关于“手风琴技术”的来源、机制、操作方法、应用以及相关信号通路

The Source, Mechanism, Operation Method and Application of “Accordion Technology” and Associated Signaling Pathways

摘要: 在长久的骨科治疗中骨不连及骨缺损对于每个骨科医生来说都是个棘手的问题。Ilizarov成骨技术已经在世界范围内用于治疗许多骨科疾病。虽然成功，但牵张间隙中骨痂形成的缺失或延迟会导致显著的发病率。人们急需一个能缩短治疗时间的技术，随后一个交替牵张压缩的手风琴式技术诞生。而基于牵张成骨的“手风琴技术”对缩短治疗骨不连、大段骨缺损、畸形矫形时间疗效显著。此外，手风琴技术还会激活成骨相关信号通路，来进一步促进骨的生长愈合。有文献报道了该技术对于加速矿化的有效性，但对于采用“手风琴技术”的时机、具体操作方法尚缺乏统一标准，相关的作用机制也值得进一步探讨。故本文拟对“手风琴技术”来源、机制、操作方法、适应症、相关信号通路及其发展做一综述，为该技术在骨不连、骨缺损、畸形矫形治疗方面的临床研究提供借鉴参考。

Abstract: Bone nonunion and bone defect is a difficult problem for every orthopedic surgeon in the long-term orthopedic treatment. The Ilizarov osteogenesis technique has been used worldwide to treat many orthopedic diseases. Although successful, the absence or delay of callus formation in stretch spaces leads to significant morbidity. There was a desperate need for a technique that could shorten the treatment time, and an accordion technique of alternate stretch and compression was born. The “accordion technique” (AT) based on distraction osteogenesis is effective in shortening the time of nonunion, large bone defect and deformity correction. In addition, “accordion technology” also activates osteogenic signaling pathways to further promote bone growth and healing. Some literatures have reported the effectiveness of this technique in accelerating mineralization, but there is no unified standard for the timing and specific operation methods of “accordion technology”, and the related mechanism of action is also worth further discussion. Therefore, this paper will review the source, mechanism, operation method, indications, related signal pathway and development of “accordion technology”, so as to provide reference for the clinical research of this technology in the orthopedic treatment of bone nonunion, bone defect and deformity.