萎缩性骨不连的治疗研究进展
Research Progress in the Treatment of Atrophic Nonunion
DOI: 10.12677/ACM.2023.13122767, PDF,   
作者: 刘佶灵:成都中医药大学附属医院骨科,四川 成都
关键词: 萎缩性骨不连临床治疗方式研究现状综述Atrophic Nonunion Clinical Treatment Research Status Review
摘要: 目的:通过收集并整理现今萎缩性骨不连的治疗方法,提出相关研究的优势与不足,为未来研究方向和临床治疗提供思路。方法:检索SSCI、Pubmed、CNKI、VIP、万方数据库中从2000年1月1日开始,截止于2023年8月31日这一时间范围内,发表的有关萎缩性骨不连基础研究和临床研究的相关文献,对研究结果进行总结分析。结果:1) 萎缩性骨不连治疗仍以手术为主;2) 物理治疗、生物工程和中医治疗被认为有效,但存在一些不足;3) 随着近来3D打印等新技术的发展,萎缩性骨不连的治疗有了新的方向。结论:本研究对当前治疗萎缩性骨不连的方法统计较为全面,提出了当前研究的不足并指导了未来研究的方向。
Abstract: Objective: To collect and sort out the current treatment methods of atrophic nonunion, put forward the advantages and disadvantages of related research, and provide ideas for future research direc-tions and clinical treatment. Methods: SSCI, Pubmed, CNKI, VIP, and Wanfang databases were searched for basic and clinical studies on atrophic nonunion published from January 1, 2000 to Au-gust 31, 2023, and the results were summarized and analyzed. Results: 1) The treatment of atrophic nonunion was still mainly surgery; 2) Physiotherapy, bioengineering, and TCM treatments are considered effective, but have some shortcomings; 3) With the recent development of new technologies such as 3D printing, the treatment of atrophic nonunion has a new direction. Conclu-sion: This study provides a comprehensive statistical analysis of the current methods for the treat-ment of atrophic nonunion, puts forward the shortcomings of the current research, and guides the direction of future research.
文章引用:刘佶灵. 萎缩性骨不连的治疗研究进展[J]. 临床医学进展, 2023, 13(12): 19655-19667. https://doi.org/10.12677/ACM.2023.13122767

参考文献

[1] Tzioupis, C. and Giannoudis, P.V. (2007) Prevalence of Long-Bone Non-Unions. Injury, 38, S3-S9. [Google Scholar] [CrossRef
[2] Andrzejowski, P. and Giannoudis, P.V. (2019) The “Dia-mond Concept” for Long Bone Non-Union Management. Journal of Orthopaedics and Traumatology, 20, Article No. 21. [Google Scholar] [CrossRef] [PubMed]
[3] Brownlow, H.C., Reed, A. and Simpson, A.H. (2002) The Vascularity of Atrophic Non-Unions. Injury, 33, 145-150. [Google Scholar] [CrossRef
[4] Menger, M.M., Laschke, M.W., Nussler, A.K., Menger, M.D. and Histing, T. (2022) The Vascularization Paradox of Non-Union Formation. Angiogenesis, 25, 279-290. [Google Scholar] [CrossRef] [PubMed]
[5] Garcia, P., Holstein, J.H., Maier, S., Schaumloffel, H., Al-Marrawi, F., Hannig, M., Pohlemann, T. and Menger, M.D. (2008) Development of a Reliable Non-Union Model in Mice. Journal of Surgical Research 147, 84-91. [Google Scholar] [CrossRef] [PubMed]
[6] 潘治军. 高能量骨折导致萎缩性骨不连的炎症生物学机理研究[Z]. 陕西省, 榆林市第四人民医院, 2018-01-03.
