Schmidmaier Gerhard, Schwabe Philipp, Strobel Catrin, Wildemann Britt
Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany.
Injury. 2008 Sep;39 Suppl 2:S37-43. doi: 10.1016/S0020-1383(08)70014-7.
With optimal surgical treatment within an appropriate time frame, bony tissue has the potential to regenerate defects without the formation of scar tissue. However, even under optimal mechanical circumstances and appropriate operative treatment, healing can fail and delayed or non-union occur. In Europe delayed bone healing leads to socio-economic costs of up to 14.7 billion euros per year. In addition to the optimal clinical treatment, the success of bone regeneration depends on the following main aspects: (1) adequate mechanical stabilization and biological competence of the organism, (2) osteogenic cells, (3) osteoconductive structures or scaffolds, and (4) growth factors (Diamond Concept)(1). Further, (5) a sufficient vascularisation is essential for the nutritive supply. Within the last years two growth factors, BMP-2 and BMP-7, were approved for clinical use in orthopaedic and trauma surgery for different indications.(2,3) The establishment of carrier systems and application techniques for growths factors is the focus of current research. The combination of a well established stabilization system and local drug delivery system for bioactive factors could be a therapeutical strategy to optimize bone healing and reduce the complication rate, in the future.
在适当的时间框架内进行最佳手术治疗时，骨组织有可能再生缺损而不形成瘢痕组织。然而，即使在最佳的力学环境和适当的手术治疗下，愈合仍可能失败，导致延迟愈合或不愈合。在欧洲，延迟性骨愈合每年导致的社会经济成本高达147亿欧元。除了最佳的临床治疗外，骨再生的成功还取决于以下几个主要方面：（1）机体足够的力学稳定性和生物学活性，（2）成骨细胞，（3）骨传导结构或支架，以及（4）生长因子（钻石概念）(1)。此外，（5）充足的血管化对于营养供应至关重要。在过去几年中，两种生长因子，骨形态发生蛋白-2（BMP-2）和骨形态发生蛋白-7（BMP-7），已被批准用于骨科和创伤外科的不同适应证的临床治疗(2,3)。生长因子载体系统和应用技术的建立是当前研究的重点。将成熟的稳定系统与生物活性因子的局部给药系统相结合，可能是未来优化骨愈合和降低并发症发生率的一种治疗策略。
