Dynamics of the level of cytokines in the isolated femoral fracture under conditions of system ozone therapy

A close link between processes of immune-based and osteogenesis, influence of immune system on reparative processes after a traumatic femur fracture, as well as state of increased afferent signals emitted by intraosseous receptors and hyperstimulation of immune cells during trauma accounts for feasibility of using efferent multimodal therapy interventions, which may be accomplished by medical ozone. The aim of the study was to assess dynamic changes in pain syndrome and level of pro- and anti-inflammatory cytokines in isolated femur fracture treated with systemic ozone therapy.
The study group coprised 32 male patients with isolated femur fracture, average age 44.2±2.4 years. Starting from day 2 after surgical treatment, all patients received standard anticoagulant treatment and antibiotic therapy, 16 patients additionally received ozone therapy applied as small autohemotherapy (MAGT) at ozone therapeutic unit by using ozone destructor UOTA-60-01 “Medozon” manufactured by Medozon LLC, Moscow. Ozone concentration in ozone-oxygen mixture was 20 mg/l, per 10 ml-volume, applied as 7-9 injections course every other day. Patient-provided assessment of pain level in all groups was investigated by using a visual analogue pain scale. Concentrations of IL-6 and IL-4 cytokines were measured by using standard test systems (pruchased from Vector-Best JSC, Novosibirsk). Statistical data processing was carried out by using software package Statistica 10.0. The subjective pain level prior to the onset of the course ozone therapy and 2 days after surgical treatment was higher than average level after the end of MAGT course, pain level decreased to low level and significantly differed from that one before surgery, which indicates developed analgesic effect after systemic ozone therapy, likely associated with oxidative modification of inflammatory mediators. The level of pro-inflammatory cytokine IL-6 in patients with IPPK during systemic ozone therapy significantly decreased, which indicates some normalizing effect induced by ozone therapy on parameters of immunocyte secretory activity and prevents ovgert effects triggered by “cytokine storm”. Concentration of IL-4 vs after traumatic femur damage did not significantly differ among patient groups, except for differences with control group. Spearman correlation analysis revealed high degree of dependence between pain intensity and level of pro-inflammatory cytokines, whereas ozone therapy led to decreased pain intensity in lesion site and directly correlated with decreased IL-6 concentration. Thus, use of ozone at therapeutic concentrations limits excessive reactions of innate immunity that can lead to massive tissue damage in early stages of the posttraumatic process.