应用组织工程学技术修复关节软骨缺损

Repair of articular cartilage defects by tissue engineering technology

目的:关节软骨缺损一直是临床上的一个难题。目前的治疗包括自体或异体骨软骨移植修复、软骨膜或骨膜移植修复。组织工程学技术的发展使体外培养软骨细胞修复关节软骨缺损进入了一个新的发展时期,通过查阅文献对体外培养软骨细胞修复关节软骨缺损进行综述。资料来源:应用计算机检索Medline1993-01/2004-06关于组织工程学技术修复关节软骨缺损的文章,检索词为“articularcartilagedefects、tis-sueengineeringtechnology”,限定语言种类为英文;同时计算机检索中国期刊数据库1993-01/2004-06相关组织工程学技术修复关节软骨缺损的文章,检索词“关节软骨缺损,组织工程学技术,体外培养”,限定语言种类为中文。资料选择:对资料进行初审,纳入标准:①有关软骨细胞的结构、功能、及其体外培养的意义研究。②有关体外培养种子细胞的选择的研究。③软骨细胞修复关节软骨缺损的前景展望的研究。排除标准:文献中重复研究、综述、Mata分析类文章。未排除文章中资料是否应用了随机、对照和盲法。资料提炼:共收集到32篇相关文献,含追溯法查找文献6篇,18篇符合纳入标准,排除14篇文献,其中4篇系重复研究,7篇为临床应用,3篇为软骨细胞支架的研究。18篇文献中有7篇对软骨细胞的特征进行综述,5篇是理想种子细胞的选择的研究,6篇为软骨细胞修复关节软骨缺损的前景展望的研究。资料综合:软骨细胞体外培养大量扩增、分化维持其正常的表型及代谢的调控因素为组织工程化软骨修复软骨缺损、体外培养软骨细胞建立软骨细胞库开拓了一条新的途径。软骨细胞、间充质干细胞(骨髓、骨膜或软骨膜来源)、滑膜细胞或转基因细胞等均可作为种子细胞。可来源于同种异体甚至异种细胞。自体软骨细胞植入技术已经作为一个传统自体软骨细胞移植术的替代品被骨科界广泛接受。结论:体外培养软骨细胞技术,目前已经成熟。组织工程学技术修复关节软骨缺损的方法很多。组织工程学技术的发展使体外培养软骨细胞修复关节软骨缺损进入了一个新的发展时期,基质诱导的自体软骨细胞植入技术修复关节软骨缺损开辟了新的道路。

OBJECTIVE： The repair of articular cartilage defects has been a difficult problem in clinical treatment. Presently cartilaginous autografi or allograft, periosteal and perichondral graft had been wideb applied to repair cartilage defects. The advancement of tissue engineerirlg makes articular cartilage defects repaired by transplantation of ehondroeytes euhured in vitro, a new developing phase. This paper aimed to review articular cartilage defects repaired with articular ehondroestes cultured in ritru by consulting literatures. DATA SOURCES： The relevant articles to the articular cartilage defects repaired with tissue engineering teehnnlogy published ftom January 1993 to April 2004 were searched For in Medlme datahuse hy inputting the key words “articular cartilage defects, tissue engineeriug technology” in English into a computer. Similarly. the relevant articles to the articular cartilage defects repaired with tissue engineering terhnology published fiom January 1993 to April 2004 were searched For in China National Knowledge Infrastmetnre（CNKl） hy using the key words “articular cartilage defects. tissue engineering technology, culture in vitro, and the language was limited to Chinese, STUDY SELECTION： Having heen looked through primarily, the included artieles were ①the study, on strueture, function and ehondrocytes cultured in vitro. ②selection of seed cells cultured in ritro and ③prospeet of articular cartilage defects repaired with ehondroevtes. The excluded articles were those about repetitive study, review and Mata analysis. Whether the articles adopted randomized, controlled and hlind methods was not excluded. DATA EXTRACTION： A total of 32 relevant literatures were collected, including 6 literatures by means of tracing. 18 aceo rdant with inclusion criteria and 1.4 were excluded （4 about repetitive study. 7 about clinical application and 3 ahout the scaffold of ehondmcytesl. Of the 18 articles. 7 were the study on the eharaeteristics of choudroevtes, and 5 were related to the selection of seed cells and 6 were prospects of articular cartilage defects repaired with tissue engineering technology. DATA SYNTHESIS： The regulatery factors that maintain the normal phenotypes and metabolism of ehondroeytes cultured in vitru after separation and differentition can exploit a new, approach to the repair of rartilage defects by tissue engineered cartilage and the bank establishment of ehondrncytes cultured in vitro. Chondrorvtes. mesenehymal stem cells（derived from bone marrow,periosteum or perichondrium）,synovial cells or transgene cells could be used as seed cells in tissue engineering,which might be the cells of the allograft or xenograft.It was widely accepted in orthopaedics that the conventional transplantation of autologous chondrocytes was constituted by the implantation of autologous chondrocytes.CONCLUSION： The technology of chondrocytes cultured in vitro has been mature at present.Many methods have been explored widely to repair articular cartilage defects.The development of tissue engineering make the articular cartilage defects repaired by chondrocytes cultured in vitro step into a new progress.Matrix-induced autologous chondrocyte implantation creates a new way for the repair of articular cartilage defects.