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肢体骨骼创伤修复的进展 被引量:22

ADVANCE IN MANAGEMENT OF SKELETAL TRAUMA OF THE EXTREMITIES
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摘要 目的阐述四肢骨折修复的最新进展。方法复习国内外文献,结合研究成果和临床经验,总结近几年肢体骨折的治疗方法。结果肢体骨骼创伤修复的进展主要表现在骨折治疗理念的更新、微创技术的开发和普及、内植入物的创新和改进、计算机导航技术的应用以及组织工程技术的发展。随着骨折治疗的原则从解剖复位坚强内固定演变成保护骨折环境的生物学接骨术,应运而生的是微创外科技术,包括微创接骨板技术、髓内钉固定术、外支架固定术、关节镜技术和计算机辅助的导航技术。与微创技术相一致,设计并应用了诸如微创接骨板和微创稳定系统一类新的内植入物,为骨质疏松性骨折和复杂的关节骨折和干骺端骨折提供有效的治疗手段。骨延迟连接和骨不连接有了新的更有效的治疗手段,包括可降解的具有骨传导和诱导作用的骨替代材料的应用。除了吻合血管的游离骨移植之外,骨迁徙技术也能修复长骨节段性缺损,而组织工程骨的研究和探索已经显示出治疗骨缺损的潜能,其与显微外科技术的结合,将是修复长骨节段性缺损的发展趋势。结论肢体骨折是十分常见的损伤,在强调复位、生物学固定的同时,应特别重视功能的恢复。 Objective To investigate the advance in the management of skeletal trauma of the extremities. Methods The literature at home and abroad was reviewed, and the research findings with clinical experience in the therapeutic methods for fracture of the extremities were summarized. Results The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computer-assisted surgery was applied, and the tissue engineering was developed. The fracture management was changed from the anatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery, and computer- assisted surgery. In concordance with the MIS principles, the new implants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or non-union of fractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bone transport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality. Conclusion Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency in this field.
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2006年第4期313-318,共6页 Chinese Journal of Reparative and Reconstructive Surgery
关键词 骨骼创伤 修复 进展 Skeletal trauma Reparation Development
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