促进骨折愈合的治疗策略及机制研究进展

Research progress on therapeutic strategies and potential mechanisms to bone fracture healing

骨折愈合和修复是一个复杂的过程,包括膜内成骨和软骨内成骨两种方式。绝大多数骨折患者经治疗后可以愈合,但由于术后感染、患者自身成骨能力差等原因,仍有5%~10%的骨不连患者无法愈合进而导致截肢等风险。目前骨不连的治疗包括自体骨移植、使用重组生长因子BMP等策略,但尚无获得批准的治疗药物,因此还需对骨折愈合过程中的生物学机制进行深入研究,寻找其他低风险、高治愈效率的替代疗法。该综述简要介绍了骨损伤后骨折修复和再生的生物学过程,总结了目前临床上用于促进骨折愈合的方法,并对促进骨折愈合的重要分子机制及作用靶点等进行了归纳和总结。

Fracture healing and repair is a complex process via intramembranous and endochondral ossification. Clinically, the vast majority of fracture patients could reach union. However, there are still 5%~10% of nonunion patients who cannot reach union or even face the risk of amputation due to postoperative infection and poor ability of osteogenesis after bone fracture. The current treatments of nonunion include autologous bone transplantation, recombinant growth factor BMP and other strategies. Up to now, no drugs have been approved by FDA for treating nonunion or promoting fracture healing. Therefore, it is necessary to conduct in-depth research to uncover underlying molecular mechanisms of fracture healing, and to find other low-risk, high-efficiency alternative treatments. This review briefly introduces the biological process of fracture repair and regeneration after bone injury, summarizes the current clinical methods for promoting fracture healing, and wraps up the important signaling pathways and targets that could potentially promote fracture healing.