Influence of Metabolic Therapy on Markers of Inflammation and Reparative Regeneration of Bone Tissue in Patients With Closed Diaphyseal Fractures of the Tibia

Background. Violation of bone tissue osteoreparation processes and increased inflammatory response in the fracture area lead to nonunion and significant slowdown in the functional recovery of the injured limb, which worsens the prognosis for recovery and increases the risk of patient disability. Study objective. To assess the serum level of markers of inflammation and reparative regeneration of bone tissue in patients with closed diaphyseal fractures of the tibia who receive metabolic therapy including a complex of hyperbaric oxygen therapy and an antioxidant (cytoflavin). Material and methods. The following parameters were studied in 110 patients with closed diaphyseal fractures of the tibia: C-reactive protein, procalcitonin, bone alkaline phosphatase, osteocalcin, P1NP, calcium, phosphorus. All patients were divided into 2 study groups: group 1 (comparison group) consisted of 45 people who received standard treatment in the early postoperative period; group 2 (main group) included 65 individuals, whose standard treatment regimen was supplemented with a complex of antioxidant (intravenous infusions of cytoflavin No. 10-15) and hyperbaric oxygen therapy (sessions of 55 minutes at 1.0-1.8 ATA, No. 10-15). Results. Analysis of the dynamics of osteomarker levels demonstrated stimulation of reparative osteogenesis, which was characterized by a decrease in the level of calcium and phosphorus ions in the blood serum in comparison with both the initial level and the findings in the comparison group, an increase in the content of P1NP to 186.0 (174.0; 196.5) ng / ml against the initial 167.0 (115.0; 181.1) ng/ml (p=0.012), activation of the bone isoenzyme of alkaline phosphatase and hyperexpression of osteocalcin, reflecting osteoblastic activity, accompanied by a decrease in the levels of the inflammation markers C-reactive protein and procalcitonin. Conclusions. Complex metabolic therapy led to the correction of the inflammatory syndrome and stimulation of reparative osteogenesis at the site of the tibial fracture.