Wallace A L, Makki R, Weiss J B, Hughes S P
Department of Orthopaedic Surgery, University of Edinburgh, Scotland.
J Orthop Trauma. 1995;9(4):324-32. doi: 10.1097/00005131-199509040-00009.
Early recovery of the vasculature is of profound importance in healing fractures, but the exact role of the regenerating endothelium remains controversial. Serum activity of endothelial cell-stimulating angiogenesis factor (ESAF) was measured after tibial osteotomy in two groups of sheep over a period of 42 days. Each osteotomy was held in an instrumented external fixator, and in one group the musculoperiosteal vasculature was excluded from the osteotomy site. In the well-vascularized group (n = 4), ESAF activity was significantly higher 2-5 days after osteotomy, with a peak at 4 days (21.1 +/- 5.4, p < 0.05), and displayed a biphasic pattern of secretion with a second peak at 7 days (24.3 +/- 5.5). In the devascularized group (n = 4) overall activity was lower, with only a single peak occurring at 9 days (17.5 +/- 3.2). These findings were correlated with significant differences in structural properties and on histological examination. The early detection of such regional vascular responses may prove to be of significant clinical value in high-energy trauma, enabling prediction of those fractures at risk of delayed or nonunion.
血管系统的早期恢复对骨折愈合极为重要，但再生内皮的确切作用仍存在争议。在两组绵羊胫骨截骨术后42天内，测量内皮细胞刺激血管生成因子（ESAF）的血清活性。每次截骨均用带仪器的外固定器固定，其中一组将肌骨膜血管从截骨部位排除。在血管丰富组（n = 4），截骨术后2 - 5天ESAF活性显著升高，在第4天达到峰值（21.1 +/- 5.4，p < 0.05），并呈现双相分泌模式，在第7天出现第二个峰值（24.3 +/- 5.5）。在去血管组（n = 4），总体活性较低，仅在第9天出现一个峰值（17.5 +/- 3.2）。这些发现与结构特性和组织学检查中的显著差异相关。早期检测这种局部血管反应在高能创伤中可能具有重要的临床价值，能够预测那些有延迟愈合或不愈合风险的骨折。