[7] Richter, J., Schulze, W. and Muhr, G. (2000) Diaphyseal Fe-mur Pseudarthroses—Only a Technical Problem. Chirurgie, 71, 1098-1106. [Google Scholar] [CrossRef] [PubMed]
[8] Reed, A.A., Joyner, C.J., Brownlow, H.C., et al. (2002) Human Atrophic Fracture Non-Unions Are Not Avascular. Journal of Orthopaedic Research, 20, 593-599. [Google Scholar] [CrossRef
[9] Rodriguez-Merchan, E.C. and Forriol, F. (2004) Nonunion: General Principles and Experimental Data. Clinical Orthopaedics and Related Research, 419, 4-12. [Google Scholar] [CrossRef
[10] 段涛. 钢板联合皮质外骨桥技术治疗肱骨干骨折术后萎缩性骨不连的效果[J]. 中国卫生标准管理, 2020, 11(17): 55-57.
[11] Furuhata, R., Yokoyama, Y., Tanji, A., et al. (2023) Plate Fixation Using Parallelogram Prism Iliac Bone Grafts for Clavicle Oblique Nonunion with Shortening Deformity: A Case Report. BMC Musculoskeletal Disorders, 24, Article No. 346. [Google Scholar] [CrossRef] [PubMed]
[12] Min, S.H., 徐佳, 汪春阳, 等. 外固定支架在肱骨干萎缩性骨不连中的应用及疗效[J]. 生物骨科材料与临床研究, 2019, 16(4): 30-32.
[13] 郭保逢, 赵巍, 徐执扬, 等. 无植骨Ilizarov外固定技术治疗股骨萎缩性骨不连[J]. 中国修复重建外科杂志, 2019, 33(8): 940-946.
[14] 闫旭, 梅炯. 髓内钉动力化在促进长骨愈合中的应用与争议[J]. 中华创伤骨科杂志, 2020, 22(8): 733-736.
[15] 郑天雷, 李岩, 刘圣凯, 等. 适时动力化治疗股骨干骨折髓内钉固定延迟愈合[J]. 中国矫形外科杂志, 2018, 26(22): 2017-2021.
[16] Perumal, R., Shankar, V., Basha, R., et al. (2018) Is Nail Dynamization Beneficial after Twelve Weeks—An Analysis of 37 Cases. Journal of Clinical Orthopaedics and Trauma, 9, 322-326. [Google Scholar] [CrossRef] [PubMed]
[17] 孙卫平, 杜宏伟, 郑毅. 扩髓交锁髓内钉治疗胫骨萎缩性骨不连[J]. 中国矫形外科杂志, 2005(20): 21-22.
[18] Vaughn, J., Gotha, H., Cohen, E., et al. (2016) Nail Dynamization for Delayed Union and Nonunion in Femur and Tibia Fractures. Orthopedics, 39, e1117-e1123. [Google Scholar] [CrossRef] [PubMed]
[19] 李德钊, 贺雁翔, 徐学战, 等. 微创植骨加红骨髓移植配合中药治疗萎缩性骨不连的临床研究[J]. 中国医药指南, 2014, 12(19): 118-119.
[20] 郭旭, 彭宁宁, 孙立山, 等. 脱钙牙基质联合同种异体骨植入治疗长骨萎缩性骨不连的效果[J]. 广东医学, 2016, 37(20): 3098-3100.
[21] 胡雷鸣, 欧学海, 魏登科, 等. 带监测皮岛的游离腓骨移植治疗尺桡骨萎缩性骨不连[J]. 中国现代手术学杂志, 2020, 24(4): 278-282.
[22] 赵庭波, 许勇, 周方园, 等. 骨皮质剥离术在无菌性骨不连治疗中的应用[J]. 生物骨科材料与临床研究, 2018, 15(3): 39-41.
[23] 丁培根, 李长军, 周续祥. 重建钢板与记忆接骨板治疗锁骨萎缩性骨不连疗效比较[J]. 中国医药, 2006(9): 559-560.
