Metaphyseal Fracture Healing

機(jī)譯：phy骨骨折愈合

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Most of what is known about fracture healing comes from studies of shaft fractures in long bones. In contrast, patients more often have fractures closer to the ends (metaphyses). Here most bone tissue has a spongy, cancellous structure different from the compact bone of the shaft. There is an increasing awareness that metaphyseal fractures heal differently. However, the more easily studied shaft healing has usually been considered as good enough representative for fracture healing in general. My work shows that the biology of metaphyseal healing is more different from shaft healing than was previously known and that this has implications on the effect of various commonly prescribed drugs. First we studied biopsies of healing cancellous bone collected from human donors. We found that the most abundant new bone formation occurred freely in the marrow rather than on the surface of old trabeculae, as described in most literature. There was little cartilage, indicating that the dominant bone formation process is mostly membranous in nature. This is a contrast to the ample cartilage formation commonly found in the well-characterized shaft fracture models. Next we characterized a model that allows for mechanical quantification of regenerating cancellous bone. By contrasting this cancellous healing model with the standard shaft healing model we could demonstrate that the NSAID indomethacin, the glucocorticoid dexamethasone, and the bisphosphonate alendronate all had different effects on the mechanical quality of bone regeneration in shaft and metaphysis; while anti-inflammatory drugs strongly impaired shaft healing, metaphyseal healing was not similarly affected. Alendronate had a positive effect on both models, though the effect was strongest in the metaphyseal model. Taken together these differences shed some light as to the differences in healing biology. The last step (within the boundaries of this thesis) was a characterization of how healing in cortical and cancellous bone differs in terms of immune cell involvement. We could find little difference between the two bone types day 3. However, day 5 an increase in the number of granulocytes could be noted in the cancellous bone while the cortical bone had a higher number of lymphocytes. To conclude, this work furthers our understanding of how metaphyseal healing differs from shaft healing. It has clinical implications as it motivates an increased attention to the site of fracture while contemplating treatment. I hope this thesis can be read as an argument for increased interest in metaphyseal fracture healing.

機(jī)譯：關(guān)于骨折愈合的大多數(shù)知識(shí)都來(lái)自對(duì)長(zhǎng)骨干骨折的研究。相比之下，患者的骨折往往更靠近末端（（骨）。在這里，大多數(shù)骨組織都具有海綿狀的松質(zhì)結(jié)構(gòu)，與軸的緊實(shí)骨不同。人們?cè)絹?lái)越意識(shí)到干meta端骨折的愈合方式不同。但是，通常較容易研究的軸愈合通常被認(rèn)為足以代表骨折愈合。我的工作表明，干phy端愈合的生物學(xué)特性與干shaft端愈合的生物學(xué)特性比以前已知的要大得多，這對(duì)各種常用處方藥的療效都有影響。首先，我們研究了從人類捐贈(zèng)者那里收集的愈合松質(zhì)骨的活檢組織。我們發(fā)現(xiàn)，最豐富的新骨形成自由發(fā)生在骨髓中，而不是大多數(shù)小梁的表面上。幾乎沒(méi)有軟骨，表明主要的骨形成過(guò)程本質(zhì)上主要是膜性的。這與特征明確的干骨折模型中常見(jiàn)的大量軟骨形成形成對(duì)比。接下來(lái)，我們對(duì)模型進(jìn)行了表征，該模型可以對(duì)再生的松質(zhì)骨進(jìn)行機(jī)械量化。通過(guò)將這種松散的愈合模型與標(biāo)準(zhǔn)的軸愈合模型進(jìn)行比較，我們可以證明NSAID消炎痛，糖皮質(zhì)激素地塞米松和雙膦酸鹽阿侖膦酸鹽對(duì)軸和干physi端的骨再生機(jī)械質(zhì)量均具有不同的影響。盡管抗炎藥嚴(yán)重?fù)p害了軸的愈合，但干meta端的愈合并未受到類似的影響。阿侖膦酸鹽對(duì)兩種模型均具有積極作用，盡管在干phy端模型中這種作用最強(qiáng)。這些差異加在一起為康復(fù)生物學(xué)的差異提供了一些啟示。最后一步（在本論文的范圍內(nèi)）是表征皮質(zhì)和松質(zhì)骨的愈合在免疫細(xì)胞受累方面如何不同。我們?cè)诘?天發(fā)現(xiàn)兩種骨類型之間幾乎沒(méi)有差異。但是，在第5天，松質(zhì)骨中的粒細(xì)胞數(shù)量增加了，而皮質(zhì)骨中的淋巴細(xì)胞數(shù)量增加了?？偠灾?，這項(xiàng)工作使我們對(duì)干healing端愈合與軸端愈合之間的區(qū)別有了進(jìn)一步的了解。它具有臨床意義，因?yàn)樗诳紤]治療的同時(shí)激發(fā)了對(duì)骨折部位的更多關(guān)注。我希望這篇論文可以作為對(duì)干phy端骨折愈合的興趣增加的論據(jù)。

