反应
i. 炎症
ii. 肉芽组织形成
修复
iii. 软骨愈伤组织形成
iv. 板层骨沉积
重塑
v. 重塑原始骨轮廓
反应
骨折后,血细胞在损伤部位附近积聚。骨折后不久,血管收缩,停止进一步出血。在几个小时内,血管外血细胞形成一个称为血肿的凝块,作为愈伤组织形成的模板。这些细胞,包括巨噬细胞,释放炎症介质,如细胞因子(肿瘤坏死因子α(TNFα),白细胞介素-1家族(IL-1),白细胞介素6(IL-6),11(IL-11)和18(IL) -18))并增加毛细血管通透性。炎症在24小时达到峰值,并在7天内完成。通过肿瘤坏死因子受体1(TNFR1)和肿瘤坏死因子受体2,TNFα介导间充质干细胞(起源于骨髓)向成骨细胞和软骨细胞的分化。基质细胞衍生因子1(SDF-1)和CXCR4介导间充质干细胞的募集。 IL-1和IL-6是骨愈合最重要的细胞因子。 IL-1促进愈伤组织和血管的形成。 IL-6促进成骨细胞和破骨细胞的分化。血凝块内的所有细胞都退化并死亡。在该区域内,成纤维细胞复制。在7-14天内,它们形成松散的细胞聚集体,散布着小血管,称为肉芽组织。破骨细胞移动以重新吸收死骨末端,并去除其他坏死组织。
脚注:
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