[24] 皇高祥. 附加辅助钢板结合自体植骨治疗髓内钉术后无菌性骨不连的临床研究[D]: [硕士学位论文]. 大连: 大连医科大学, 2023.[CrossRef
[25] Chamseddine, A.H., Mouchantaf, M.E., Freiha, K.F., Asfour, A.H., Dib, A.A., Wardani, H.M., Bazzal, A.M. and Nahed, G.E. (2022) Bridge Plating with Decortication, Au-tologous Bone Graft, and Tight Closure: A “Stepwise Surgical Diamond Concept” for Treatment of Nonunion in a Series of Fifty Five Patients. International Orthopaedics, 46, 1241-1251. [Google Scholar] [CrossRef] [PubMed]
[26] Zhang, X. and Ma, Y. (2023) Global Trends in Research on Ex-tracorporeal Shock Wave Therapy (ESWT) from 2000 to 2021. BMC Musculoskeletal Disorders, 24, Article No. 312. [Google Scholar] [CrossRef] [PubMed]
[27] Wang, F.S., Wang, C.J., Huang, H.C., Chung, H., Chen, R.F. and Yang, K.D. (2001) Physical Shock Wave Mediates Membrane Hyperpolarization and Ras Activation for Osteogene-sis in Human Bone Marrow Stromal Cells. Biochemical and Biophysical Research Communications, 287, 648-655. [Google Scholar] [CrossRef] [PubMed]
[28] Wang, F.S., Yang, K.D., Chen, R.F., Wang, C.J. and Sheen-Chen, S.M. (2002) Extracorporeal Shock Wave Promotes Growth and Differentiation of Bone-Marrow Stromal Cells towards Osteoprogenitors Associated with Induction of TGF-beta1. The Journal of Bone and Joint Surgery. British Volume, 84, 457-461. [Google Scholar] [CrossRef
[29] Heimes, D., Wiesmann, N., Eckrich, J., Brieger, J., Mattyasovszky, S., Proff, P., et al. (2020) In Vivo Modulation of Angiogenesis and Immune Response on a Collagen Matrix via Extracorporeal Shockwaves. International Journal of Molecular Sciences, 21, Article No. 7574. [Google Scholar] [CrossRef] [PubMed]
[30] Wu, X., Wang, Y., Fan, X., Xu, X. and Sun, W. (2022) Extracorporeal Shockwave Relieves Endothelial Injury and Dysfunction in Steroid-Induced Osteonecrosis of the Femoral Head via miR-135b Targeting FOXO1: In Vitro and in Vivo Studies. Aging, 14, 410-429. [Google Scholar] [CrossRef] [PubMed]
[31] Modena, D.A.O., Soares, C.D., Candido, E.C., Chaim, F.D.M., Cazzo, E. and Chaim, E.A. (2022) Effect of Extracorporeal Shock Waves on Inflammation and Angiogenesis of Integumentary Tissue in Obese Individuals: Stimulating Repair and Regeneration. Lasers in Medical Science, 37, 1289-1297. [Google Scholar] [CrossRef] [PubMed]
[32] Ginini, J.G., Maor, G., Emodi, O., Shilo, D., Gabet, Y., Aizenbud, D., et al. (2018) Effects of Extracorporeal Shock Wave Therapy on Distraction Osteogenesis in Rat Mandible. Plastic and Reconstructive Surgery, 142, 1501-1509. [Google Scholar] [CrossRef
[33] Basoli, V., Chaudary, S., Cruciani, S., Santaniello, S., Bal-zano, F., Ventura, C., et al. (2020) Mechanical Stimulation of Fibroblasts by Extracorporeal Shock Waves: Modulation of Cell Activation and Proliferation through a Transient Proinflammatory Milieu. Cell Transplantation, 29. [Google Scholar] [CrossRef] [PubMed]
[34] Sansone, V., Ravier, D., Pascale, V., et al. (2022) Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 11, 1977. [Google Scholar] [CrossRef] [PubMed]
[35] Zelle, B.A., Gollwitzer, H., Zlowodzki, M. and Buhren, V. (2010) Ex-tracorporeal Shock Wave Therapy: Current Evidence. Orthopaedic Trauma, 24, S66-S70. [Google Scholar] [CrossRef
[36] Gerdesmeyer, L., Schaden, W., Besch, L., et al. (2015) Os-teogenetic Effect of Extracorporeal Shock Waves in Human. International Journal of Surgery, 24, 115-119. [Google Scholar] [CrossRef] [PubMed]
[37] Kuo, S.J., Su, I.C., Wang, C.J. and Ko, J.Y. (2015) Extracorporeal Shockwave Therapy (ESWT) in the Treatment of Atrophic Non-Unions of Femoral Shaft Fractures. International Jour-nal of Surgery, 24, 131-134. [Google Scholar] [CrossRef] [PubMed]
[38] 黄晶焕, 李晓林. 体外冲击波疗法治疗骨不连研究进展[J]. 国际骨科学杂志, 2018, 39(1): 17-20.
