Rodham Paul L, Giannoudis Vasileios P, Kanakaris Nikolaos K, Giannoudis Peter V
Academic Department of Trauma & Orthopaedics, Leeds General Infirmary, Leeds, United Kingdom of Great Britain and Northern Ireland.
Department of Trauma & Orthopaedics, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland.
EFORT Open Rev. 2023 May 9;8(5):264-282. doi: 10.1530/EOR-23-0047.
The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss. Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth. Autologous bone graft remains the gold standard, providing all of these qualities. Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft. Artificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties. Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus; however, their licencing is limited and larger studies are required to clarify their role. For recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.
在现代骨科创伤中，增强骨折愈合的能力至关重要，尤其是在处理具有挑战性的病例时，包括假体周围骨折、骨不连和急性骨丢失。用于增强骨折愈合的材料理想情况下应具有成骨、骨诱导、骨传导性，并促进血管长入。自体骨移植仍然是金标准，具备所有这些特性。该技术的局限性包括移植量低和供区并发症，替代技术包括使用同种异体骨或异种骨。人工支架可以提供骨传导结构，但不能提供骨诱导刺激，且机械性能往往较差。重组骨形态发生蛋白可以提供骨诱导刺激；然而，它们的许可有限，需要更多大型研究来阐明其作用。对于难治性骨不连或高危病例，使用结合上述技术的复合移植物成功实现骨愈合的机会最大。
