骨折端分离对骨折愈合的影响

骨折端分离对骨折愈合的影响河南洛阳正骨研究所（４７１００２）孙维琰，段更庚笔者对１５０例股骨干骨折患者的临床观察，对骨折端分离与骨折愈合的影响进行了探讨，现报告如下。观察方法选择１８～６５岁创伤性新鲜闭合股骨干骨折１５０例，患者一般情况良好，无其他严...     

微动对骨折愈合影响的研究进展

微动对骨折愈合影响的研究进展张先龙曹炳芳骨折愈合是一个极其复杂的生物学修复过程，而且受到许多因素的影响。如何促进骨折愈合一直是骨科领域的研究热点。随着人们对骨折愈合研究的深入，对骨折的治疗也已进入了分子生物学时代，传统的骨折愈合理论也正在受到冲击。近...     

骨折愈合刺激素对体外培养成骨细胞的影响

目的　观察骨折愈合刺激素对体外培养成骨细胞的作用。方法　在新生SD大鼠头颅骨次代成骨细胞 (OB2 )培养液中分别加入不同浓度 (2× 10 2 U/L～ 2× 10 4U/L)骨折愈合刺激素 ,观察OB2的增殖功能 (用波长 5 70nm处OD值表示 ) ,取药物敏感浓度 (2× 10 2 U/L)分别观察分化功能〔用碱性磷酸酶 (ALP)活性表示〕和矿化功能 (用矿化结节数量 /视野表示 )。结果　OB2 增殖功能 (OD值 )实验组为 0 336± 0 0 73～ 0 35 9± 0 0 5 1,对照组为 0 347± 0 0 35 ;OB2 分化功能〔ALP(U/g蛋白质 )活性〕实验组为 83± 9,对照组为 81± 4 ;OB2 矿化结节数量 /视野 (个 )实验组为 6 0± 1 82 6 ,对照组为1 5± 1 0。结论　骨折愈合刺激素各浓度对OB2 的增殖和分化功能均无明显作用 (P >0 0 5 ) ,而对其矿化功能具有明显的刺激作用 (P <0 0 1)。     

周期性载荷对骨折愈合的影响

周期性载荷对骨折愈合的影响张建国张昌政＊姜开厚＊＊李华滢＊＊夏家骝＊＊＊临床和实验证实，骨折经适合固定后再施加周期性载荷，能刺激骨痂生长，促进骨折愈合，增加骨折愈合处的强度和刚度〔１～３〕。但有关骨折愈合能增强弯曲载荷的资料尚缺乏。因此，本文研究了周...     

神经系统对骨折愈合影响的研究进展

许多年以来，人们在临床实践中观察到一个有趣的现象，截瘫和颅脑损伤患者伴随的四肢骨折往往可以见到大量的骨痂过度生长，甚至在肌肉中出现异位骨化，骨折愈合明显快于没有中枢神经损伤的四肢骨折患者。而神经性关节炎患者，由于感觉神经损害，患肢骨折愈合往往显著延缓...     

