关节软骨损伤和缺损修复策略

Research on repair strategies for articular cartilage defects

关节软骨的损伤是临床中常见的疾病。由于关节软骨自身修复能力有限,采用关节镜下清创术、软骨移植、软骨细胞移植、组织工程技术及凝胶类关节软骨修复材料是目前对关节软骨损伤进行修复的主要手段。本文对目前用于关节软骨损伤和缺损修复的主要策略及各类修复技术的优缺点进行了综合评述。关节镜下清创术对早期骨性关节炎疗效显著;软骨及软骨细胞移植对小面积软骨缺损修复效果较为理想;组织工程技术是目前对关节软骨损伤和缺损修复的一个热点方向,但存在支架材料与软骨缺损区整合不紧密等问题;凝胶类关节软骨修复材料具有与自然关节软骨相似的力学和生物摩擦学特性,但其生物活性及与自然关节软骨间的结合强度有待进一步提高,如何实现材料生物活性、生物力学性能和生物摩擦学性能功能一体化是凝胶类关节软骨修复材料亟待解决的焦点问题。

Articular cartilage damage is very common in clinical practices. Due to the low self-healing abilities of articular cartilage, the repair strategies for articular cartilage such as arthroscopic lavage and debridement, osteochondral or chondro- cytes transplantation, tissue engineering and hydrogel based artificial cartilage materials are the primary technologies of repair- ing articular cartilage defect. In this paper, the main repair strategies for the articular cartilage damage and the advantages or disadvantages of each repair technology are summarized. The arthroscopic lavage and debridement is successful in treating the early stage of osteoarthritis. Osteochondral and chondrocytes transplantation are beneficial to treat small full thickness defects. The technology of tissue engineering becomes a new method to heal articular cartilage damage, but the major problem is the absence of bonding strength between the implants and natural defect surfaces. Hydrogel based artificial cartilage possesses similar bio-mechanical and bio-tribological performances to that of natural articular cartilage. However, both bioactivity and in- terfacial bonding strength between the implant and natural cartilage could be further improved. How to simultaneously optimize the mechanical and bioactive as well as biotribological properties of hydrogel based materials is a focus problem concerned.