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The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures.
International Orthopaedics ( IF 2.7 ) Pub Date : 2020-02-15 , DOI: 10.1007/s00264-020-04506-z
Philippe Hernigou 1
Affiliation  

PURPOSE One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. MATERIAL AND METHODS These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. RESULTS Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. CONCLUSION It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

中文翻译:

整形外科手术中的骨髓病史(第I部分创伤):敲击,在损伤控制复苏中进行骨髓注射以及通过骨髓抽吸治疗骨折。

目的人类进行的最古老的手术之一是对骨进行切入术,但是直到最近40年,骨髓抽吸术才被用于治疗骨不连。材料和方法这些进步之所以成为可能是由于改进了在骨头上打孔的仪器和技术,这一历史始于大约8000-10,000年前的颅骨变态,并一直持续到开始使用创伤性复苏的胸骨骨髓注射。二十世纪;该方法在二十一世纪初得到了改进,允许盆腔骨髓抽吸术治疗骨不连。结果在世界许多地方都发现了远古时期的破骨颅骨,这表明破骨颅骨是古老而广泛的。从新石器时代开始,到哥伦布时期以前的安第斯文明开始,作者通过描述用于在颅骨上打洞的各种外科工具来追溯这种外科技术的发展。在19世纪末提出了这些工具(海风或海胆)以研究骨髓。在20世纪初,胸骨成为了“体内”研究骨髓的研究中心,并描述了在第二次世界大战期间对胸骨骨髓中的液体注射进行休克复苏的方法。随着塑料导管的引入和改进的插管技术,骨内输注作为静脉通路的替代途径的需求减少了,有时甚至被放弃了。但是,在1980年代中期,詹姆斯·奥尔洛夫斯基(James Orlowski)允许复兴使用骨内输注进行儿科复苏。从那时起,这项技术已经普及,现在被认为是成人紧急情况下静脉注射的替代方法。特别是,骨内通路已获得美国外科医生学院创伤委员会的支持,并从高级创伤生命支持计划中获得IIA级推荐,现在建议将骨髓输注用于“损伤控制”复苏。尽管骨盆的骨占人体体积的一半,但直到1950年,才提出将骨盆作为骨髓穿刺和骨髓间充质干细胞的来源,以改善骨折的愈合。
更新日期:2020-02-15
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