[39] Harrison, A., Lin, S., Pounder, N. and Mikuni-Takagaki, Y. (2016) Mode & Mechanism of Low Intensity Pulsed Ultrasound (LIPUS) in Fracture Repair. Ultrasonics, 70, 45-52. [Google Scholar] [CrossRef] [PubMed]
[40] Nolte, P.A., van der Krans, A., Patka, P., Janssen, I.M., Ryaby, J.P. and Albers, G.H. (2001) Low-Intensity Pulsed Ultrasound in the Treatment of Nonunions. The Journal of Trauma, 51, 693-702. [Google Scholar] [CrossRef] [PubMed]
[41] Xiao, H., Yan, A., Li, M., Wang, L. and Xiang, J. (2023) LIPUS Accelerates Bone Regeneration via HDAC6-Mediated Ciliogenesis. Biochemical and Biophysical Research Communications, 641, 34-41. [Google Scholar] [CrossRef] [PubMed]
[42] Pretorius, J., Mohamed, Y., Mustafa, A., Nemat, N., Ellanti, P., Hammad, Y., Shaju, T. and Nadeem, S. (2022) A Retrospective Study: Is Low-Intensity Pulsed Ultrasound (LIPUS) an Effective Alternate Treatment Option for Non-Union? Cureus, 14, e29230. [Google Scholar] [CrossRef] [PubMed]
[43] Elmajee, M., Munasinghe, C., Nasser, A.A.H., Nagappa, S. and Mahmood, A. (2022) The Perceptions of Clinicians Using Low-Intensity Pulsed Ultrasound (LIPUS) for Orthopaedic Pathology: A National Qualitative Study. Injury, 53, 3214-3219. [Google Scholar] [CrossRef] [PubMed]
[44] Pinfildi, C.E., Guerra, R.S. and Ventura, M.C. (2022) Six Month Nonunion Tibial Diaphysis Osteotomy Treated with Conventional Pulsed Therapeutic Ultrasound: A Case Report. Physi-otherapy Theory and Practice, 38, 3233-3240. [Google Scholar] [CrossRef] [PubMed]
[45] 姜懿轩, 宫苹, 张亮. 低强度脉冲超声促进骨组织再生相关机制的研究进展[J]. 华西口腔医学杂志, 2020, 38(5): 571-575.
[46] Leighton, R., Watson, J.T., Giannoudis, P., Papakostidis, C., Harrison, A. and Steen, R.G. (2017) Healing of Fracture Nonunions Treated with Low-Intensity Pulsed Ultrasound (LIPUS): A Systematic Review and Meta-Analysis. Injury, 48, 1339-1347. [Google Scholar] [CrossRef] [PubMed]
[47] 吴信举, 陶周善, 谢加兵, 等. 骨不连的非手术治疗进展[J]. 沈阳医学院学报, 2021, 23(2): 167-172.
