RESUMEN
PURPOSE: Fracture healing relies on the body to coordinate an inflammatory and anabolic reaction to re-establish osseous union. Although many factors affect this process or even disrupt it, the role of the body's nutritional reserves is not well understood. The purposes of this study were to describe the weight changes and to identify trends in laboratory values commonly used in nutritional assessment during mandibular fracture treatment. MATERIALS AND METHODS: A prospective cohort study was designed. The study cohort included patients who sustained a mandibular fracture from September 1, 2017, to March 31, 2018. The primary outcome variable was the percentage weight change from baseline. Secondary outcome variables included serum albumin and serum prealbumin levels. Weight change was analyzed using a linear mixed model. Paired Wilcoxon tests were used to compare laboratory values with baseline levels. RESULTS: Thirty-nine patients met the inclusion criteria with sufficient follow-up data for analysis. The linear mixed model predicted a peak weight loss of 4.1% of the initial body weight by day 34. The serum prealbumin level increased over the study period (P < .001), and the albumin level was increased from baseline at week 3 (P < .05) but not significantly different from baseline after that time. CONCLUSIONS: During the course of treatment for mandibular fractures, patients lost an average of more than 4% of their body weight. However, the study did not show any meaningful change in nutritional laboratory values. Although it is important for patients and surgeons to be able to anticipate a weight loss of about 4 to 5% during mandibular fracture treatment, it is unlikely that this represents a large challenge to the nutritional status of patients.
Asunto(s)
Fracturas Mandibulares , Prealbúmina , Pérdida de Peso , Peso Corporal , Humanos , Fracturas Mandibulares/sangre , Fracturas Mandibulares/cirugía , Cirugía Ortognática , Estudios Prospectivos , Albúmina SéricaRESUMEN
Due to the high biotolerance, favourable mechanical properties, and osseointegration ability, titanium is the basic biomaterial used in maxillofacial surgery. The passive layer of titanium dioxide on the surface of the implant effectively provides anticorrosive properties, but it can be damaged, resulting in the release of titanium ions to the surrounding tissues. The aim of our work was to evaluate the influence of Ti6Al4V titanium alloy on redox balance and oxidative damage in the periosteum surrounding the titanium miniplates and screws as well as in plasma and erythrocytes of patients with mandibular fractures. The study included 31 previously implanted patients (aged 21-29) treated for mandibular fractures and 31 healthy controls. We have demonstrated increased activity/concentration of antioxidants both in the mandibular periosteum and plasma/erythrocytes of patients with titanium mandibular fixations. However, increased concentrations of the products of oxidative protein and lipid modifications were only observed in the periosteum of the study group patients. The correlation between the products of oxidative modification of the mandible and antioxidants in plasma/erythrocytes suggests a relationship between the increase of oxidative damage at the implantation site and central redox disorders in patients with titanium miniplates and screws.
Asunto(s)
Materiales Biocompatibles/efectos adversos , Fracturas Mandibulares/cirugía , Oxidación-Reducción/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Titanio/efectos adversos , Adulto , Aleaciones , Antioxidantes/metabolismo , Eritrocitos/efectos de los fármacos , Eritrocitos/metabolismo , Femenino , Humanos , Masculino , Fracturas Mandibulares/sangreRESUMEN
The level of complications in patients with the mandibular fractures does not have a tendency to the decline. A research purposes is a study of the basic laws of immunological reactions and possibility of optimizing processes osteogenesis by drugs-cytokines at patients with the mandibular fractures with delayed consolidation of bone tissue. 46 patients with the mandibular fractures were observed. The maintenance of cytokines IL - 1ß, TNF - α, IL - 4, SICAM-1 in the blood serum, IgA, IgM, IgG in a mouth liquid was probed. It is set that in pathogenesis of delayed consolidation a basic role is played by changes reactivity of organism, which realized in three directions: immunodeficit of humoral immunity, immunodepression of cellular factors of defence, disbalance in functioning of the cytokines system. It is necessary to count the levels of products SICAM-1 and cytokine IL-1ß in the blood serum by the diagnostic criteria of bone repair features at patients with the mandibular fractures: development of delayed consolidation of mandibular fragments is accompanied the increase of their parameters at the control group more than in 2 and in 15 times (668,2±10,3 pg/ml and 363,4 ±6,6 pg/ml relatively). Includding in the complex treatment of the mandibular fractures of immunomodulator Ronkoleukin showed clinico-immunological efficiency for the patients with impaired bone repair.
