Delayed healing and nonunion formation are major challenges in orthopedic surgery, which require the development of novel treatment strategies. Vascularization is considered one of the major prerequisites for successful bone healing, providing an adequate nutrient supply and allowing the infiltration of progenitor cells to the fracture site. Hence, during the last decade, a considerable number of studies have focused on the evaluation of vascularization strategies to prevent or to treat nonunion formation. These involve (1) biophysical applications, (2) systemic pharmacological interventions, and (3) tissue engineering, including sophisticated scaffold materials, local growth factor delivery systems, cell-based techniques, and surgical vascularization approaches. Accumulating evidence indicates that in nonunions, these strategies are indeed capable of improving the process of bone healing. The major challenge for the future will now be the translation of these strategies into clinical practice to make them accessible for the majority of patients. If this succeeds, these vascularization strategies may markedly reduce the incidence of nonunion formation.

中文翻译：

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预防骨不连形成的血管化策略

延迟愈合和骨不连形成是骨科手术中的主要挑战，需要开发新的治疗策略。血管化被认为是成功骨愈合的主要先决条件之一，提供足够的营养供应并允许祖细胞浸润到骨折部位。因此，在过去十年中，相当多的研究集中在评估血管化策略以预防或治疗骨不连形成。这些涉及 (1) 生物物理应用、(2) 全身药理学干预和 (3) 组织工程，包括复杂的支架材料、局部生长因子递送系统、基于细胞的技术和外科血管化方法。越来越多的证据表明，在不工会中，这些策略确实能够改善骨愈合过程。未来的主要挑战将是将这些策略转化为临床实践，使大多数患者可以使用它们。如果成功，这些血管化策略可能会显着降低骨不连形成的发生率。