Gardner Trevor Noel, Mishra Sanjay
Oxford Orthopaedic Engineering Centre, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
Med Eng Phys. 2003 Jul;25(6):455-64. doi: 10.1016/s1350-4533(03)00036-5.
The mechanism by which mechanical stimulus of reparative tissues directs the pattern of healing of a bone fracture is not understood. Several hypotheses have been developed that predict the ossification pattern during healing for a given ambient mechanical environment. These have remained unproved because of the absence of data on stress fields in the reparative tissue of real fractures. The present study examines the predictive performance of the most recent hypothesis that was proposed by Claes and Heigele (J. Biomech. 32 (1999) 255), against measured and calculated data from the clinical fracture reported by Gardner et al. (J. Biomech. 33 (2000) 415). The hypothesis was used to predict ossification from the preceding stress and strain fields present in the FEM of Gardner et al. at four temporal stages during healing. Predictions were then compared with the observed differentiation and maturation. During early healing of the interfragmentary gap region, the hypothesis correctly predicted the formation of connective tissue and fibrocartilage, and during later healing it correctly predicted the beginning of endochondral ossification. At the periphery of the periosteal callus, the hypothesis correctly predicted intramembraneous ossification during early healing, and also its thickening by endochondral ossification during later healing. However, the hypothesis incorrectly predicted intramembraneous ossification during early healing of the main periosteal callus, although in later healing it correctly predicted endochondral ossification.
修复组织的机械刺激引导骨折愈合模式的机制尚不清楚。已经提出了几种假设，用于预测给定周围机械环境下愈合过程中的骨化模式。由于缺乏真实骨折修复组织中应力场的数据，这些假设尚未得到证实。本研究根据Gardner等人（《生物力学杂志》33(2000)415）报告的临床骨折的测量和计算数据，检验了Claes和Heigele（《生物力学杂志》32(1999)255）提出的最新假设的预测性能。该假设用于根据Gardner等人有限元模型中愈合过程四个时间阶段存在的先前应力和应变场预测骨化。然后将预测结果与观察到的分化和成熟情况进行比较。在骨折间隙区域早期愈合期间，该假设正确预测了结缔组织和纤维软骨的形成，在后期愈合期间，它正确预测了软骨内骨化的开始。在骨膜骨痂的周边，该假设正确预测了早期愈合期间的膜内骨化，以及后期愈合期间通过软骨内骨化使其增厚。然而，该假设错误地预测了主要骨膜骨痂早期愈合期间的膜内骨化，尽管在后期愈合中它正确预测了软骨内骨化。