[48] Kuzyk, P.R. and Schemitsch, E.H. (2009) The Science of Electrical Stim-ulation Therapy for Fracture Healing. Indian Journal of Orthopaedics, 43, 127-131. [Google Scholar] [CrossRef] [PubMed]
[49] Chalidis, B., Sachinis, N., Assiotis, A., Maccauro, G. and Graziani, F. (2011) Stimulation of Bone Formation and Fracture Healing with Pulsed Electromagnetic Fields: Biologic Responses and Clinical Implications. International Journal of Immunopathology and Pharmacology, 24, 17-20. [Google Scholar] [CrossRef
[50] Aaron, R.K., Boyan, B.D., Ciombor, D.M., Schwartz, Z. and Simon, B.J. (2004) Stimulation of Growth Factor Synthesis by Electric and Electromagnetic Fields [Review]. Clinical Orthopaedics and Related Research, 419, 30-37. [Google Scholar] [CrossRef] [PubMed]
[51] Bhavsar, M.B., Han, Z., DeCoster, T., et al. (2020) Electrical Stimulation-Based Bone Fracture Treatment, If It Works So Well Why Do Not More Surgeons Use It? Euro-pean Journal of Trauma and Emergency Surgery, 46, 245-264. [Google Scholar] [CrossRef] [PubMed]
[52] Aleem, I., Aleem, I., Evaniew, N., et al. (2016) Efficacy of Elec-trical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials. Scientific Reports, 6, Arti-cle No. 31724. [Google Scholar] [CrossRef] [PubMed]
[53] Ciombor, D. and Aaron, R. (2005) The Role of Electrical Stimulation in Bone Repair. Foot and Ankle Clinics, 10, 579-593. [Google Scholar] [CrossRef] [PubMed]
[54] Daish, C., Blanchard, R., Fox, K., et al. (2018) The Application of Pulsed Electromagnetic Fields (PEMFs) for Bone Fracture Repair: Past and Perspective Findings. Annals of Biomedical Engineering, 46, 525-542. [Google Scholar] [CrossRef] [PubMed]
[55] Shi, H.F., Xiong, J., Chen, Y.X., et al. (2013) Early Application of Pulsed Electromagnetic Field in the Treatment of Postoperative Delayed Union of Long-Bone Fractures: A Prospective Randomized Controlled Study. BMC Musculoskeletal Disorders, 14, Article No. 35. [Google Scholar] [CrossRef] [PubMed]
[56] Assiotis, A., Sachinis, N.P. and Chalidis, B.E. (2012) Pulsed Elec-tromagnetic Fields for the Treatment of Tibial Delayed Unions and Nonunions. A Prospective Clinical Study and Review of the Literature. Journal of Orthopaedic Surgery and Research, 7, Article No. 24. [Google Scholar] [CrossRef
[57] Yao, J.F., Shen, J.Z., Li, D.K., Lin, D.S., Li, L., Li, Q., Qi, P., Lian, K.J. and Ding, Z.Q. (2012) Rap System of Stress Stimulation Can Promote Bone Union after Lower Tibial Bone Fracture: A Clinical Research. International Journal of Medical Sciences, 9, 462-466. [Google Scholar] [CrossRef] [PubMed]
[58] 杜全红, 谷燕燕, 于文海, 等. 张-压应力刺激治疗四肢长骨萎缩性骨不连[J]. 中国矫形外科杂志, 2021, 29(14): 1323-1326.
[59] Schwarz, C., Wulsten, D., Ellinghaus, A., Lienau, J., Willie, B.M. and Duda, G.N. (2013) Mechanical Load Modulates the Stimulatory Effect of BMP2 in a Rat Nonunion Model. Tissue Engineering Part A, 19, 247-254. [Google Scholar] [CrossRef] [PubMed]
[60] Klosterhoff, B.S., Vantucci, C.E., Kaiser, J., Ong, K.G., Wood, L.B., Weiss, J.A., Guldberg, R.E. and Willett, N.J. (2022) Effects of Osteogenic Ambulatory Mechanical Stimulation on Early Stages of BMP-2 Mediated Bone Repair. Connective Tissue Research, 63, 16-27. [Google Scholar] [CrossRef] [PubMed]
[61] 张苗, 张玲莉, 雷乐, 李慧, 邹军. 机械刺激对成骨细胞影响的研究进展[J]. 中国骨质疏松杂志, 2017, 23(9): 1240-1244.
