自体、异体骨软骨移植及组织工程材料修复的关节软骨损伤

Osteochondral autograft and allograft and tissue engineering materials for repair of articular cartilage injury

背景:关节软骨损伤的修复已成为近年来医学基础研究的一个重要领域。由于关节软骨损伤后不易修复,决定了关节软骨损伤的修复是热点中的难点。目的:概述能够对关节软骨损伤进行修复和功能重建的生物材料,为选择理想的组织工程支架材料提供一种理论上的选择。方法:由第一作者通过计算机检索1989到2014年Pub Med数据库和中国知网数据库。英文检索词为"articular cartilage injury,bone graft,tissue engineering scaffold materials",中文检索词为"关节软骨损伤、骨移植、组织工程支架材料"。检索近年来关于关节软骨的结构和功能、不同关节软骨损伤修复材料的选择及修复过程中影响因素等方面的相关文献,针对目前软骨损伤修复材料的应用作一个较系统的回顾及总结,分别对软骨修复材料各自优缺点进行综合评述,从材料学的视角介绍了几种软骨修复材料在软骨组织工程支架中的应用情况,在此基础上对临床软骨损伤修复提供一种理论上的选择。结果与结论:常用的软骨修复材料包括自体、异体骨软骨移植材料,胶原、透明质酸钠和壳聚糖等天然高分子材料。自体、异体骨软骨移植的修复方法只能暂时的缓解疼痛,修复组织容易发生退变,都不能成功修复损伤软骨,与这些已经投入临床的技术相比,尚处在实验研究阶段的组织工程学技术的临床研究仍在不断进行,在众多关节软骨修复材料中,无论是自体移植材料还是组织工程支架材料其生物力学性能各有不同,且目前还无法再造与天然生成的软骨具有相同力学性能的软骨组织。

BACKGROUND：In recent years, repair of articular cartilage injury has become an important field in basic medical research. Because injured articular cartilage is difficult to repair, the repair of articular cartilage injury has become a difficult hotspot.OBJECTIVE： To review the biomaterials possibly used for articular cartilage repair and functional reconstruction, thereby providing a theoretical basis for the selection of the desired tissue engineering scaffolds.METHODS： The first author searched the PubMed and CNKI databases （1989-2014） using the keywords of ＂articular cartilage injury, bone graft, tissue engineering scaffold materials＂ in English and Chinese, respectively. Articles related to the structure and function of the articular cartilage and materials for repair of different articular cartilage injuries were selected to systematically review and summarize the materials for articular cartilage repair. Then, advantages and disadvantages of these repair materials were reviewed to introduce several kinds of cartilage repair materials applied as cartilage tissue engineering scaffolds from the perspective of materialogy, thus providing a theoretic basis for the clinical selection of cartilage repair materials.RESULTS AND CONCLUSION： Commonly used cartilage repair materials include osteochondral autograft and allograft, collagen, sodium hyaluronate, chitosan and other natural polymer materials. Osteochondral autograft and allograft transplantation can be only used for temporary pain relief, but cannot repair the injured cartilage successfully, In addition,tissue engineering technology is in the research phase and its clinical research is ongoing. Either autograft materials or tissue-enaineered scaffold materials have their own biomechanical properties, and up to now. it is still imoossible toproduce the artificial cartilage tissue that has the same mechanical properties to the natural cartilage tissues.