Schell H, Duda G N, Peters A, Tsitsilonis S, Johnson K A, Schmidt-Bleek K
Julius Wolff Institut and Center for Musculoskeletal Surgery Charité - Universitätsmedizin Berlin, Berlin, Germany.
Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Exp Orthop. 2017 Dec;4(1):5. doi: 10.1186/s40634-017-0079-3. Epub 2017 Feb 7.
Fracture treatment is an old endeavour intended to promote bone healing and to also enable early loading and regain of function in the injured limb. However, in today's clinical routine the healing potential of the initial fracture haematoma is still not fully recognized. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) formed in Switzerland in 1956 formulated four AO principles of fracture treatment which are still valid today. Fracture treatment strategies have continued to evolve further, as for example the relatively new concept of minimally invasive plate osteosynthesis (MIPO). This MIPO treatment strategy harbours the benefit of an undisturbed original fracture haematoma that supports the healing process. The extent of the supportive effect of this haematoma for the bone healing process has not been considered in clinical practice so far. The rising importance of osteoimmunological aspects in bone healing supports the essential role of the initial haematoma as a source for inflammatory cells that release the cytokine pattern that directs cell recruitment towards the injured tissue. In reviewing the potential benefits of the fracture haematoma, the early development of angiogenic and osteogenic potentials within the haematoma are striking. Removing the haematoma during surgery could negatively influence the fracture healing process. In an ovine open tibial fracture model the haematoma was removed 4 or 7 days after injury and the bone that formed during the first two weeks of healing was significantly reduced in comparison with an undisturbed control. These findings indicate that whenever possible the original haematoma formed upon injury should be conserved during clinical fracture treatment to benefit from the inherent healing potential.
骨折治疗是一项古老的工作，旨在促进骨愈合，并使受伤肢体能够早期负重并恢复功能。然而，在当今的临床实践中，初始骨折血肿的愈合潜力仍未得到充分认识。1956年在瑞士成立的骨科学会（AO）制定了四条至今仍然有效的AO骨折治疗原则。骨折治疗策略不断进一步发展，例如相对较新的微创钢板接骨术（MIPO）概念。这种MIPO治疗策略具有不干扰原始骨折血肿的优点，而原始骨折血肿可支持愈合过程。到目前为止，临床实践中尚未考虑这种血肿对骨愈合过程的支持作用程度。骨愈合中骨免疫学方面的重要性不断提高，这支持了初始血肿作为炎症细胞来源的重要作用，这些炎症细胞释放细胞因子模式，引导细胞向受伤组织募集。在回顾骨折血肿的潜在益处时，血肿内血管生成和成骨潜能的早期发展引人注目。手术中清除血肿可能会对骨折愈合过程产生负面影响。在绵羊开放性胫骨骨折模型中，在受伤后4天或7天清除血肿，与未受干扰的对照组相比，愈合前两周形成的骨明显减少。这些发现表明，在临床骨折治疗中，只要有可能，应保留受伤时形成的原始血肿，以从其固有的愈合潜力中获益。
