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创伤性骨折约占交通事故总因素近50%,绝经后女性的骨折发生率较男性显著增加,其中约5%~10%的骨折患者会出现延迟愈合或骨不连等并发症,严重影响患者术后恢复,增加了家庭及社会的经济负担,但骨折愈合的机制目前机制尚未完全明确。骨折愈合中免疫细胞发挥着重要的调控作用,其中先天性免疫应答最先启动参与骨折愈合,而巨噬细胞因其“多面性”的特点,作为一线应答的免疫细胞通过参与炎症反应、成骨及破骨细胞分化、矿化及血管再生等过程,对骨折愈合发挥复杂而精密的调控作用。然而,巨噬细胞在不同的免疫微环境下,可极化为不同的亚群,发挥着不同甚至相反的功能。目前认为,巨噬细胞主要有三种极化状态:未活化M0型巨噬细胞、经典激活M1型巨噬细胞和可选择性激活M2型巨噬细胞,各种极化状态均在不同阶段参与了骨折愈合的调控过程。其中,M0型巨噬细胞参与骨折修复的机制源于与骨组织中间充质干细胞的相互作用;M1型巨噬细胞具有促炎功能,被认为在创伤初期发挥着不可或缺的作用;而M2型巨噬细胞则主要在创伤中晚期促进基质矿化沉积及创伤的修复。本文对巨噬细胞不同亚群在骨折不同阶段发挥的作用及目前针对巨噬细胞的实验研究进行综述,有助于明确骨折的免疫学机制,为以巨噬细胞为靶点的骨折免疫学干预研究提供新思路。“,”Traumatic fracture accounts for about 50% of the total of traffic accidents. The incidence of fracture in postmenopausal women is significantly higher than that in men. About 5%-10% of patients with bone fracture will suffer from complications such as delayed union or nonunion, which seriously affects the recovery of patients after operation and increases the economic burden of families and society, however, the specific regulatory mechanism has not been fully defined. Immune cells play an important regulatory role in fracture healing, and innate immune response is the first to initiate and participate in fracture healing. Macrophages are innate immune cells which widely exist in various tissues of the body. They play a complex and precise regulatory role in fracture healing by participating in inflammatory response, osteogenic and osteoclast differentiation, mineralization and angiogenesis. Nevertheless, macrophages can be polarized into different subsets and perform different or even opposite functions under different immune microenvironments. At present, it is believed that there are three main polarization states of macrophages: non-activated M0 macrophages, classically activated M1 macrophages and selectively activated M2 macrophage. It has been shown that each subset was positively involved in the regulation process of fracture healing at different stages. Herein, in this paper, the role of different subsets of macrophages in different stages of fracture healing and the related experimental studies are reviewed, helpfully to clarify the immunological mechanism of fracture in-depth and provide new strategies for the research on the immunological intervention of fractures targeting macrophages.