Asunto(s)
Regeneración Ósea/inmunología , Fracturas Mandibulares/tratamiento farmacológico , Fracturas Mandibulares/inmunología , Osteogénesis/inmunología , Adulto , Regeneración Ósea/efectos de los fármacos , Femenino , Humanos , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Factores Inmunológicos/administración & dosificación , Molécula 1 de Adhesión Intercelular/sangre , Molécula 1 de Adhesión Intercelular/inmunología , Interleucina-1beta/sangre , Interleucina-1beta/inmunología , Interleucina-4/sangre , Interleucina-4/inmunología , Masculino , Fracturas Mandibulares/sangre , Osteogénesis/efectos de los fármacos , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
BACKGROUND: Metal alloys utilized in the management of jaw fractures may exert genotoxic effects. Our purpose was to compare the genotoxicity of intermaxillary fixation devices containing nickel and chromium to that of titanium miniplates utilized in treatment of jaw fractures through the analysis of sister chromatid exchange. METHODS: In this prospective study, in a total of 28 non-smoker patients (10 females, 18 males; mean age 33.43±10.76; range 15 to 60 years) with jaw fractures, 14 were treated with intermaxillary fixation by administration of nickel-chromium wire and arch bar and 14 with titanium miniplates to investigate the genotoxicity of different metal alloys. The outcome variable was the frequency of sister chromatide exchange in peripheral lymphoctyes, determined through the analysis of venous blood samples obtained preoperatively and 4 to 6 weeks postoperatively. RESULTS: The frequency of the average sister chromatid exchange was found to be significantly higher in patients treated with the nickel-chromium intermaxillary fixation devices than those treated by titanium miniplates (1.29±0.29 vs. 0.46±0.39, p<0.001). CONCLUSION: Although titanium miniplate osteosynthesis is an invasive technique in comparison with the nickel-chromium-containing intermaxillary fixation devices, titanium seems to exert less genotoxic effect than the nickel-chromium alloy. However, this finding should be supported in clinical studies with a larger sampling size.
Asunto(s)
Aleaciones de Cromo/efectos adversos , Fijación Interna de Fracturas/efectos adversos , Fijadores Internos/efectos adversos , Fracturas Mandibulares/cirugía , Intercambio de Cromátides Hermanas/efectos de los fármacos , Titanio/efectos adversos , Adolescente , Adulto , Aleaciones de Cromo/administración & dosificación , Femenino , Humanos , Masculino , Fracturas Mandibulares/sangre , Fracturas Mandibulares/genética , Persona de Mediana Edad , Mutágenos/administración & dosificación , Mutágenos/efectos adversos , Estudios Prospectivos , Titanio/administración & dosificación , Adulto JovenRESUMEN
PURPOSE: The aims of the study were to evaluate procollagen type III N-terminal propeptide (PIIINP) concentrations in blood serum of males in the course of normal healing of mandible fractures, and to determine the correlations between kinetic changes of PIIINP, stages of fracture healing and the applied treatment. MATERIAL AND METHODS: We collected blood serum samples from 43 male patients aged between 20 and 30 years, treated for mandible fractures. The patients were divided into 2 groups depending on the type of osteosynthesis used for immobilization of the fragments. Group I (n=10) consisted of patients whose reduced bone fragments were fixed with biodegradable fixations, while group II (n=33) included patients with titanium osteosynthesis devices. The control group (n=25) consisted of healthy males at the same age. PIIINP concentrations were determined with the radioimmunological method (RIA). RESULTS: We found a significant increase in PIIINP concentrations in both study groups (I and II) at defined stages of mandible fracture healing. Differences were noticed in the dynamics of the increase depending on the type of applied osteosynthesis devices. CONCLUSION: The results point to the fact that the injury and/or mandible fracture increase the collagen type III metabolism and its dynamics depends on the type of the used bone fixation.
