中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (4): 683-687.doi: 10.3969/j.issn.1673-8225.2012.04.026

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

应力条件下微小骨折块的愈合★

万永鲜，徐丽丽，卓乃强，鲁晓波   

  1. 泸州医学院附属医院骨与关节外科，四川省泸州市  646000
  • 收稿日期:2011-09-18 修回日期:2011-10-29 出版日期:2012-01-22 发布日期:2014-04-04
  • 通讯作者: 鲁晓波，教授，硕士生导师，泸州医学院附属医院骨与关节外科，四川省泸州市 646000 luxiaobo1963@126.com
  • 作者简介:万永鲜★，男，1979年生，湖北省随州市人，汉族， 2011年泸州医学院毕业，硕士，主治医师，主要从事骨关节功能修复与重建研究。wyx200308@163.com

Healing of micro fracture under stress

Wan Yong-xian, Xu Li-li, Zhuo Nai-qiang, Lu Xiao-bo   

  1. Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou  646000, Sichuan Province, China
     
  • Received:2011-09-18 Revised:2011-10-29 Online:2012-01-22 Published:2014-04-04
  • Contact: Lu Xiao-bo, Professor, Master’s supervisor, Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, Sichuan Province, China luxiaobo1963@126.com
  • About author:Wan Yong-xian★, Master, Attending physician, Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, Sichuan Province, China wyx200308@163.com

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摘要：

背景：应力刺激可以促进四肢长骨干骨折愈合。
目的：观察应力因素对微小骨折块愈合的影响。
方法：制作兔双侧股骨大转子劈裂撕脱微小骨折模型，一侧采用克氏针固定(对照组)，另一侧采用拉力螺钉置入固定(实验组)。
结果与结论：①X射线表现：实验组骨痂生长速度较对照组快，外骨痂量多，灰度高，骨痂塑型时间短。②CT表现：实验组内外骨痂生长速度比对照组要快，骨折处塑形较对照组好。③骨痂组织切片光镜观察发现，两组骨折愈合都表现为软骨内成骨方式，实验组血肿消失、机化较快，修复性纤维组织较早被软骨性骨痂取代，骨痂生长旺盛，断端骨痂愈合早且快，而且软骨性骨痂骨化、骨样小梁转化为编织骨均较对照组早，骨改建塑型亦较对照组好。④实验组和对照组骨折间隙内骨痂钙、磷元素的含量术后均逐渐升高至6周后开始下降，4周时实验组钙磷含量指标明显高于对照组(P < 0.01)。表明微小骨折块的愈合方式表现为软骨内成骨，适宜的加压固定较不加压固定骨折块周围组织水肿消退快，炎性反应小，骨痂中钙磷沉积早，含量大，骨折愈合时间短，骨痂质量好塑型快。

关键词: 应力, 微小骨折, 骨折愈合, 拉力螺钉, 克氏针

Abstract:

BACKGROUND: Stress stimulation can promote the healing of long bone fractures.
OBJECTIVE: To observe the effects of stress on the healing of micro fracture.
METHODS: Micro fracture models in bilateral greater trochanter of femur of rabbits were established. The micro fractures in one side fixed by Kirschner wire were taken as control and those in the other side fixed by lag screw were experimental group.
RESULTS AND CONCLUSION: X-ray showed that the growth of bone callus was quicker, external callus was more, gray value of callus was higher, and callus modeling time was shorter in the experimental group than in the control group. CT showed quicker growth of external callus and better fracture shaping of the experimental group compared with the control group. Light microscopy observation of callus tissue sections: the fracture healing way of the two groups was cartilaginous ossification; haematoma vanished , organization was quick, the recoverability fiber structure was replaced by bone callus in the early stage, the callus grew well, and healing at fracture was early and quick in the experimental group; ossification of cartilage bone callus and the transformation of trabecular bone into woven bone occurred more early, and the bone reconstruction was better of the experimental group compared with the control group. The calcium and phosphorus in callus of both groups were gradually increased before 6 weeks, and decreased at 6 weeks. The content of calcium and phosphorus at 4 weeks was obviously higher in the experimental group than that in the control group (P < 0.01). Healing way of the micro fracture is cartilaginous ossification. Appropriate compressive fixation is superior to fixation without compression because it can shorter the time of extinction of edema, deposition of calcium and phosphorus in bone callus and healing time, reduce the inflammatory response, increase the content of calcium and phosphorus in bone callus, and improve the quality of bone callus for quick shaping. 

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