雷洛昔芬对兔骨折愈合的影响

目的 研究雷洛昔芬(raloxifene,RLX)对兔骨折愈合的影响.方法 健康新西兰大白兔80只,雌性44只,雄性36只,体重1.9～2.1 kg.取72只动物制备左前肢桡骨中段0.5 cm骨缺损模型,按给药不同分为4组,每组18只(雌性10只,雄性8只).A、B、C组分别于术后第2天给予7.5、15.0、30.0mg/(kg·d)RLX至50d,D组不作处理.剩余8只不作任何处理,作为血清骨钙素检测正常对照.于术后不同时间点行骨密度、生物力学测定、X线片组织学和免疫组织化学染色观察,测定血清雌二醇、血浆胆固醇含量、血清骨钙素水平及子宫干重/体重比.结果 术后20 d各组骨密度达峰值,A、B、C组骨密度均高于D组(P＜0.05);但A、B、C组间差异无统计学意义(P＞0.05).术后30、50 d,A、B、C组最大破坏载荷和最大位移均较D组大(P＜0.05);A、B、C组间差异无统计学意义(P＞0.05).术后7、20、30d,A、B、C组骨折X线评分较D组高(P＜0.05);50 d时B、C组与D组间及A、C组间比较差异均有统计学意义(P＜0.05),B、C组间差异无统计学意义(P＞0.05).术后30、50 d,A、B、C组骨折愈合处新骨面积百分比均高于D组(P＜0.05).术后30d,B、C组骨折愈合处Col Ⅱ蛋白分泌较D组增多(P＜0.05),A、D组差异无统计学意义(P＞0.05);50 d时各组间差异均无统计学意义(P＞0.05).术后10、30及50 d各组血清骨钙素水平均较正常对照动物明显增高(P＜0.05);B、C组均较D组高(P＜0.05);A组与D组比较,A、B、C组间比较差异均无统计学意义(P＞0.05).术后30 d,各组血浆胆固醇含量无明显变化(P＞0.05);50 d时A、B、C组均明显降低,与D组比较差异有统计学意义(P＜0.05).术后30、50 d,B、C组血清雌二醇含量与D组比较差异有统计学意义(P＜0.05),余各组间比较差异无统计学意义(P＞0.05).术后30、50d,B、C组子宫干重/体重小于D组(P＜0.05),A、D组差异无统计学意义(P＞0.05).结论 以7.5 mg/(kg·d)剂量口服RLX可安全有效促进兔桡骨缺损骨折模型骨折愈合.     

苯妥英促进骨折愈合的临床观察

目的　观察苯妥英对骨折愈合的促进作用。方法　选择40 例胫腓骨闭合性骨折患者,随机分为两组,治疗组用苯妥英和接骨丹口服,对照组仅用接骨丹口服。术后分期观察一般情况,纵向叩击痛,骨折临床愈合时间,X线片骨痂生长情况。结果　全部患者骨折均在伤后3个月内愈合,但治疗组纵向叩击痛、临床愈合时间及X线片骨痂生长均明显优于对照组。结论　口服苯妥英有明显的促进骨折愈合的作用。由于中成药接骨丹含有钙成分,避免了单用苯妥英使血钙降低的可能性     

雌激素对实验性骨质疏松症骨折愈合的影响

目的 研究不同剂量的雌激素对卵巢除后发生骨质疏检习股骨骨折愈合的影响。方法 成年ｂａｌｂ／ｃ小鼠卵巢除后３个月开始制作右股骨中段闭合骨折模型,同一天开始皮下注射高低两种剂量雌激素,小鼠于折骨后５、１０、１５、２０、３０天分批处死,采用Ｘ射线、骨痂称重、骨痂中钙盐沉积率测定、组织学检查、血清生化检测等方法研究雌激素对骨折愈合的影响,并和卵巢除组、假手术对照组进行比较。结果 卵巢除组骨痂较小,     

神经生长因子对骨折愈合影响的研究进展

神经生长因子 (ｎｅｒｖｅｇｒｏｗｔｈｆａｃｔｏｒ,ＮＧＦ) ,是由Ｌｅｖｉ-ＭｏｎｔａｌｃｉｎｉＲ在 50年代初发现的第一个神经营养因子。ＮＧＦ对中枢和外周神经系统的生物效应 ,是维持和促进发生中的交感神经及来自神经嵴的感觉神经细胞的存活、分化和成熟以及执行功能。ＮＧＦ在机体组织器官 (包括脑 )有广泛的分布 ,它在靶组织中的浓度与交感神经、感觉神经在靶区分支的密度和ｍＲＮＡ含量有关 ;而靶器官产生的ＮＧＦ可诱使轴突朝特定靶器官方向生长。近年来随着对骨痂中肽能神经分布研究的深入 ,发现骨痂中有交感神经成份的神经肽Ｙ…     

Influence of shock waves on fracture healing

During the last decades the influence of physical factors on fracture healing has been widely described. With the use of shock waves for the treatment of urolithiasis, a new mechanical medium has been introduced into medicine. For the first time the influence of shock waves on fracture healing was studied in rats. With fractioned shock-wave treatment (5 times 100 shock waves at 14 or 18 kV) an enhancement in healing could be achieved.     

