神经损伤与骨折愈合

Relationship between nerve injury and fracture healing

背景:神经调节骨折愈合是一个复杂的过程,失神经骨折愈合是目前研究的热点问题之一。目的:文章通过综合近年来的相关研究进展,回顾分析不同成分神经损伤及不同层面神经损伤对骨折愈合的影响,探讨神经损伤后骨折愈合的影响因素及其作用机制。方法:应用计算机检索维普数据库、中国知识资源总库、PubMed和Highwire数据库(1993-01/2009-10)与神经损伤和骨折愈合有关的文章,检索词分别为"骨折愈合;神经损伤;神经肽;生长因子"和"fracture healing;nerve injuries;neuropeptides;growth factors"同时对文章参考文献进行人工检索。纳入所述内容与骨折愈合、失神经支配骨折愈合以及神经损伤与骨折愈合关系相关的文章。排除相关性较低、重复研究以及较陈旧的文章。结果与结论:初检索到1638篇文献,中文文献有686篇,英文文献有952篇。阅读标题和摘要进行初筛,共纳入28篇符合标准的文献。经分析得出以下结论:骨折愈合是一个复杂的过程,受到机体大环境以及局部小环境的多层面、多途径调节,而且在这个过程中有许多生长因子的参与。不同成分神经损伤及不同层面神经损伤对骨折愈合有明显的影响,脑损伤并四肢骨折的患者,其骨痂大量生长,甚至在肌肉中出现异位骨化,骨折愈合明显快于单纯骨折的患者。

BACKGROUND： Neural regulation of fracture healing is a complex process. The denervation of fracture healing is a hot issue. OBJECTIVE： Through comprehensive research progress in recent years, this paper retrospective analyze the effect of various components and levels of nerve injury on fracture healing, and to explore the factors of fracture healing after nerve injury and its mechanism. METHODS： A computer-based research was conducted in VIP, CNKI, PubMed and Highwire database from 1993 to 2009 using Key words of ＂fracture healing; nerve injuries; neuropeptides; growth factors＂ both in English and Chinese, and literature references were manual retrieved. Documents related to bone healing, denervation, and relationship between nerve injury and fracture healing were included. The irrelative, repetitive research or old data were excluded. RESULTS AND CONCLUSIONS： A total of 1 638 literatures were collected, including 686 Chinese literatures and 952 English literatures. Through reading titles and abstracts, 28 standard literatures were included. Fracture healing is a complex process, subject to multi-level and multi-route regulations of the general and local environments in the body, and in this process many growth factors involved. Different components and levels of nerve injury have significant influence to fracture healing. The patients who have sustained a traumatic brain injury and limb fracture patients, a lot of callus around the fracture site is increased significantly, the heterotopic ossification in the muscle even appeared, and the rate of fracture healing was faster than the patients with simple fracture.