骨折不愈合的诊断及治疗建议

The diagnosis and treatment recommendations of bone nonunion

骨折的愈合是一个复杂的过程,能否成功愈合取决于多种内源和外源因子,愈合过程中的一些因素改变往往导致骨折的延迟愈合甚至骨不连。骨不连的发生率在5%~10%之间,随着严重损伤患者数量增多,骨不连发生率亦在随之增加。骨不连有很高的社会经济负担,主要是由间接成本造成的,如由于治疗时间长而造成的生产力损失。近年来,对于骨不连发病的影响因素、诊断及治疗方式的研究加深了外科医师对骨不连的认识。随着对骨不连认识的不断深入,外科医师对骨折的早期处理也进行了改善,从而降低了骨不连发生的风险,另外对骨不连本身的处理方式也得以进一步改良。本文的目的即在于回顾目前已发表的文献,以期增加临床医师对骨不连这一骨折并发症的认识以及为临床上选择恰当合理的治疗方法提供参考。

Fracture healing is a complex process, which depends on many endogenous and exogenous factors. Changes of some factors in the process of fracture healing will lead to delayed or nonunion of fracture healing. The rate of fracture nonunion is estimated to be between 5% and 10%, and the rate of nonunion may be increasing as the number for patients with severe injuries improves. There is a high socioeconomic burden for bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration. In recent years, the research on the factors, diagnosis and treatment of nonunion has deepened the understanding of the disease. As knowledge of fracture healing has increased, surgeons have improved early management of fractures, reducing the risk of fracture nonunion and improving management of established nonunion. This review summarizes the published literatures in order to increase clinicians' understanding of the bone nonunion and provide references for clinical selection of correct and reasonable treatment methods.