Roganov G.G., Kushnir K.G., Nepreluk O.A

Crimea state medical university named after S. I. Georgievsky, Simferopol.

The influence of complex therapy on blood serum lipid peroxidation levels in patients with a fracture of the lower jaw.

In recent years, due to the increased overall level of traumatism the number of affected with injuries in the maxillofacial region increased significantly, both in our country and abroad. The cases of severe complications such as osteomyelitis of the mandible began to appear more frequently. The problem of the prevention and treatment of traumatic osteomyelitis, despite the large number of papers devoted to solving it, continues to be one of the most pressing and complex in the dental surgery. This is due to the complexity of the mechanism of purulent-destructive process in the bone. Many of its links are poorly understood until now. It is known that the effectiveness of treatment of fractures of the mandible is largely dependent on early diagnosis of purulent-inflammatory nature complications.

The purpose of research.

Improve the efficiency of treatment of patients with fractures and traumatic mandible osteomyelitis by including in treatment complex drugs with pathogenic (antihypoxic) therapeutic effects.

Clinical characteristics of patients.

Under clinical supervision there were 97 patients with fractures.

the lower jaw, received to inpatient treatment to dental office RCH named after N.A. Semashko (Simferopol).

The results of the research.

At present, it is generally accepted that the induced chemiluminescence is the most accurate method of determining the intensity of lipid peroxidation (LP), which is characterized by four main indicators of CL kinetics; S (30) - (light sum), Imax - (quick flash intensity CL), ST - (light sum until the maximum intensity) and tg2 (tangent decrease after the peak signal intensity). Last indicator is sometimes also called the maximum rate of inhibition. Tg2 value is greater the higher antioxidant activity present in the reaction system of the chemical compounds.

In the diagnosis of infectious and inflammatory complications of the mandible fractures object of study was to determine the intensity of lipid peroxidation reactions. Results of blood serum LP allows to reveal the features of the general and local body's response to injury and associated with it pathological changes, to some extent, to predict the future course (or subsiding) local and systemic inflammatory reactions, and to evaluate the chances of a successful reparation.

The analysis of blood serum LP of patients with a mandible fracture before beginning of treatmen processes found increased activity of lipid peroxidation, as evidenced by the parameters characterizing the processes.

Indicators blood serum LP in patients with a mandible fracture before treatment (n = 40)

Indicators (unit of measure)	Before treatment (М+m)	Healthy indiv. (normal) (М+m)	Р
Е (30) (conv. unit)	44,44+0,84	32,23±3,41	<0,05
Imax (conv. unit)	4,71+0,15	3,62+0,31	<0,05
ST (conv. unit)	7,55+0,25	6,01 ±0,19	<0,05
tg2 (conv. unit)	-119,29+8,44	-84,65+7,14	<0,05

Note: p-significant differences in comparison with those in healthy individuals.

It is important here to underline the fact that rates of serum peroxidation levels in patients with a fracture of the lower jaw before the start of treatment were significantly increased (p <0,05) compared to the norm.

In general, the 8th day of traditional treatment there was a significant change in these indicators, showingthe lowering LP activity in serum and reducing overall inflammatory reactions. Part of the indicators (Imax and ST), though showed positive dynamics, but the differences with normal levels did not reach a standard confidence levels.

On the eighth day of the therapy with the inclusion Erbisol showed a significant decrease in serum LP parameters. These positive changes were seen as a consequence of increasing antioxidant activity of blood serum under the influence of Erbisol (Table 2). The results showed modulating action of the drug on lipid peroxidation processes. Thus, on the 8th day of treatment, the great majority of patients in this subgroup parameters of LP came to the normal values (at p1> 0,05).

Indices of lipid peroxidation in blood serum of patients with a mandible fracture before and on the 8th day of therapy incorporating Erbisol (n = 30) (Table 2)

Indicators (unit of measure)	Before treatment (М+m)	8th day of therapy	Р	P1
Е (30) (conv. unit)	44,44+0,84	34,55+1,02	<0,01	>0,05
Imax (conv. unit)	4,71+0,15	3,46+0,18	<0,01	>0,05
ST (conv. unit)	7,55+0,25	5,46+0,21	<0,01	>0,05
tg2 (conv. unit)	-119,29+8,44	-86,01+6,81	<0,05	>0,05

Notes: p - significance compared to the same period before treatment; P1 - the accuracy in comparison with similar indicator of healthy individuals.

Conclusion

According to the blood serum LP processes research in induced chemiluminescence method established that infectious-inflammatory complications of mandible fracture occur against a background of marked disorders of redox processes due to local metabolic hypoxia.

It is established that the inclusion of Erbisol in complex treatment of patients with a fracture of the mandible reduces the risk of traumatic osteomyelitis of 10.1%, compared with conventional therapy.