[62] 艾江平, 谭光宏, 余德涛, 邢祯全, 张福聪, 王佳斌, 陈峰. 机械刺激对骨质疏松症的影响的研究进展[J]. 实用医学杂志, 2012, 28(20): 3474-3476.
[63] Torstrick, F.B. and Guldberg, R.E. (2014) Local Strategies to Prevent and Treat Osteoporosis. Current Osteoporosis Reports, 12, 33-40. [Google Scholar] [CrossRef] [PubMed]
[64] 李晶, 马铁, 宋成林, 李涛, 高海宁, 姚婷婷, 晋俊杰, 张超, 胡广璇, 刁小芮, 衣雪洁, 常波. 机械敏感离子通道蛋白Piezo1响应机械力刺激调节骨代谢的研究进展[J]. 中国骨质疏松杂志, 2022, 28(5): 718-722, 732.
[65] Asano, T., Kaneko, E., Shinozaki, S., Imai, Y., Shibayama, M., Chiba, T., Ai, M., Kawakami, A., Asaoka, H., Nakayama, T., Mano, Y. and Shimokado, K. (2007) Hyperbaric Oxygen Induces Basic Fibroblast Growth Factor and Hepatocyte Growth Factor Expression, and En-hances Blood Perfusion and Muscle Regeneration in Mouse Ischemic Hind Limbs. Circulation Journal, 71, 405-411. [Google Scholar] [CrossRef] [PubMed]
[66] Chen, X., Cheng, X., Ma, W., et al. (2017) Effects of Hyperbaric Oxygen Therapy on Open Tibial Fractures in Rabbits after Transient Seawater Immersion. Undersea and Hyperbaric Medicine, 44, 235-242. [Google Scholar] [CrossRef] [PubMed]
[67] Kürklü, M., Yurttaş, Y., Köse, O., Demiralp, B., Yüksel, H.Y. and Kömürcü, M. (2012) Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Atrophic Tibial Nonunion with Ilizarov External Fixator: A Radiographic and Scintigraphic Study in Rabbits. Acta Orthopaedica et Traumatologica Turcica, 46, 126-131. [Google Scholar] [CrossRef
[68] 王富强, 邢浩, 王雨苗. 骨不连的治疗进展[J]. 世界最新医学信息文摘, 2018, 18(9): 122-123+128.
[69] 庞李贺, 寿康全, 鲍同柱. 无菌性股骨干骨不连治疗的研究进展[J]. 海南医学, 2019, 30(21): 2835-2839.
[70] Wang, P., Gong, Y., Zhou, G., Ren, W. and Wang, X. (2023) Biodegradable Implants for Internal Fixation of Fractures and Accelerated Bone Regeneration. ACS Omega, 8, 27920-27931. [Google Scholar] [CrossRef] [PubMed]
[71] Jia, W.T., Zhang, C.Q., Wang, J.Q., et al. (2010) The Prophylactic Effects of Platelet-Leucocyte Gel in Osteomyelitis. Bone & Joint Journal, 92, 304-310. [Google Scholar] [CrossRef
[72] Memeo, A., Verdoni, F., De Bartolomeo, O., Albisetti, W. and Pedretti, L. (2014) A New Way to Treat Forearm Post-Traumatic Non-Union in Young Patients with Intramedullary Nailing and Platelet-Rich Plasma. Injury, 45, 418-423. [Google Scholar] [CrossRef] [PubMed]
[73] Guzel, Y., Karalezli, N., Bilge, O., et al. (2015) The Biomechani-cal and Histological Effects of Platelet-Rich Plasma on Fracture Healing. Knee Surgery, Sports Traumatology, Arthros-copy, 23, 1378-1383. [Google Scholar] [CrossRef] [PubMed]
[74] Desai, P., Hasan, S.M., Zambrana, L., et al. (2015) Bone Mesen-chymal Stem Cells with Growth Factors Successfully Treat Nonunions and Delayed Unions. HSS Journal, 11, 104-111. [Google Scholar] [CrossRef] [PubMed]
[75] 张远华, 李敬矿, 刘平胜, 等. 鼠神经生长因子治疗创伤性骨不连临床研究[J]. 中国临床解剖学杂志, 2018(36): 101-104.