Asunto(s)
Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Mandibulares/cirugía , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Implantes Absorbibles , Adulto , Fijación Interna de Fracturas/instrumentación , Humanos , Fijadores Internos , Masculino , Fracturas Mandibulares/sangre , Fracturas Mandibulares/fisiopatología , Radioinmunoensayo , Titanio , Adulto JovenRESUMEN
This investigation permit to detect, that first resorption stage of the mandible reparative regeneration terminats after fracture 5 days later. Calcitonine injection during 5 days after fracture i.e. in paratiroid hormone dependent stage distorts normal reparative process. Rats with traumatic osteomielitis become 1.5 times more and rats with normal regeneration become 3 times less. Injection calcitonine in KT-dependent stage, i.e. in 6-11 days after fracture increases quantity of rats with normal regeneration in 7 times and decreases quantity animals with traumatic osteomielitis on 50%. There's recommendation to inject KT from 6 days after trauma.
Asunto(s)
Regeneración Ósea/efectos de los fármacos , Calcitonina/administración & dosificación , Mandíbula/fisiología , Fracturas Mandibulares/tratamiento farmacológico , Animales , Calcitonina/sangre , Masculino , Fracturas Mandibulares/sangre , RatasRESUMEN
PURPOSE: The aim of this work was estimation of the PIIINP, PICP and ICTP concentrations in blood serum during non-complicated mandible fracture healing; settlement of dependences between kinetics of changes of examined markers with reference to particular bone fracture phases and applied treatment methods; the determination of usefulness of collagen metabolism markers type III and I for the monitoring of mandibular fracture healing. MATERIAL AND METHODS: The material was blood serum of men aged 20-30 years, who were treated for mandible fractures in Maxillofacial Clinic Medical University of Bialystok. Depending on the treating method, examined patients were divided into two groups. Patients treated with non-operative method were I group (n = 31), II group was made of patients treated with surgery (n = 33). The concentrations of markers measured on the 2nd, 14th, 42nd, 90th day after trauma and in II group these substances were measured additionally on the 2nd and 14th day after surgery. Control group consisted of 20 healthy men the same age. Concentrations of markers were measured with the radioimmunological method (RIA). RESULTS: Regular process of mandible fracture healing in men in various periods occurs with PICP, PIIINP and ICTP concentration changes in blood serum. CONCLUSIONS: Changes of maker concentration show that, mandible fracture healing treated non-operatively is a more dynamic process than stable osteosynthesis method applied. Lack of positive correlation of the PIIINP and PICP concentration in blood serum of patients in two examined groups can indicate on the different mechanisms of mandible fracture healing connected with different methods of the treatment.
Asunto(s)
Colágeno Tipo II/metabolismo , Colágeno Tipo I/metabolismo , Fracturas Mandibulares/sangre , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Humanos , Masculino , Fracturas Mandibulares/metabolismo , Fracturas Mandibulares/cirugía , Péptidos , Radioinmunoensayo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Study of the qualitative and quantitative composition of the "mandibular" diet in 66 residents of the European North with mandibular fractures showed its deficiency, which led to delayed consolidation of the fractures. Use of individual balanced rations including calcium alginate in 68 patients led to more rapid consolidation of fractures and accelerated recovery of the patients' working capacity.
Asunto(s)
Alginatos/uso terapéutico , Suplementos Dietéticos , Análisis de los Alimentos , Fracturas Mandibulares/sangre , Fracturas Mandibulares/dietoterapia , Adolescente , Adulto , Curación de Fractura , Ácido Glucurónico , Ácidos Hexurónicos , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Apoyo Nutricional , Federación de RusiaRESUMEN
68 patients with mandible's fractures were observed. There was studied the importance of peroxygenation of lipids and antioxydation system for prognosing and diagnosing of posttraumatic osteomyelitis of mandible. It was established that the intensifies of peroxygenation of lipids increased and the level of antioxydation system decreased in cases of mandible's fractures. The patients having posttraumatic osteomyelitis afterwards had the more changes in concentration of peroxygenation of lipids.
