic fracture in middle-aged and older adult patients.
ABSTRACT
Objective To investigate the clinical efficacy of bilateral decompressive craniotomy for treating the patients with double hedge severe craniocerebral injury (DHSCBI).Methods Sixty patients with DHSCBI were divided by random digits table method into treatment group and control group with 30 cases each.The treatment group was treated with bilateral decompressive craniotomy,while the control group was treated with traditional unilateral craniotomy.The acute brain swelling,incisional hernia,intracranial pressure of postoperative 1,3,7 d were observed and recorded.The patients were followed up for 3 months to evaluate the clinical efficacy.Results The incidence of acute brain swelling and incisional hernia in treatment group were 13.3％ (4/30) and 20.0％ (6/30),respectively,which were significantly lower than those in control group [56.7％ (17/30) and 63.3％ (19/30)] (P ＜0.01 ).The intracranial pressure of postoperative 1,3,7 d in treatment group [(21.34 ±3.05),(18.43 ±2.63),(15.52 ±2.21) mm Hg(1mm Hg =0.133 kPa)] were significantly lower than those in control group[ (31.21 ± 4.46),(29.13 ±4.16),(24.97 ±3.57) mm Hg] (P ＜0.05).The clinical efficacy in treatment group [53.3％ (16/30)] was significantly higher than that in control group [23.3％ (7/30)] (P ＜ 0.05 ).The mortality rate in treatment group [16.7％ (5/30)] was significantly lower than that in control group [40.0％(12/30)] (P ＜0.05).Conclusions Compared with traditional unilateral craniotomy,bilateral decompressive craniotomy can reduce the incidence of acute brain swelling and incisional hernia of DHSCBI patients,and have better prognosis.It is worthy of clinical application.