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作者
Sandberg, Olof;
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年度 2016
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原文格式 PDF
正文語(yǔ)種 eng
中圖分類

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1. Estrogen and raloxifene improve metaphyseal fracture healing in the early phase of osteoporosis. A new fracture-healing model at the tibia in rat. [J] . Stuermer EK, Sehmisch S, Rack T, Langenbeck's archives of surgery . 2010,第2期

機(jī)譯：在骨質(zhì)疏松癥的早期階段，雌激素和雷洛昔芬可改善干phy端骨折的愈合。一種新的大鼠脛骨骨折愈合模型。
2. Estrogen and raloxifene improve metaphyseal fracture healing in the early phase of osteoporosis. A new fracture-healing model at the tibia in rat [J] . E. K. Stuermer, S. Sehmisch, T. Rack, Langenbeck's Archives of Surgery . 2010,第2期

機(jī)譯：在骨質(zhì)疏松癥的早期，雌激素和雷洛昔芬改善了干phy端骨折的愈合。大鼠脛骨骨折愈合的新模型
3. Metaphyseal fracture healing follows similar biomechanical rules as diaphyseal healing. [J] . Claes L, Reusch M, Gockelmann M, Journal of orthopaedic research . 2011,第3期

機(jī)譯：干fracture端骨折的愈合遵循與干dia端愈合相似的生物力學(xué)規(guī)則。
4. Computer aided less invasive stabilization for metaphyseal femoral and tibial fractures [C] . G ZHENG, PA GRUTZNER, LP NOLTE International Society for Computer Assisted Orthopaedic Surgery . 2003

機(jī)譯：計(jì)算機(jī)輔助復(fù)雜性股骨和脛骨骨折的侵入性穩(wěn)定
5. Influence of glucocorticoid and bone morphogenetic protein on fracture healing using a rat closed femoral fracture model. [D] . Gilley, Robert Stuart. 2002

機(jī)譯：糖皮質(zhì)激素和骨形態(tài)發(fā)生蛋白對(duì)大鼠閉合股骨骨折模型骨折愈合的影響。
6. Estrogen and raloxifene improve metaphyseal fracture healing in the early phase of osteoporosis. A new fracture-healing model at the tibia in rat [O] . E. K. Stuermer, S. Sehmisch, T. Rack, -1

機(jī)譯：在骨質(zhì)疏松癥的早期雌激素和雷洛昔芬改善了干phy端骨折的愈合。大鼠脛骨骨折愈合的新模型
7. Estrogen and raloxifene improve metaphyseal fracture healing in the early phase of osteoporosis. A new fracture-healing model at the tibia in rat [O] . E. K. Stuermer, S. Sehmisch, T. Rack, 2008

機(jī)譯：在骨質(zhì)疏松癥的早期，雌激素和雷洛昔芬改善了干phy端骨折的愈合。大鼠脛骨骨折愈合的新模型

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Metaphyseal Fracture Healing

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