Influence of haemorrhagic shock on fracture healing

Background The purpose of the study was to evaluate the effect of haemorrhagic shock on the outcome of fracture healing.Material and methods Forty-two male Wistar rats were randomly divided into a control group and a shock group. After producing a tibia fracture we induced shock by creating a blood loss of 12 ml/kg body weight. The rats were isovolumetrically resuscitated with a colloid volume solution. Blood flow was measured by laser Doppler flowmetry. Mechanical properties were tested by three-point bending after 4 weeks.Results The blood flow of the shock group was characterised by no reduction in the distal region and in the soft tissue in the first 24 h, while the flow in the control group was reduced to 39% of the pre-fracture level. Biomechanical testing showed a better fracture healing outcome for the shock group than for the control group in failure load (31/11 N; P=0.06) and flexural rigidity (22,7/4,7 Nmm²; P=0.07).Conclusions In the shock group the restoration of vascularity in the distal region and in the soft tissue in the early healing stages, provoked by the isovolumic resuscitation, led to enhanced fracture healing. In addition, the results indicate that a fast blood supply may generate an improved initial healing process that results in an increased mechanical outcome of bone healing. In general, our findings underline the close interrelation between blood supply and successful fracture healing.This research study was presented at the 2nd Berlin Symposium "Significance of Musculo-Skeletal Soft Tissue on Pre-Operative Planning, Surgery and Healing", Berlin, 13–14 February 2003 (oral presentation)     

骨折类型对掌骨骨折钢板内固定术后骨愈合的影响

[目的] 评价掌骨骨折类型、患者职业与骨折愈合的相关性。[方法] 回顾性分析了104例掌骨关节外骨折，评价指标为愈合时间和愈合的并发症。与评价指标相关的因素为：骨折类型（横形骨折／非横形骨折）、患者类别、软组织损伤情况和钢板类型。[结果] 12例患者发生了骨折愈合问题：横形骨折组8例，非横形骨折组4例，横形骨折比非横形骨折更易发生愈合困难（P=0．01）。两种骨折类型的患者中，手工劳动者比非于工劳动者更易发生骨折愈合的问题（P〈0．01）：优势手骨折、软组织损伤和钢板的类别与骨折愈合问题没有相关性。[结论] 掌骨骨折的愈合与骨折类型、患者职业有相关性。     

Influence of blood supply on fracture healing of vertebral bodies

Introduction

The relevance of blood supply for bone fracture healing has been discussed throughout the literature, using scaphoids as the most referred to. But, there is virtually nothing known about the relevance of blood supply for the vertebral fracture healing and even the guidelines of AO do not deal with this issue.

Materials and methods

A prospective cohort study of 107 patients was run from January 2016 to December 2016, with 54 male and 53 female patients, who were treated for traumatic vertebral fractures of thoracolumbar spine using posterior stabilization only. The average age was 67 years and the follow-up 12.3 weeks. The total number of vertebrae was 129. We analyzed the fracture morphology and measured the vertebral bodies in all three dimensions, with five reference planes. The progress of vertebral deformity in time measured before and after the surgery was correlated with the potential damage of the main vascular canal in the rear of each vertebral body. The bone pattern and morphology were analyzed in detail as well. Pathological fractures were not taken into our consideration.

Results

The overall deformity progression of vertebral bodies in the fractures with morphologically damaged blood supply was in all measured dimensions significantly higher than in the fractures with supposedly maintained perfusion. The osteoporosis played its role as well, but only with medium effect size compared with strong effect size of the vessel canal damage (Cohen). The combination of the both factors (damage to the vessel canal together with osteoporosis) showed also a strong correlation with a relevant deformity progression (Evans), but not much different from the vessel canal damage alone. With regard to the relevant changes of the vertebral body dimensions/volume, we found relevant changes in 52% of all fractures (SD 0.5017) generally, for the subgroup with the canal damage in 84% (SD 0.3691), with strong correlation (Evans, 0.7721). In the group of fractures with maintained perfusion, we found such changes in only in 5% of fractures (SD 0.2333).

