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骨折固定的四维空间事件 被引量:4

Four-dimensional space events of fracture healing
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摘要 背景:骨折的固定方式和手术操作对骨折愈合的最终结局产生十分重要的影响,但有关骨折愈合的不良结局是手术操作与其后伴发的一系列四维空间事件共同作用的结果。目的:探讨骨折愈合的四维空间事件。方法:检索中国知网和Medline数据库;中文检索词为骨折愈合,股骨骨折,应力遮挡,骨折与血供;英文检索词为Fracture healing,femoral fracture,stress shielding,fracture and blood flow。检索符合骨折愈合过程四维空间事件的相对宏观的事实描述,包括逻辑的支持证据和反驳证据。结合文献复习对骨折固定后主要的四维空间事件进行分析。结果与结论:骨折固定后主要的四维空间事件包括血运潮汐、力学脉冲与生物学脉冲、硬组织小间隙的磨盘效应、应力遮挡效应以及内固定物的四维空间漂移效应等。骨折及手术创伤后伴发长达数月的超代偿血运潮汐,因此骨折术后宏观上并不缺血,但硬组织小间隙在不稳定状态下会发生磨盘效应,造成骨折间隙内的碾挫损伤以及骨折间隙内的微观缺血。固定过于坚强导致的应力遮挡效应是取内固定后再骨折以及骨骼萎缩变细的重要原因。钢板固定螺钉的微小轴向漂移可能具有重要的理论意义,具有"智能性"轴向动力化效应,可使钢板分担的应力随着骨折的愈合逐步降低。对骨折愈合四维空间事件的探讨将为骨折愈合及牵拉成骨的调控提供基本的逻辑基础。 BACKGROUND: Fracture fixation and surgical procedures have a very important impact on the final outcome of fracture healing, but the adverse outcome of fracture healing is the result of the combined action of surgical procedures and a series of four-dimensional space events. OBJECTIVE: To explore the four-dimensional space events in fracture healing. METHODS: China National Knowledge Infrastructure and Medline were retrieved, with the key words of "fracture healing, femoral fracture, stress shielding, fracture and blood flow" in Chinese and English. Retrieval of relatively macroscopic factual descriptions corresponds to the four-dimensional space events of fracture healing process, including logically supported and refuted evidence. Combined with literat ure review, the main four-dimensional space events after fracture fixation were analyzed. RESULTS AND CONCLUSION: The main four-dimensional space events after fracture fixation include blood flow tides, mechanical and biological impulses, grinding disc effect of small gap in hard tissue, stress shielding effect and four-dimensional space drift effect of internal fixation material. Fractures and surgical trauma are accompanied by months of super-compensatory blood flow tides, so there is no ischemia in the macro-level after fracture surgery, but the grinding disc effect will occur in the small gap of hard tissue under unstable condition, resulting in contusion injury and micro-ischemia in the fracture gap. Stress shielding effect caused by too strong fixation is an important reason for refracture after internal fixation removal and bone atrophy and thinning after internal fixation. The small axial drift of plate fixation screw may have important theoretical significance. It has "intelligent" axial dynamic effect, which can make the stress shared by plate gradually decrease with the healing of fracture. Discussing the four-dimensional space events of fracture healing will provide basic logic for the regulation of fracture healing and distraction osteogenesis.
作者 刘振东 秦泗河 Liu Zhendong;Qin Sihe(Department of Orthopedics,Dandong Municipal 966 Hospital,Dandong 118000,Liaoning Province,China;Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids,Beijing 100176,China)
出处 《中国组织工程研究》 CAS 北大核心 2020年第6期903-910,共8页 Chinese Journal of Tissue Engineering Research
基金 全军医药卫生“十五”青年基金资助课题(01Q007),项目负责人:刘振东~~
关键词 骨折愈合 四维空间 磨盘效应 牵拉成骨 应力遮挡效应 漂移 fracture healing four-dimensional space grinding disc effect distraction osteogenesis stress shielding effect drift
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