胫骨中下段骨折不愈合原因的研究进展  

Research progress on the reasons of the middle and distal tibial fracture nonunion

作　　者：常文利[1] 张英泽[1] 陈伟[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中国骨与关节杂志》2017年第9期713-716,共4页Chinese Journal of Bone and Joint

摘　　要：成人胫骨干骨折占全部成人胫腓骨骨折的24.75%。临床中胫骨干骨折不愈合的发生率为5%,开放性胫骨骨折延迟愈合的发生率为6.80%,其中胫骨中段1/3延迟愈合的发生率高达92.40%,给临床治疗带来很多困难。明确胫骨中下段的解剖及临床特质有助于全面认识胫骨中下段骨折,对其发生率、危险因素、相应的治疗措施的认识有助于对骨折进行评估并判断预后,以指导临床。The incidence of tibial shaft fracture accounts for 24.75% in all adults with tibiofibular fracture. The delayed union rate of open tibial fracture was 6.80%, and that for the middle third tibial fracture 92.40%. Special anatomical features of the middle and distal tibial fracture and the injury mechanism are important factors, affecting the tibial fracture healing. The blood supply of the tibial shaft is composed of three vascular systems： nutrient artery system, periosteum vascular system, and metaphyseal vascular system. If any of these blood supplies was destroyed, the rate of tibial fracture delayed union and nonunion can reach more than 3 times. Soft tissue defect with arterial damage is a risky factor for delayed union. Besides, age, smoking, previous history of fracture, drug combination, fracture types, and operation approaches also can result in the middle and distal tibial fracture nonunion. Endocrine metabolic disease is also an important factor to hinder the bone formation, such as diabetes, thyroid disease, vitamin D deficiency, and lack of estrogen. Clinical doses of nonselective NSAIDs can reduce calcium levels and hydroxyproline levels, subsequently increase the rate of nonunion. Cox-2-selective inhibitors can inhibit mesenchymal cell differentiation into osteoblasts. All the above-mentioned factors eventually lead to tibial fracture nonunion. This article reviews causes of the tibial delayed union and nonunion and their related treatment measures with the aim to improve the outcomes of clinical treatment.

关 键 词：胫骨骨折 骨折 不愈合 延迟愈合 综述 

分 类 号：R683[医药卫生—骨科学]