Conclusion

For decision making, we should take mechanical fracture analysis and dynamic processes within traumatized tissue a part of whose is the blood supply and oxygenation into surgical consideration. We recommend anterior rather than posterior stabilization for the cases with damaged vessel canal, and the vertebroplasty could pose an alternative in the elderly.

     

骨质疏松治疗仪对骨折愈合影响的研究

目的 回顾分析应用骨质疏松治疗仪治疗闭合性桡骨远端骨折,观察其在促进骨折愈合的作用.方法 2007年5月～2010年1月,选择69例闭合性桡骨远端骨折,年龄55岁～86岁,平均67.2岁.按就诊时间为序,单数进入实验组,双数进入对照组,将69例患者按序分配到实验组和对照组,实验组35例,对照组34例.实验组在手法复位石膏托外固定术后即开始连续16周应用天津希统生产的XT-2000B骨质疏松治疗仪治疗.2次/d,40 min/次.对照组在手法复位石膏托外固定术后不给予骨质疏松治疗仪治疗.其余康复治疗及预防感染,活血化淤,促进骨折愈合的药物等的应用完全相同.实验组和对照组分别在2w,6w,12w,16w复查X片.结果 所有患者获得4月的随访.实验组在6w,12w,X片上有明显骨痂生长,16w有大量骨痂生长,且有部分病例髓腔再通.对照组在12w,X片上有少量骨痂生长,16w骨痂生长明显.但未发现有髓腔再通的病例.结论 应用骨质疏松治疗仪治疗骨折具有促进骨折愈合,缩短骨折治疗时间的作用.     

Influence of an interlocking condition on the fracture healing process]

In order to clarify the influence of interlocking condition on the fracture healing process, the following three studies were carried out. First, an axial loading test was done in which an interlocking nail was inserted into a osteotomised human femoral bone. As a callus substitute, several kinds of resin were packed into the osteotomy gap. Load-formation curves were detected with strain gauges. These experiments suggest that the strain of the fractured end and its substitutes increase as the stiffness of the substitutes increases. Next, three weeks after the fixation with an interlocking nail of the osteotomized rabbit femur, the half of the femora were dynamized. The other half were not. Four to 56 weeks after osteotomy, the femora were harvested for radiographical and histological examination. No significant differences were detected between the two groups. In the last study, static and dynamic condition models similar to the second experiment were made. At 12 weeks, femora were harvested and measured for maximum bending strength. There were no statistically significant differences. These studies suggest that a so-called static condition has no unfavorable effects on fracture healing.     

Influence of extensive muscle injury on fracture healing in rat tibia

OBJECTIVES: The treatment of tibial fractures associated with severe soft tissue injury remains a challenge. The objective of our experiment was to ascertain the influence of standardized muscle injuries on fracture healing in a nailed rat tibial fracture model. We hypothesized that a severe crush injury of leg muscles might not be as deleterious to fracture healing as total loss of a large muscle segment. STUDY DESIGN: A randomized study in male Wistar rats with a diaphyseal osteotomy. METHODS: Three separate, but complementary experiments were done in 51 rats. The first experiment involved 30 rats randomly assigned to three increasingly severe soft tissue interventions in a nailed tibial osteotomy model. The second experiment involved 14 rats divided into two groups to study blood flow measurements of the muscle envelope after soft tissue injury. Seven rats were used in the third experiment to provide biomechanical data and dimensions of the rat tibia. The protocol for the first experiment was intramedullary nailing after a middiaphyseal osteotomy of the left tibia. In group A, the soft tissue injury was minimal, while the muscles in the anterolateral compartment were crushed in group B. Resection of the anterolateral compartment muscles, resulting in only skin coverage at the fracture site, was performed in group C. The fibular nerve was resected in all three groups so that the animals were non-weight bearing on the operated extremity. At 4 weeks, the healing bones in each group were studied clinically, radiographically, and biomechanically. RESULTS: Radiographs in two planes revealed a clearly visible fracture line in the three intervention groups at 4 weeks. The callus area following muscle resection in group C was significantly reduced compared with the minimal soft tissue injury in group A. Biomechanically, resection of the anterolateral compartment muscles in group C reduced maximum bending load and fracture energy compared with fractures with minimal soft tissue injury in group A, while bending rigidity and fracture energy was reduced compared with muscle crush in group B. No difference in mechanical characteristics was detected between the healing bones in groups A and B. CONCLUSION: This animal study indicates that crushing of the leg muscle envelope with reduced blood flow does not influence the quality of bone healing at 4 weeks to a significant degree. Resection of a large muscle segment impairs tibial fracture healing significantly.     