Asunto(s)
Peróxidos Lipídicos/sangre , Fracturas Mandibulares/sangre , Osteomielitis/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Peroxidación de Lípido , Masculino , Fracturas Mandibulares/complicaciones , Persona de Mediana Edad , Osteomielitis/etiología , Osteomielitis/metabolismo , PronósticoRESUMEN
Despite great differences in the patients with complicated and uncomplicated mandibular fractures, the activity of serum transaminases reflects the severity of damage to osteomuscular tissue and time course of development of inflammatory reaction. The leukocytic intoxication index (LII) characterizes stress reaction of the blood system during the first hours and development of inflammation in later periods of the posttraumatic period. The ratio of de Ritis coefficient/LII indicates the level of endogenous intoxication, cell membrane permeability, development and time course of the inflammatory process. Hence, these parameters are diagnostically and prognostically significant for predicting the outcome of the posttraumatic period and serve as criteria for development of optimal treatment algorithms.
Asunto(s)
Fracturas Abiertas/sangre , Recuento de Leucocitos , Fracturas Mandibulares/sangre , Transaminasas/sangre , Adolescente , Adulto , Curación de Fractura/fisiología , Fracturas Abiertas/complicaciones , Fracturas Abiertas/fisiopatología , Humanos , Inflamación/sangre , Inflamación/etiología , Masculino , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/fisiopatología , Persona de Mediana EdadRESUMEN
One of the basic measures of quality of repairing processes of soft tissue and bone injury is collagen synthesis. C-terminal propeptide of type I procollagen (PICP) is admitted index of type I collagen biosynthesis. The aim of the study was estimation of PICP concentrations in the course of fracture repair process in relation to the treatment method. The material of investigations was blood serum of 25 men (age 20-30 years) with fracture of mandible. The patients were divided into 2 groups depending on the method of treatment: I group was patients treated non-surgical method (n = 12); II group--surgical method (n = 13). Blood samples in the first group were taken on 2nd, 14th, 42nd, 90th day of healing process and additionally on 2nd and 14th day after surgery--in the second group. The PICP concentrations in blood serum were determined by RIA method. Statistical analysis of results shown significant increase of PICP concentrations in I group of patients in 14th (167.1 +/- 42.8 micrograms/L) and in 42nd (216.0 +/- 59.1 micrograms/L) day of healing process in comparison to the values in the second day after injury--the first study (124.3 +/- 41.8 micrograms/L). In the II group of patients the statistically significant increase of PICP concentration in 14th day after surgical procedure (156.9 +/- 30.5 micrograms/L), 42nd (163.1 +/- 35.3 micrograms/L) and in 90th (153.1 +/- 40.2 micrograms/L) day of healing process after injury in comparison to the values in the second day after injury--the first study (119.9 +/- 35.8 micrograms/L). The results indicate, that a normal course of mandibular fracture healing influences the change in PICP concentrations in serum in examined men. A different dynamics of PICP concentrations, observed in the serum in patients with mandibular fractures treated surgically and non-surgically, suggests various mechanisms of bone tissue reconstruction connected with the method of treatment.
Asunto(s)
Fracturas Mandibulares/sangre , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Adulto , Curación de Fractura/fisiología , Humanos , Masculino , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/terapiaRESUMEN
Insulin-like growth factor-I (IGF-I) is potent stimulator of proliferation and differentiation of osteoblasts, the biosynthesis of collagen type-I and noncollagenous proteins and alkaline phosphatase activity. The role of IGF-I in bone repair has not as yet been clearly defined. The aim of the present study was the quantitative analysis of IGF-I in the serum and tissue in four phases of fractured jaws healing in rat models. IGF-I concentrations in the serum and bone extracts were determined by RIA. In respect to the control group (K) the significant increase of IGF-I occurred in the serum in phase I (211 +/- 68 ng/ml, K-153 +/- 50 ng/ml) (p < 0.05). At the tissue levels a statistically significant increase in IGF-I was confirmed in phase II (262 +/- 60 ng/g, K-182 +/- 56 ng/g) (p < 0.05). The present results demonstrate that in rat models with fractured jaws in the first two phases of healing elevated levels of IGF-I in the serum and bone tissue were observed which indicate the significant role of this polypeptide in the early healing stages.
