BACKGROUND:In closed fractures, the initial hematoma that is inclined to remove is seldom considered as the important reasons for bone healing. OBJECTIVE:To observe the mechanism and potential role of original fracture hematoma in fracture healing. METHODS:Ninety-six patients with closed fractures of the long bones undergoing open reduction and internal fixation were randomly divided into experimental group (n=48) and control group (n=48). In the experimental group, original fracture hematoma, 1.0-2.0 mL, was first taken out during the internal fixation and placed into a special sterile plastic bag; then, 3-4 pieces of hematomas were filed into the fracture site and sutured layer by layer. On the contrary, original fracture hematomas from the control group were discarded. Blood samples were extracted to detect the biochemical indicators at 1 month after internal fixation. X-ray examination was done at 1, 3, 6 months after internal fixation for observation of fracture healing. RESULTS AND CONCLUSION: X-ray films showed that the healing rate at 3 months after operation was 95% in the experimental group and 78% in the control group, and there was a significant difference between the two groups (P < 0.05). Levels of bone glaprotein, I-type precolagen carboxy terminus peptide and serum bone alkaline phosphatase were significantly higher in the experimental group than the control group (P < 0.01 orP < 0.05). These findings indicate that the original fracture hematoma can accelerate calus formation, promote bone induction, provide nutrition to the fracture site, and participate in revascularization. Therefore, the original fracture hematomas is one of the effectively therapeutic methods for union and nonunion of fractures.%背景：临床实践中闭合性骨折内固定过程中，骨折原始血肿很少视为骨折愈合的重要因素，常被有意清除，非常可惜。目的：对比分析骨折血肿在骨折愈合过程中所发挥的机制及作用。方法：采用随机数字表将96例四肢骨折患者随机分成试验组和对照组各48例，实施闭合性骨折切开复位内固定术。试验组中先将内固定过程中取出的血肿块放置于特制无菌塑料袋中，每块血肿体积均为1.0-2.0 mL，于内固定装置固定完毕后将三四块骨折血肿重新填塞于骨折断端结合处周围，逐层缝合；对照组将固定过程中取出的骨折断端血肿丢弃，作为空白对照。内固定后1个月随访，抽血检测所有患者骨生化代谢指标；同时分别在术后第1，3，6个月行X射线检查，观察骨折愈合情况。结果与结论：X射线检查提示，内固定后3个月，试验组与对照组骨折愈合率分别占95%，75%(P <0.05)。骨代谢指标结果显示，试验组骨钙素、Ⅰ型前胶原羧基端肽、血清骨碱性磷酸酶水平较对照组显著增高(P <0.01或P <0.05)。结果说明原始骨折血肿可有效促进骨折断端骨痂形成，提示加强骨诱导，提供骨折断端营养，参与血管重建，是促进骨折愈合及预防骨折不愈合的有效途径。
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