Effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperativefracture healing and serum levels of nerve growth factor, vascular cell adhesion molecule and alkaline phosphatase in patients with limb comminuted fracture / 中国综合临床

ABSTRACT

Objective To investigate the effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperative fracture healing and serum levels of and serum nerve growth factor (NGF),vascular cell adhesion molecule (s VCAM),alkaline phosphatase (ALP) in patients with limb comminuted fracture.Methods From January 2014 to May 2016,seventy-four patients with limb comminuted fracture in the Eighth People's Hospital of Shanghai were enrolled in this study and randomly divided into the control group (37 cases) and the study group (37 cases).The traditional incision and reduction fixation were used in the control group.The study group was treated with locking compression plate internal fixation combined with minimally invasive plate bone grafting technique.The patients were followed up for 1 ～ 4 months after operation.The clinical efficacy,perioperative indicators (operation time,intraoperative blood loss,fracture healing time),serum (nerve growth factor,vascular cell adhesion molecule,alkaline phosphatase) levels change at the time of admission and after first D and complications rate were statistically compared.Results The total effective rate of the study group was 97.30％ (36/37),higher than that in the control group (78.38％ (29/37)),and the difference was statistically significant (x2 =4.554,P＜0.05).The operation time of the study group was (84.76 ± 11.08) min,longer than that of the control group ((71.89 ± 10.54) min),the intraoperative blood loss of the study group ((108.52 ± 21.33) ml) was less than that of the control group ((245.30±24.61) ml),and the fracture healing time of the study group ((9.04 ± 1.81) weeks) was shorter than that of the control group ((12.79 ±2.02) weeks),and the difference was statistically significant (t =5.119,t =25.547,t =8.410,P＜ 0.05).The levels of serum NGF,s VCAM and ALP in the two groups after operation were higher than those before operation,and the levels of serum NGF ((1.33±0.19) ng / L) and ALP ((312.04±31.07) U/L) in the study group were higher than those in the control group ((0.85 ± 0.22) ng/L,(181.28±30.45) U/L),and the level of serum s VCAM ((502.18±40.07) μg/L) was lower than that in the control group ((579.28 ± 41.15) μg/L),and the difference was statistically significant (t =10.044,18.283,8.165,P＜0.05).The incidence of complications in the study group was 8.11％ (3/37),lower than that in the control group (27.03％ (10/37)),the difference was statistically significant (x2 =4.573,P ＜ 0.05).Conclusion Minimally invasive plate osteosynthesis combined with locking compression plate fixation in the treatment of limb comminuted fracture can shorten the healing time of the fracture,improve the treatment effect,improve the levels of serum NGF,s,VCAM and ALP,and it have lower complication rate with higher safety.