Gajdobranski Dorde, Zivković Dragana
Klinika za decju hirurgiju, Institut za zdravstvenu zastitu dece i omladine, Novi Sad, 21000 Novi Sad, Hajduk Veljkova 10.
Med Pregl. 2003 Mar-Apr;56(3-4):146-51. doi: 10.2298/mpns0304146g.
Bone fracture healing is a complex cascade of events at cellular and biochemical levels, that ends by complete structural and functional restoration of a damaged bone. Impaired healing develops in 5-10% of all fractures, and manifests as delayed union or non-union. This paper deals with the problem of impaired healing as well as with methods of fracture healing enhancement.
There are many factors causing impaired fracture healing (inadequate vascularization, mechanical causes, infection, etc.), and it is very important to recognize the principle cause of delayed union and non-union, since therapy is based on eliminating the factor that causes it.
Through constant attempts to find adequate solutions and procedures in order to resolve the problem of impaired fracture healing, many alternatives in treatment of impaired healing have been developed. Some of these procedures may also be useful in treatment of fresh fractures, especially when it comes to fractures that are prone to delayed union and non-union more than usual. All currently known methods of healing enhancement may be classified as biological, mechanical and biophysical.
Certain methods are in clinical use for several decades. The newest methods, such as locally applied growth factors, composite biosynthetic grafts, gene therapy and systemic approaches are studied all around the world, and are on the verge of clinical application. Due to impressive number of therapeutic options, certain therapeutic procedures of choice will be developed for specific impairments.
骨折愈合是细胞和生化水平上一系列复杂的事件，最终受损骨骼实现结构和功能的完全恢复。在所有骨折中，有5% - 10%会出现愈合受损，表现为延迟愈合或不愈合。本文探讨了愈合受损的问题以及促进骨折愈合的方法。
导致骨折愈合受损的因素众多（血管化不足、机械原因、感染等），识别延迟愈合和不愈合的主要原因非常重要，因为治疗是基于消除导致该问题的因素。
通过不断尝试寻找适当的解决方案和程序来解决骨折愈合受损的问题，已经开发出了许多治疗愈合受损的替代方法。其中一些方法也可能对新鲜骨折的治疗有用，特别是对于那些比平常更容易出现延迟愈合和不愈合的骨折。目前所有已知的促进愈合的方法可分为生物学、机械学和生物物理学方法。
某些方法已在临床使用数十年。最新的方法，如局部应用生长因子、复合生物合成移植物、基因治疗和全身治疗方法正在全球范围内进行研究，并且即将应用于临床。由于治疗选择众多，将针对特定损伤开发某些首选治疗程序。
