Kapetanakis Stylianos, Nastoulis Evangelos, Demesticha Theano, Demetriou Thespis
Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
Department of Anatomy, Medical School, Faculty of Medicine Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Open Orthop J. 2015 Jun 26;9:226-36. doi: 10.2174/1874325001509010226. eCollection 2015.
Venous Thromboembolism is a serious complication in the trauma patient. The most commonly studied and used anticoagulant treatment in prophylaxis of thrombosis is heparin. The prolonged use of unfractionated heparin has been connected with increased incidence of osteoporotic fractures. Low molecular-weight-heparins (LMWHs) have been the golden rule in antithrombotic therapy during the previous two decades as a way to overcome the major drawbacks of unfractioned heparin. However there are few studies reporting the effects of LMWHs on bone repair after fractures. This review presents the studies about the effects of LMWHs on bone biology (bone cells and bone metabolism) and underlying the mechanisms by which LMWHs may impair fracture healing process. The authors' research based on literature concluded that there are no facts and statistics for the role of LMWHs on fracture healing process in humans and the main body of evidence of their role comes from in vitro and animal studies. Further large clinical studies designed to compare different types of LMWHs, in different dosages and in different patient or animal models are needed for exploring the effects of LMWHs on fracture healing process.
静脉血栓栓塞是创伤患者的一种严重并发症。在预防血栓形成方面，研究和使用最广泛的抗凝治疗药物是肝素。长期使用普通肝素与骨质疏松性骨折的发生率增加有关。在过去二十年中，低分子量肝素（LMWHs）一直是抗血栓治疗的金标准，以此来克服普通肝素的主要缺点。然而，很少有研究报道低分子量肝素对骨折后骨修复的影响。这篇综述介绍了关于低分子量肝素对骨生物学（骨细胞和骨代谢）影响的研究，并阐述了低分子量肝素可能损害骨折愈合过程的潜在机制。作者基于文献的研究得出结论，关于低分子量肝素在人类骨折愈合过程中的作用，尚无事实和统计数据支持，其作用的主要证据来自体外和动物研究。需要进一步开展大型临床研究，比较不同类型、不同剂量的低分子量肝素在不同患者或动物模型中的效果，以探索低分子量肝素对骨折愈合过程的影响。
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