Ilizarov技术基础研究进展

Advances in understanding basic researches of Ilizarov technique

历经数十年的创新与发展,Ilizarov技术已在世界范围内得到充分认可并广泛应用于肢体畸形矫正及创伤后遗症等治疗中,为骨科发展做出举世瞩目的贡献。张力-应力诱导组织再生是Ilizarov技术核心,机械应力刺激信号经转导后引发生物级联反应,包括局部骨形态发生蛋白表达改变、炎症反应和免疫反应、血管再生、干细胞归巢以及其他系统性反应,从而共同维持组织再生。新生骨矿化速率缓慢是Ilizarov技术的主要局限性之一,为帮助Ilizarov技术更好地应用于临床,近年来促进牵拉区骨矿化的基础研究成为该领域研究的热点,如物理措施、化学药物和生物疗法等。随着对机械牵拉促进组织再生的逐步探索和深入理解,胫骨横向骨搬移越来越多地被用于治疗下肢血管性疾病,如糖尿病足和血栓闭塞性脉管炎。归纳及总结Ilizarov技术基本生物学机制和促进牵拉区域骨矿化方法,为今后牵拉成组织技术机制的研究和临床技术的革新提供思路。

Over the past several decades of innovation and development,Ilizarov technique has been widely recognized and applied in correction of limb deformity and post-traumatic sequelae with outstanding clinical outcomes,which making remarkable contributions to the development of orthopaedics.There is no doubt that tissue regeneration induced by tension-stress is the core of Ilizarov technique,and a series of biological cascades contributing to tissue regeneration could be triggered by mechanical stimulation through signal transduction including bone morphogenetic proteins regulations,inflammatory responses and immune responses,angiogenic activities,stem/progenitor cell homing and other systematic effects.One of main limitations of Ilizarov technique is slow rate of new bone mineralization.To facilitate this technique application better in clinical practices,a multitude of researches of means for promoting bone mineralization have become hot spots in this field in recent years,such as physical measures,chemicals and biological therapies.With better understanding of distraction histogenesis for promoting tissue regeneration,transverse tibial bone transport has been increasingly applied to vascular disease management in lower extremity,such as diabetic foot and thromboangitis obliterans.This review focuses on the recent advances in understanding the basic biological mechanisms of Ilizarov technique and new methods for promoting bone consolidation in distraction areas,providing evidence and ideas for further mechanism investigations and approach innovations.