Schmidmaier G, Schwabe P, Wildemann B, Haas N P
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Germany.
Injury. 2007 Sep;38 Suppl 4:S35-41. doi: 10.1016/s0020-1383(08)70007-x.
Still a major problem in orthopedic and trauma surgery is the delayed healing or the non-union of long bone fractures. Demographic data reveal that due to the steadily rising age of the population, complications with the musculoskeletal system will increase during the next years. Bone morphogenetic proteins (BMPs) have successfully been applied in clinic for the treatment of delayed healing and non-unions. The broad difference concerning the indication, timing of treatment, dosage and application technique of BMPs calls for the need to perform further prospective studies in order to standardize the treatment and furthermore optimize the procedures or even develop new therapeutic strategies. For example, the application technique may be improved and in some cases injectable BMP preparations could be of use. Also the coating of implants with growth factors might be valuable in order to stimulate bone healing and to prevent delayed healing or non-union. This article tries to discuss some of the open questions, however can and will not reflect the absolute standard of care. To make the BMP treatment a standard of care, more clinical data and long time experiences are necessary. The intramedullary application of BMP in combination with autologous or allogenic bone grafts or bone substitutes after debridement and stabilization with implants seems to be an adequate procedure for treatment of atrophic non-unions. However, the total number of patients is too small to draw final conclusions. Further clinical studies need to be performed in the future.
在骨科和创伤外科中，一个主要问题仍然是长骨骨折的愈合延迟或不愈合。人口统计数据显示，由于人口年龄的稳步上升，未来几年肌肉骨骼系统并发症将会增加。骨形态发生蛋白（BMPs）已成功应用于临床治疗愈合延迟和不愈合。BMPs在适应证、治疗时机、剂量和应用技术方面存在很大差异，这就需要进行进一步的前瞻性研究，以便规范治疗，进而优化治疗程序，甚至开发新的治疗策略。例如，应用技术可能会得到改进，在某些情况下，可注射的BMP制剂可能会有用。用生长因子包被植入物也可能有助于刺激骨愈合，预防愈合延迟或不愈合。本文试图讨论一些尚未解决的问题，但无法也不会反映绝对的治疗标准。要使BMP治疗成为一种治疗标准，还需要更多的临床数据和长期经验。在清创并用植入物稳定后，将BMP髓内应用与自体或异体骨移植或骨替代物相结合，似乎是治疗萎缩性不愈合的一种适当方法。然而，患者总数太少，无法得出最终结论。未来需要进行更多的临床研究。
