Department of Orthopaedics, Division of Pediatric Orthopaedics, University of Medicine and Dentistry New Jersey, New Jersey Medical School, Newark, NJ, USA.
J Am Acad Orthop Surg. 2011 Feb;19(2):101-11. doi: 10.5435/00124635-201102000-00005.
Delayed bone healing during distraction osteogenesis negatively affects clinical outcome. In addition to autologous bone grafting, several mechanical, chemical, biologic, and external treatment modalities may be employed to promote bone growth during distraction osteogenesis in the pediatric patient. Mechanical approaches include compressive loading of the distraction regenerate, increased frequency of small increments of distraction, and compression-distraction. Intramedullary nailing and submuscular plating can reduce the time in external fixation; however, these techniques are associated with technical difficulties and complications. Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation. Other promising modalities include diphosphonates, physician-directed use (off-label use) of bone morphogenetic proteins, and local injection of bone marrow aspirate and platelet gel at the osteotomy site. Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis in children.
牵引成骨过程中延迟的骨愈合会对临床结果产生负面影响。除了自体骨移植外，还可以采用多种机械、化学、生物和外部治疗方法来促进小儿牵引成骨过程中的骨生长。机械方法包括对牵引再生区施加压缩载荷、增加小增量的牵引频率以及压缩-牵引。髓内钉和肌肉下接骨板可以减少外固定的时间；然而，这些技术与技术难度和并发症有关。外源性应用低强度脉冲超声或脉冲电磁场可能会缩短外固定的时间。其他有前途的方法包括双膦酸盐、医生指导下（超说明书使用）使用骨形态发生蛋白以及在骨切开部位局部注射骨髓抽吸物和血小板凝胶。需要进行精心设计的临床研究，以制定安全有效的各种方法指南，以增强儿童牵引成骨过程中的新骨形成。
