人工生物材料在肌腱损伤中的应用

Application of artificial biomaterials for the treatment of tendon injury

目的:着重讨论组织工程在肌腱损伤中的临床应用。方法:应用计算机检索Medline数据库、中国期刊全文数据库1974/2009相关文献,检索词为"生物材料,肌腱愈合机制,预防粘连,Biological material,Sinew mechanismheals",并手工查阅相关书籍。结果:国内外学者不断探索如何在肌腱修复过程中通过内外源性生长因子调控细胞增殖、分化以及基质合成,促进肌腱修复并减少肌腱粘连和生物力学强度的衰减。肌腱缺损的治疗主要有自体肌腱移植、异体肌腱移植、人工肌腱移植、组织工程化肌腱植入,虽各有优缺点,但目前的研究热点是人工生物材料肌腱,且已应用于临床。当然,还有许多问题需要解决:包括肌腱组织工程种子细胞的来源,同种异体肌腱细胞的免疫学反应,特殊力学强度和降解性能支架材料的制备和筛选,细胞与支架材料之间相互作用关系及细胞—材料复合体与周围组织相互关系的问题等。随着人们对肌腱修复愈合理论认识的深入,防止肌腱粘连的药物也从用单一的药物或生物材料发展到药物与屏障材料结合的复合式药膜,加之中药以及分子生物学产品的发展,使它们不但抑制了外源性愈合,还促进了内源性愈合。防治方法也由简单的手术处理发展到全程的立体综合治疗,以期望达到理想的最佳效果。结论:尽管肌腱修复的生物材料研究在某些方面取得了一些突破性进展,但在很多方面仍需进一步实验探讨。

OBJECTIVE： To investigate the clinical application of tissue engineering for treating tendon injury. METHODS： A computer-based online search was conducted in Medline and China Academic Journals Database with the key words of “Biological material, Sinew mechanism heals” in both English and Chinese from 1974 to 2009. Relevant books were hand-retrieved. RESULTS： Scholars at home and abroad tried to investigate how to regulate cell proliferation, differentiation, and matrix synthesis by endogenous and exogenous growth factors so as to promote tendon repairing, relieve tendon adhesion, and decrease attenuation of biomechanical intensity. Tendon detect was mainly treated by autologous tendon transplantation, allogeneic tendon transplantation, artificial tendon transplantation, and tissue-engineered tendon transplantation. All those methods had both advantages and disadvantages. However, artificial biomaterial tendon has attracted much attention and it has been used for clinical application. Of course, there are still more problems to be solved, for example, source of tissue-engineered seed cells, immunological reaction of allogeneic tendon cells, specific mechanical intension, preparation and selection of degradable scaffold materials, correlation between cell and scaffold materials, and correlation between cell-material compound and peripheral tissues. With the development of tendon repairing and healing, single drug which was used to prevent tendon adhesion has developed into drug-barrier compound. Additionally, with the development of Chinese herb and molecular biological products, they not only inhibited exogenous healing, but also promote endogenous healing. Meanwhile, simple surgery has also developed into combined therapy. CONCLUSION： Although biomaterials for tendon repairing have achieved breakthrough in some respects, the results need also to be further studied.