Claes Lutz, Gebhard Florian, Ignatius Anita, Lechner Raimund, Baumgärtel Stefan, Kraus Michael, Krischak Gert D
Centre of Musculoskeletal Research, Institute of Orthopaedic Research and Biomechanics, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany.
Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, Centre of Surgery, Ulm University, Ulm, Germany.
Arch Orthop Trauma Surg. 2017 Jul;137(7):945-952. doi: 10.1007/s00402-017-2695-x. Epub 2017 Apr 20.
Previously, it was found that fracture healing is impaired by blunt chest trauma and an additional soft-tissue trauma. The mechanisms leading to this disturbance are largely unknown. Here, we investigated the effect of thoracic and soft-tissue trauma on blood flow of the injured lower leg and on tissue differentiation and callus formation during fracture healing.
Male Wistar rats received either a mid-shaft fracture of the tibia alone (group A), an additional chest trauma (group B), or additional chest and soft-tissue traumas (group C). Peripheral blood flow was determined by Laser Doppler Flowmetry before and after the injury, and on observation days 1, 3, 7, 14, and 28. Quantitative histological analysis was performed to assess callus size and composition.
All groups displayed an initial decrease in blood flow during the first 3 days post-trauma. A recovery of the blood flow that even exceeded preoperative levels occurred in group A and later and to a lesser degree in group B, but not in group C. The amount of callus formation decreased with increasing trauma load. More cartilage was formed after 7 days in groups B and C than in group A. At later healing time points, callus composition did not differ significantly.
An increasing injury burden causes a decreasing blood supply capacity and revascularization, and leads to impaired callus formation and an increasing delay in bone healing.
此前发现，钝性胸部创伤和额外的软组织创伤会损害骨折愈合。导致这种干扰的机制在很大程度上尚不清楚。在此，我们研究了胸部和软组织创伤对受伤小腿血流量以及骨折愈合过程中组织分化和骨痂形成的影响。
雄性Wistar大鼠分别接受单纯胫骨中段骨折（A组）、额外的胸部创伤（B组）或额外的胸部和软组织创伤（C组）。在受伤前后以及观察第1、3、7、14和28天时，通过激光多普勒血流仪测定外周血流量。进行定量组织学分析以评估骨痂大小和组成。
所有组在创伤后的前3天均显示血流量初始下降。A组血流量恢复，甚至超过术前水平，B组恢复较晚且程度较小，而C组未恢复。随着创伤负荷增加，骨痂形成量减少。B组和C组在7天后形成的软骨比A组更多。在愈合后期，骨痂组成无显著差异。
损伤负担增加会导致血液供应能力和血管再生下降，并导致骨痂形成受损和骨愈合延迟加剧。
