Milgram J W
Clin Orthop Relat Res. 1986 May(206):236-47.
Thirty-two pathologic specimens from patients who previously had sustained intraarticular fractures, usually of either the radial head or the patella, and subsequently had excision of the affected bone, were analyzed with respect to the healing mechanisms of articular fractures in humans. The cases were divided into five groups based on the duration of the time interval between fracture and joint-surface resection. The fracture clefts were sometimes perpendicular to the joint surface but often were more complex, and microscopically showed far more comminution than was appreciated from the gross examination. In all cases the articular chondrocytes demonstrated minimal reactive or reparative response to the injuries, even those cells that were situated directly adjacent to a fracture cleft. All significant repair was derived from the fracture-exposed bone marrow. At early stages, this consisted of granulation tissue. Later specimens showed fibrous tissue bridging the cartilage fracture gaps. Chondrous metaplasia within the surface layers of this fibrous callus could be observed occasionally, particularly in specimens with older fractures. However, it was often absent. In the cancellous bone, the healing of the fractures was by osseous, not chondroosseous, callus. In comminuted fractures areas of osteonecrosis were demonstrated in a number of cases.
对32例曾发生关节内骨折（通常为桡骨头或髌骨骨折）并随后接受患骨切除术的患者的病理标本进行分析，以研究人类关节骨折的愈合机制。根据骨折与关节面切除之间的时间间隔长短，将病例分为五组。骨折裂隙有时垂直于关节面，但通常更为复杂，显微镜下显示的粉碎程度远比肉眼检查时所认识到的严重。在所有病例中，关节软骨细胞对损伤的反应或修复反应极小，即使是那些直接毗邻骨折裂隙的细胞也是如此。所有显著的修复均源自骨折暴露的骨髓。早期由肉芽组织构成。后期标本显示纤维组织跨越软骨骨折间隙。偶尔可在这种纤维性骨痂表层观察到软骨化生，尤其是在骨折时间较长的标本中。然而，这种情况也常常不存在。在松质骨中，骨折的愈合是通过骨性骨痂，而非软骨性骨痂。在一些粉碎性骨折病例中显示存在骨坏死区域。
