可注射型骨修复材料治疗骨折延迟愈合或不愈合

Injected bone restoring materials in the treatment of delayed union or nonunion of bone fracture

目的:根据近年来应用可注射型骨修复材料治疗骨不愈合的研究近况,探讨这种微创骨修复方法的研究进展。资料来源:应用计算机检索Medline1985-01/2005-12相关骨不连、骨诱导,注射型材料、骨修复的文献,检索词“fracturenonunion,boneinduction,carrier,percutancous”,并限定文献语言种类为English。同时计算机检索CBM1994-10/2004-10相关可注射型的骨修复材料方面的文献,检索词为“骨不连;骨诱导;载体”,并限定文献语言种类为中文。资料选择:对资料进行初审,选取包括骨诱导材料,骨不连的文献,开始查找全文。纳入标准:①骨不连与骨诱导。②经皮注射型材料,成骨方法。排除标准:①骨感染、骨良恶性肿瘤。②综述文献、重复研究、Meta分析类文章。资料综合:可注射型的骨修复材料广泛应用于临床骨折延迟愈合和不愈合的治疗,具有简单、经济、有效、并发症少的特点。其中,自体骨髓及复合物可以通过基质细胞的分化和骨基质的合成,促进骨愈合。骨形成蛋白及复合物作为一种高效诱导成骨因子,可以作用于间充质细胞或骨髓基质细胞,使其转化为软骨和骨细胞,具有良好的骨诱导特性。磷酸钙骨水泥及复合物作为一种骨传导材料,常作为骨诱导剂的缓释载体,形成复合生物活性材料,使其既具有骨传导能力,又具有骨诱导能力,明显提高了骨缺损的修复效果。骨基质、骨基质胶、胶原(主要是Ⅰ型胶原)及复合物具有传导成骨及诱导成骨的双重性能,如与其他力学性能较好的材料联合应用可望取得更好的效果。实验室研究已经证实成纤维细胞的成骨潜能,而多种骨生长因子的联合应用具有更好的促进成骨效果。但临床应用外源性生长因子还存在着因子来源、费用及其免疫反应和副作用等问题。金葡菌作为一种毛细血管增殖剂,能刺激毛细血管向骨折端长入,近年已广泛运用于骨折延迟愈合和不愈合的治疗。而脐血和胎盘注射液在促进成骨方面也取得了令人满意的效果。结论:可注射性骨修复材料具有广阔的临床应用前景,但需要严格掌握适应证及固定方式,并进一步研究解决注射材料的有效性,持续性,载体的选择以及移植部位异位骨化等问题。

OBJECTIVE： To probe into the development of mieroinvasive bone restorative procedure according to recent researching status of injected bone restorative materials in the treatment of bone disunion. DATA SOURCES： A computer based search of Medline for literatures related to bone nonunion, bone induction, injected materials and bone restoration from January 1985 to December 2005 was conducted with the key words of ＂fracture nonunion, bone induction,carrier, percutancous＂, and limited the language to English. Meanwhile, CBM was searched for articles related to injected bone restorative materials from October 1994 to October 2004 with computer with the key words of ＂fracture nonunion, bone induction, carrier＂ and limited the language to Chinese. STUDY SELECTION： Data were searched firstly, literatures about boneinduced materials and bone nonunion were selected, full-text was looked for. Accepting criteria： ① Bone nonunion and bone induction. ②Injected materials and method of bone formation. Excluded criteria： ③ Infection of bone, bone benign tumor and bone malignant tumor. ④ Reviews, repetitive studies and Meta analysis articles. DATA SYNTHESIS： Injected bone restorative materials were widely applied in the treatment of clinical late healed and disunion of bone fracture, which was characteristic by simple, economic, effective and with less complications. Of the total, autologous bone marrow （ABM） and compounds could promote the bone healing though the differentiation of matrix cells and the sythesis of bone matrix. As an effective induced factor of bone formation, bone morphogenetic protein （BMP） and complex had effects on mesenchymal or marrow stroma cells （MSC）, tured them into cartilage or bone cells, which had good characteristic of bone induction. Calcium acid phosphate cement and complex, as an bone-conduction materials, were mainly considered as the slow-release carrier of bone induction to form the compound bioactivity materials, which was endowed with ability of both bone conduction and bone induction were significantly enhanced the restorative effect on bone deficiency. Bone matrix, bone matrigel, collogen （mainly type Ⅰ collogen） and complex had double function of conducting and inducing bone formation, of which if combined with other better mechanics-nature materials, better effects would he achieved, Research in the laboratory has proved the fibroblastlc potency of bone formation, while the combined applying of many bone growth factors would has much better effects in promoting the bone formation, But there were some problems still existed in the clinical application of exogenous growth factors such as factor sources, cost, immune reaction, side effects and so on. Botryomycosis as a proliferating agent of micrangium, could sitimulate the micrangium grow towards the ends of bone fracture, and widely applying in the treatment of delay healed and nonunion of bonefracture in recent years. However, satisfing effects of parenteral solution of cord blood and placenta on aspect of promoting the bone formation had been achieved. CONCLUSION： Injected bone restorative materials has a wide prospect of clinical application, while the indicatios and fixed ways should be in strict control. Problems such as effectivertess and persistence of injected materials, selection of carriers, ectopic ossification of transplanted sites and so on needs further researching and settlement.