Landry P S, Marino A A, Sadasivan K K, Albright J A
Department of Orthopaedic Surgery, LSU Medical Center in Shreveport, Louisiana 71130-3932, USA.
J Trauma. 2000 Mar;48(3):479-83. doi: 10.1097/00005373-200003000-00018.
To determine whether the periosteal response to skeletal trauma is impaired when muscle is also injured, thereby providing a possible explanation for why fractures with extensive soft-tissue damage may take longer to heal.
A bone defect was made in the tibia of male Fisher rats, and the proliferative response, osteoblast concentration, and callus formation that occurred within 7 days were measured in the presence and absence of simultaneously administered model soft-tissue injury (removal of 10% of the anterior tibialis muscle from a region within 2 to 3 mm of the bone defect). Measurements were made by using autoradiography, quantitative histology, and morphometry.
Addition of the muscle injury increased proliferation in the cambium and in the fibrous periosteum on day 1, but had no effect thereafter; proliferation of fibroblasts in the loose connective tissue above the periosteum was not affected. Addition of the muscle injury resulted in increased osteoblast levels 2 to 5 days after injury but had no effect on the amount of callus produced.
The inflammatory milieu created by the muscle injury unexpectedly resulted in an increased periosteal response to skeletal trauma, suggesting that inflammatory mediators generated in response to wounding of soft tissues are unlikely to account for delayed fracture healing. These findings may indicate that surgical trauma associated with internal fixation by using plates and screws may not be as deleterious to the fracture-healing response as previously thought.
确定当肌肉也受到损伤时，骨膜对骨骼创伤的反应是否受损，从而为广泛软组织损伤的骨折愈合时间可能更长提供一种可能的解释。
在雄性Fisher大鼠的胫骨上制造骨缺损，在同时存在和不存在模型软组织损伤（从骨缺损2至3毫米范围内的区域切除10%的胫骨前肌）的情况下，测量7天内发生的增殖反应、成骨细胞浓度和骨痂形成。通过放射自显影、定量组织学和形态计量学进行测量。
肌肉损伤在第1天增加了形成层和纤维骨膜中的增殖，但此后没有影响；骨膜上方疏松结缔组织中成纤维细胞的增殖不受影响。肌肉损伤导致损伤后2至5天的成骨细胞水平增加，但对产生的骨痂量没有影响。
肌肉损伤产生的炎症环境意外地导致骨膜对骨骼创伤的反应增加，这表明软组织损伤产生的炎症介质不太可能是骨折愈合延迟的原因。这些发现可能表明，与使用钢板和螺钉进行内固定相关的手术创伤对骨折愈合反应的有害性可能不像以前认为的那样大。