[76] 刘平胜, 黄潮桐, 陈隆福, 等. 鼠神经生长因子治疗四肢创伤性骨不连27例临床疗效观察[J]. 中国医学创新, 2016, 13(34): 115-117.
[77] Zhan, M., Wang, M., Zhang, J., et al. (2020) Transforming Growth Factor Beta (TGF-β) Regulates Osteogenic Differentiation of Bone Mar-row Mesenchymal Stem Cells by Promoting Wnt Signaling Pathway in Atrophic Nonunion. Journal of Biomaterials and Tissue Engineering, 10, 265-270. [Google Scholar] [CrossRef
[78] 从凯, 李善龙, 王飞, 等. 骨形态发生蛋白2, 7治疗骨不连的效果评价[J]. 中国组织工程研究, 2020, 24(26): 4243-4250.
[79] Hernigou, P., Mathieu, G., Poignard, A., Manicom, O., Beaujean, F. and Rouard, H. (2006) Percutaneous Autologous Bone-Marrow Grafting for Nonunions. Surgical Technique. The Journal of Bone and Joint Surgery. American Volume, 2, 322-327. [Google Scholar] [CrossRef
[80] Tawonsawatruk, T., Kelly, M. and Simpson, H. (2014) Evaluation of Native Mesenchymal Stem Cells from Bone Marrow and Local Tissue in an Atrophic Nonunion Model. Tissue Engineering Part C: Methods, 20, 524-532. [Google Scholar] [CrossRef] [PubMed]
[81] Zigdon-Giladi, H., Rudich, U., Michaeli Geller, G. and Evron, A. (2015) Recent Advances in Bone Regeneration Using Adult Stem Cells. World Journal of Stem Cells, 7, 630-640. [Google Scholar] [CrossRef] [PubMed]
[82] Boregowda, S.V. and Phinney, D.G. (2012) Therapeutic Applications of Mesenchymal Stem Cells: Current Outlook. BioDrugs, 26, 201-208. [Google Scholar] [CrossRef
[83] Caplan, A.I. (2009) New Era of Cell-Based Orthopedic Therapies. Tis-sue Engineering Part B: Reviews, 15, 195-200. [Google Scholar] [CrossRef] [PubMed]
[84] Murray, I.R. and Péault, B. (2015) Q&A: Mesenchymal Stem Cells: Where Do They Come from and Is It Important? BMC Biology, 13, Article No. 99. [Google Scholar] [CrossRef] [PubMed]
[85] 胡海, 雷孝勇, 陈怀安, 等. 金葡素注射液在骨伤科领域的应用研究进展[J]. 中医正骨, 2017, 29(6): 42-43+48.
[86] 张会增, 张同润, 睢更义, 等. 断端局部注射治疗骨折术后骨不连的疗效[J]. 临床骨科杂志, 2020, 23(3): 380-383.
[87] 吴信举, 陶周善, 谢加兵, 等. 骨不连的非手术治疗进展[J]. 沈阳医学院学报, 2021, 23(2): 167-172. [Google Scholar] [CrossRef
[88] 杨立军, 张佳, 王哲, 等. 组织工程骨支架内部微孔结构流场特性分析[J]. 机械工程学报, 2018, 54(20): 71-80.
[89] 万鹏程, 俞秋纬, 王杰. 骨折延迟愈合骨不连的非手术治疗研究进展[J]. 四川中医, 2021, 39(6): 219-222.
[90] 胡学武, 游长征, 熊辉. 中医药促进骨折愈合分子机理研究进展[J]. 中医药导报, 2006, 12(10): 79-81.