脊髓；火器伤；游离铁；铁蛋白_

椎体火器伤对挫伤脊髓组织铁蛋白表达的影响

http://www.100md.com 《创伤外科杂志》 2006年第6期

脊髓；火器伤；游离铁；铁蛋白,,脊髓；火器伤；游离铁；铁蛋白,1材料,2方法,1弹道出入口面积比及脊髓损伤大体观查,2伤段脊髓组织光镜改变,3伤段脊髓组

     摘要：目的建立家猪L2椎体贯通火器伤实验模型，通过免疫组织化学方法观察不同弹速火器伤对伤段脊髓组织铁蛋白表达的影响。方法 18只家猪随机分为2组(L组：微型冲锋枪组，n＝10；H组：狙击步枪组，n=8)，在全麻状态下建立L2椎体侧方贯通伤模型，同时大体观察比较两组弹道入口及出口面积比值、脊髓损伤范围、光镜改变、伤段脊髓组织游离铁及伤段脊髓组织铁蛋白免疫组化染色。结果 18只家猪中13只动物成功建立了L2椎体火器伤模型，其中冲锋枪组(L组)6只、狙击步枪组(H组)7只。L组弹道出口、入口面积比值：2.49±0.30；H组为6.93±0.75，两组比较差异显著(P<0.01)。大体所见脊髓广泛硬膜下血肿，以损伤为中心波及范围，L组：(8.12±1.23)cm；H组：(16.92±2.19)cm。两组比较有显著性意义(P<0.01)。两组游离铁分别为：L组(2.29±0.38)μmol/mg ；H组(3.78±0.53)μmol/mg ，两组比较有显著性差异(t＝-2.23，P<0.05)。H组脊髓组织伤后有更加明显的局灶性出血及组织水肿；两组伤后铁蛋白呈不同程度的阳性表达，但H组阳性细胞颗粒数明显增多，与L组比较有极显著性差异(P< 0.01)；多元线性回归分析及变量筛选显示两组伤段脊髓组织铁蛋白表达程度与脊髓大体损伤范围及游离铁的含量具有相关性，相关系数R2=0.7339。结论铁蛋白参与了脊髓的继发损伤反应，并且与损伤程度及伤段脊髓组织中的游离铁含量相关。

    关键词：脊髓；火器伤；游离铁；铁蛋白

    Expression of ferritin after gunshot injury of spine

    LIANG Chaoge，JIA Lianshun，CHEN Changqing，et al.

    (Department of Orthopaedics,Changning Center Hospital,Shanghai 200336,China)

    Abstract： Objective To establish L2 vertaberal body gunshot injury model,and investigate the differences of the size,injuries severity,ballistic outlet,entrance ratio,levels of free iron and expression of ferritin after gunshot injury to spine caused by different velocity bullets.Methods Eighteen healthy pigs were randomly divided into 2 groups: assault rifle group (L group,low velocity group,n=10) and sniper gun injury groups (H groups,high velocity group,n=8),L2 bodies were targetted by assault rifle or sniper gun bullets.The animals were sacrificed at 3 hours after injury.The ballistic entrance,outlet,injury of spinal cord size and levels of free iron of involved spinal cord segments were measured.Then the sections was stained imunohistochemcally,the expression of ferritin was compared.ResuIts L2 vertaberal body gunshot injury model was established in 13 pigs successfully.There was significant differences in the size(P< 0.01),injuries severity,ballistic outlet,entrance ratio(P<0.01) and levels of free iron(P<0.05).The expression of ferritin significantly increased in sniper gun groups compared with that in assault rifle group after GSI(P< 0.01).Multiple linear regression analysis variance selection revealed significant associations of ferritin with the injuries severity and levels of free iron.Conclusion The bullets velocity is one of the most important determinant events in tissue wounding.Eexperimental demonstration of ferritin plays an important role in the early stage of secondary events in gunshot injury to spine. ......

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