单侧外固定架动力化对骨折愈合的影响

目的：研究单侧外固定架不同时间动力化对骨折愈合的影响。方法 3组共15只山羊，每只行左侧胫骨横断后，用单侧外固定架固定。各组分别于术后2、4、6周实施动力化，定期摄X线片，行B超检查，生物力学测试，骨折愈合后行三点弯曲试验，组织学检查。结果 4周动力化组优于其他两组。结论 支架适时动力化后可促进骨痂生长，加速骨折愈合进程，骨折术后4周动力化最佳。     

Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing

Introduction Nonsteroidal antirheumatics (NSAR; NSAID) are often used in patients with fractured bones for analgetic reasons. This animal experiment was performed to determine the influence of NSAR on the process of fracture healing. As an alternative, tramadol, the centrally acting analgetic without peripheral effects, was included in this experiment.Materials and methods Wistar rats were operated on by a transverse osteotomy of the proximal tibia of the left leg. The fracture was stabilized by intramedullary nailing (healing period 21 days). All drugs were applied orally twice a day. The animals were divided into four groups with 10 rats each: Group 1 was treated with placebo (P), group 2 with tramadol (T; 20 mg/kg body weight/day), group 3 with diclofenac sodium (DS; 5 mg/kg bw/day) for 7 days followed by 14 days of placebo, group 4 with diclofenac sodium (DL; 5 mg/kgbw/day) over 21 days. On day 21 the rats were killed, and each leg was examined by X-ray, then the tibia was examined by CT scan, three-point bending, and histology.Results The results of CT and three-point bending showed that rats treated by diclofenac presented with delayed fracture healing compared with those treated by placebo or tramadol. Bone density in CT was highest in group 1 (mean 611.4±50.1 mg/ml), followed by group 2 (mean 542.5±29.5 mg/ml). Groups 3 (mean 411±34.0 mg/ml; p=0.006) and 4 (mean 395.2±15.4 mg/ml; p=0.009) were significantly lower. The stability of the bones, as measured by the breaking force (F_max), was highest in group 1 (mean 45.8±19.0 N), followed by group 2 (mean 39.0±7.9 N; NS); group 3 (mean 20.6±7.8 N; p=0.01) was significantly lower than the placebo animals, followed by group 4 (mean 26.5±8.3 N; p=0.03). Similar results were shown for bending stiffness: group 1 (mean 1404.6±611.4 Nmm/mm), group 2 (mean 1033.2±232.1 Nmm/mm; NS), group 3 (mean 564.2±457 Nmm/mm; p=0.045), and group 4 (mean 494.8±340.2 Nmm/mm; p=0.028). There were no significant differences between groups 1 and 2 and between groups 3 and 4, respectively. Diclofenac serum levels on day 21 in rats with long-term diclofenac application (mean 301.4±83.3 ng/ml) were comparable to those in humans.Conclusion Oral application of diclofenac significantly delayed fracture healing in rats. This effect might be comparable to other NSAR and fracture healing in humans.