Department of Orthopaedic Trauma, Massachusetts General Hospital, Boston, MA, USA.
Int Orthop. 2011 Apr;35(4):599-605. doi: 10.1007/s00264-010-1013-9. Epub 2010 Apr 23.
Clinical management of delayed healing or nonunion of long bone fractures and segmental bone defects poses a substantial orthopaedic challenge. Surgical advances and bone tissue engineering are providing new avenues to stimulate bone growth in cases of bone loss and nonunion. The reamer-irrigator-aspirator (RIA) device allows surgeons to aspirate the medullary contents of long bones and use the progenitor-rich "flow-through" fraction in autologous bone grafting. Dexamethasone (DEX) is a synthetic steroid that has been shown to induce osteoblastic differentiation. A series of 13 patients treated with RIA bone grafting enhanced with DEX for nonunion or segmental defect was examined retrospectively to assess the quality of bony union and clinical outcomes. Despite the initial poor prognoses, promising results were achieved using this technique; and given the complexity of these cases the observed success is of great value and warrants controlled study into both standardisation of the procedure and concentration of the grafting material.
临床处理长骨骨折和骨段缺损延迟愈合或不愈合是一个重大的骨科挑战。外科技术的进步和骨组织工程为刺激骨丢失和不愈合病例中的骨生长提供了新的途径。扩髓冲洗抽吸（RIA）装置允许外科医生抽吸长骨的髓腔内容物，并在自体骨移植中使用富含祖细胞的“贯通”部分。地塞米松（DEX）是一种合成类固醇，已被证明能诱导成骨细胞分化。回顾性研究了 13 例接受 RIA 骨移植增强DEX 治疗的不愈合或骨段缺损患者，以评估骨愈合质量和临床结果。尽管最初的预后较差，但该技术取得了令人鼓舞的效果；鉴于这些病例的复杂性，观察到的成功具有重要价值，需要对该程序的标准化和移植材料的浓度进行对照研究。
