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Med-Science 1 Medicine Science Medulla Spinalis Yaralanması ve Kırık İyileşmesi Medulla Spinalis Injury and Fracture Healing Original Research doi: /medscience Effects of Medulla Spinalis Injury on Fracture Healing Adil Turan1, Fehmi Doruk Kuran2, Ferhat Güler1, Ebru Sezer3, Yigit Uyanıkgil4, Osman Arslan Bora5 1 Antalya Education and Research Hospital, Clinic of Orthopedics and Traumatology, Antalya 2 Bornova Private Medical Center, Izmir 3 Ege University Faculty of Medicine, Department of Biochemistry, Izmir 4 Ege University Faculty of Medicine, Department of Histology and Embryology, Izmir 5 Katip Celebi University, Faculty of Medicine, Department of Orthopedics and Traumatology, Izmir In fractures developing on the basis of the nerve conduction loss occurring after spinal trauma, healing and bone metabolism demonstrate departure from normal. The objective of this study is to study the type of effect which the interruption in the nerve conduction has on bone metabolism and bone healing and to develop relevant mechanisms. Forty-five Wistar Albino rats were randomized and divided into 3 groups. In Group 1 (n=20), a close fracture was created at the right tibia following spinal trauma at the lumbar level. In Group 2 (n=20), a fracture was created without spinal trauma. Finally, Group 3 (n=5) was made up of rats with no intervention. On the 35th day of the study, rats were sacrificed; blood samples were taken and fractured extremities were removed. Materials were histopathologically and biochemically examined. Significant weight loss was detected postoperatively in Group 1. In the same group, blood and callus BALP levels indicating bone formation were observed to be high. A significant decrease was also identified in callus calcium levels. Employed as a determinant of bone resorption, hydroxyproline levels did not demonstrate any significant differences. On the other hand, upon histopathological examination, callus size was observed to be significantly larger in the trauma group than in the other group, while the degree of maturation was lower than that of the control group. Interruption of nerve conduction induced by spinal trauma is observed to give way to an increase in callus size, despite its negative effect on the mineralization phase of bone healing. Key Words: Fracture healing, spinal injury, BALP (seafoodplus.info: Jan 28, Accept Date: Mar 19, ) seafoodplus.info Med-Science 8 Medicine Science Medulla Spinalis Yaralanması ve Kırık İyileşmesi Medulla Spinalis Injury and Fracture Healing Original Research doi: /medscience hem de gruplar arasındaki farklar istatistiksel olarak anlamlı bulunmuştur (p1<, p2=<, p3< ve p4<). Spinal travma grubunun (Grup-1) ve kontrol grubunun (Grup-2) kendi içerisinde kan ve kallus BALP düzeyleri arasında oldukça büyük bir fark tespit edilmiştir (Tablo-1). Tablo 1. Spinal travma grubunun (Grup-1) ve kontrol grubunun (Grup-2) kendi içerisinde kan ve kallus BALP düzeyleri arasında karşılaştırılması. Kallus Ca düzeyi en yüksek intakt kontol grubundaki sağlam kemikte elde edilmiştir (5,92±0,42 mol/g/kallus). Bu sonuçla diğer gruplarda bulunan sonuçlar arasındaki fark istatistiksel olarak anlamlıdır (p<). En düşük Ca değeri de grup 1’de bulunmuştur (2,45±0,40 mmol/g/kallus). Kallus hidroksiprolin düzeyi en yüksek intakt kontrol grubunda tespit edilmiştir (,00±44,50 nmol/g kallus) ve diğer iki grupta ki değerler ile bunun arasındaki fark istatistiksel olarak anlamlı bulunmuştur (p<). Ancak grup 1 ile grup 2 arasındaki fark istatistiksel olarak anlamlı değildir (p>) Her iki grupta oluşan kallus alanları ölçülmüş ve grup 1’de istatistiksel olarak anlamlı bir yükseklik tespit edilmiştir (p<). Ayrıca bu alanların ışık mikroskopisi ile incelenmesinde kallus alanlarının grup 2’de, Grup 1’e oranla daha dağınık yerleşimde olduğu görülmüştür. Ancak Huo ve ark.’nın skalasına göre yapılan değerlendirmede grup 1 ‘de iyileşme evresinin daha geri olduğu, grup 2’de ise daha iyi bir kırık iyileşmesi tespit edilmiştir. Tartışma Sağlam bir sinir sisteminin, kırık iyileşmesindeki ve kemik metabolizmasında ki rolü daha önce yapılan birçok çalışmada açıklanmaya çalışılmıştır. Laboratuar koşullarında elektrik seafoodplus.info Med-Science 12 Medicine Science Medulla Spinalis Yaralanması ve Kırık İyileşmesi Medulla Spinalis Injury and Fracture Healing Original Research doi: /medscience paraplejik ya da kuadroplejik durumdayken kırık meydana gelen hastalara, kallus mineralizasyonunu arttırıcı, kalsiyum metabolizmasını düzenleyici tedaviler verilmesi ile hem daha kaliteli bir kalus dokusu elde edilir hemde hızlı bir kaynama meydana getirilebilir. KAYNAKLAR 1. Eichenholtz S. Management of long bone fractures in paraplegic patients. J Bone Joint Surg Am. ;45(2) 2. Morse L,Teng YD, Pham L, Newton K. Spinal cord injury couses rapid osteoclastic resorbtion and growth plate abnormalites in growing rats (SCI-induced bone loss in growing rats). Osteoporos Int. ; 3. Aro H, Eerola E, Aho AJ. Fracture healing in paraplegic rats. Acta Orthop Scand. ; 4. Rivlin AS, Tator CH. Effect of duration of acute spinal cord compression in new acute cord injury in the rat. Surg Neurol. ; 5. Bonnarens F, Einhorn TA. Production of the standart closed fracture in laboratory animal bone. J Orthop Res. ;2(1) 6. Bergman I, Loxley R. Two improved and simplified methods for spectrophotometric determination of hydroxyproline. Anal Chem. ; 7. Takahashi M, Hoshino H, Kushida K, Inoue T. Direct measurement of crosslinks, pyridinoline, deoxypyridinoline and pentosidine in the hydrolysateof tissues using high performance liquid chromatography. Anal Biochem. ; 8. Eyre DR, Koob TJ, Van Ness KP. Quantitation of hydroxypridinium crosslinks in collagen by high performance liquid chromatography. Anal Biochem. ; 9. Huo MH, Troiano NW, Pelker RR, Gundberg CM, Friedlaender GE. The influence of ibuprofen on fracture repair: biomechanical, biochemical, histologic, and histomorphometric parameters in rats. J Orthop Res. ;9(3) Aro H, Eerola E, Penttinen R, Aho A. The responses of callus cells and lymphocytes to electrical stimulation in second meeting of european society of biomechanics, Strasbourg. J Biomech. Li J, Ahmad T, Sepetea M. Bone reinnervation after fracture: A study in the rat. J Bone Miner Res. ;18(8) Aro H. Efect of nerve injury on facture healing: Callus formation studed in the rat. Acta Orthop. Scand. ; Al-Harby SW, Samy MT, El Naggar MI. Delayed healing of experimental fractures denervated limbs of dogs. Clinical and radiological study. Bahrain Medical Bulletin. ;18(1). Aro H, Eerola E, Aho AJ. Healing of experimental fractures in the denervated limbs of the rats. Clin Orthop. ; seafoodplus.info
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