Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA, USA.
J Am Acad Orthop Surg. 2012 May;20(5):273-82. doi: 10.5435/JAAOS-20-05-273.
No standard criteria exist for diagnosing fracture nonunion, and studies suggest that assessment of fracture healing varies among orthopaedic surgeons. This variability can be problematic in both clinical and orthopaedic trauma research settings. An understanding of risk factors for nonunion and of diagnostic tests used to assess fracture healing can facilitate a systematic approach to evaluation and management. Risk factors for nonunion include medical comorbidities, age, and the characteristics of the injury. The method of fracture management also influences healing. Comprehensive evaluation includes an assessment of the patient's symptoms, signs, and immune and endocrine status as well as the biologic capacity of the fracture, presence of infection, and quality of reduction and fixation. Diagnostic tests include plain radiography, CT, ultrasonography, fluoroscopy, bone scan, MRI, and several laboratory tests, including assays for bone turnover markers in the peripheral circulation. A systematic approach to evaluating fracture union can help surgeons determine the timing and nature of interventions.
目前尚不存在诊断骨折不愈合的标准准则，而且研究表明，骨科医生之间对骨折愈合的评估存在差异。这种变异性在临床和骨科创伤研究环境中都可能存在问题。了解骨折不愈合的危险因素以及用于评估骨折愈合的诊断测试可以促进评估和管理的系统方法。骨折不愈合的危险因素包括合并症、年龄和损伤特征。骨折处理方法也会影响愈合。全面评估包括评估患者的症状、体征以及免疫和内分泌状况，还有骨折的生物学能力、感染的存在以及复位和固定的质量。诊断测试包括 X 线平片、CT、超声、透视、骨扫描、MRI 以及几种实验室测试，包括外周循环中骨转换标志物的检测。系统评估骨折愈合有助于外科医生确定干预的时间和性质。