Asunto(s)
Factor I del Crecimiento Similar a la Insulina/metabolismo , Fracturas Mandibulares/metabolismo , Animales , Curación de Fractura/fisiología , Masculino , Fracturas Mandibulares/sangre , Ratas , Ratas Wistar , Factores de TiempoAsunto(s)
Recuento de Células Sanguíneas , Magnetismo/uso terapéutico , Enfermedades Mandibulares/terapia , Fracturas Mandibulares/terapia , Osteomielitis/terapia , Adolescente , Adulto , Estudios de Evaluación como Asunto , Humanos , Recuento de Leucocitos , Recuento de Linfocitos , Fracturas Mandibulares/sangre , Persona de Mediana EdadRESUMEN
A comparative analysis of the course of repair osteogenesis in patients with mandibular fractures living in the Amur and Ivano-Frankovsk regions was carried out. Protein and mineral metabolism, hemogram patterns, types and incidence of complications were under study. Indexes based on the "desirability function" were used to assess the metabolic, repair, and inflammatory processes. Unfavorable effects of the hypo- and uncomfortable environmental conditions on the course of regeneration after mandibular fractures were revealed and a conclusion made about the necessity of a differentiated approach to the treatment of patients with mandibular fractures living under different climatic and geographic conditions.
Asunto(s)
Curación de Fractura , Fracturas Mandibulares/fisiopatología , Osteogénesis , Absentismo , Fijación de Fractura , Humanos , Masculino , Fracturas Mandibulares/sangre , Fracturas Mandibulares/terapia , Siberia , Férulas (Fijadores) , Factores de Tiempo , UcraniaRESUMEN
Fifty-nine patients with mandibular fractures were treated making use of intravenous laser irradiation of the blood. Laser exposure had a marked antiinflammatory and analgesic effect, compensated for changes in disordered immunity status, and normalized red cell membrane structure and function as well as its energy supply.
Asunto(s)
Sangre/efectos de la radiación , Terapia por Láser , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/terapia , Infección de Heridas/terapia , Adolescente , Adulto , Linfocitos B/inmunología , Linfocitos B/efectos de la radiación , Eritrocitos/metabolismo , Eritrocitos/efectos de la radiación , Estudios de Evaluación como Asunto , Humanos , Fracturas Mandibulares/sangre , Fracturas Mandibulares/inmunología , Persona de Mediana Edad , Osteomielitis/sangre , Osteomielitis/inmunología , Osteomielitis/terapia , Linfocitos T/inmunología , Linfocitos T/efectos de la radiación , Infección de Heridas/sangre , Infección de Heridas/inmunologíaRESUMEN
C-reactive protein (CRP) levels were determined in 80 patients (67 male, 13 female), each with a single mandibular fracture in either the symphysis, body, or angle region. All patients underwent osteosynthesis (63 with rigid plate fixation following the AO/ASIF principle, 17 with miniplates). C-reactive protein levels were measured on admission and daily during hospitalization. Preoperative CRP levels (mean, 28.5 mg/L) varied according to the time that had elapsed since injury. After surgery, there was always an increase in CRP level. The level reached its maximum (mean, 73.2 mg/L) on the second day after operation. Postoperative CRP levels were significantly influenced by the time between trauma and surgery. Significant differences were also observed with different types of fixation. Fixation with rigid plates was associated with smaller increases in CRP level than was fixation with miniplates. The location of the fracture, associated condylar fractures, the use of maxillomandibular fixation, the presence or absence of a tooth at the fracture site, and the surgical approach did not affect the CRP levels. The significance of CRP measurement for interpretation of postoperative situations is discussed and examples of cases in which there was infection are described.