同种异体幼年软骨微粒移植修复关节软骨缺损:问题及前景

Articular cartilage defect repair with particulated juvenile cartilage allograft: existing problems and prospects

背景:同种异体幼年软骨微粒制备简单、容易获取,体外培养证实软骨细胞能够迁移、增殖。在美国,同种异体幼年软骨微粒移植技术已经应用于髋、膝、肘、踝关节软骨缺损的修复。目的:对目前应用同种异体幼年软骨微粒移植修复关节软骨缺损的研究现状、应用以及价值进行综述。方法:计算机检索CNKI数据库、PubMed数据库以及Elsevier数据库的相关文献,检索词为"Allogeneic juvenile cartilage particles;cartilage tissue engineering;articular cartilage defects;repair"。查阅1983年10月至2017年6月期间收录的同种异体幼年软骨微粒修复关节软骨缺损的相关文章,包括综述、基础研究以及临床研究。通过阅读文题和摘要进行初步筛选,排除与文章主题不相关的文献,根据纳入标准和排除标准,最终纳入48篇文献进行结果分析。结果与结论:①临床上治疗软骨缺损的方法很多,在短期的随访中有较好的临床效果,能够改善患者的运动功能和缓解疼痛,但最终会导致关节软骨的进行性退变和骨性关节炎的发生;②同种异体幼年软骨微粒不同于传统的异体骨软骨移植术,其具有较强的软骨细胞增殖能力和体外形成组织工程软骨的能力,且抗原性弱,体内移植不会引起强烈的排斥反应。此外,同种异体幼年软骨微粒修复在关节镜下发现软骨缺损后即可行一期手术治疗;③同种异体幼年软骨微粒移植得良好修复效果不仅在基础研究中获得证实,同时在美国临床已经取得重要进展,其潜在的优越性能已逐渐被医生及患者接受;④然而同种异体幼年软骨微粒也存在移植物加工过程污染、疾病传播的风险。虽然该技术在美国临床已经较为广泛应用,但术后追踪随访的资料却很少,尚不能对其长期有效性进行客观评估,未来还需进行长期随访,以期可在临床广泛推广。

BACKGROUND： Particulated juvenile cartilage allograft is simple and easy to obtain, and chondrocytes can migrate andproliferate as confirmed by in vitro culture. In the Unite States, this technique has been used in the repair of cartilagedefects in the hip, knee, ankle, and elbow joints.OBJECTIVE： To review the present situation, application, and value of particulated juvenile cartilage allografttransplantation for articular cartilage repair.METHODS： A computer-based search of CNKI, PubMed, and Elsevier was performed for retrieving articles concerningparticulated juvenile cartilage allograft transplantation for articular cartilage repair published from October 1983 to June2017. The keywords were “allogeneic juvenile cartilage particles; cartilage tissue engineering; articular cartilage defects;repair” in Chinese and English, respectively. After initial screening of titles and abstracts and exclusion of irrelevantarticles, 48 eligible articles were included in final analysis.RESULTS AND CONCLUSION： （1） Although a variety of treatments for cartilage repair have achieved good clinicaloutcomes in short-term follow-up, improving the motor function of patients and relieving pain, patients eventually developprogressive degeneration of the articular cartilage and suffer from osteoarthritis. （2） Chondrocytes from allogeneicjuvenile cartilage particles have stronger ability of proliferating and repairing cartilage defects in vitro than maturechondrocytes, and have low antigenicity, which cannot cause a strong rejection after in vivo transplantation. What’s more,particulated juvenile cartilage allograft transplantation can be performed as one-stage surgery if cartilage defects areconfirmed under arthroscopy. （3） Particulated juvenile cartilage allograft transplantation has achieved good outcomes inbasic and clinical studies in the United States. Its potential superiority has gradually been accepted by doctors andpatients. （4） There are also risks for being contaminated and spreading diseases during the preparation of particulatedjuvenile cartilage allograft. This technology has been widely used in the United States, but there are rare data concerningits follow-up studies. Therefore, an investigation on its long-term follow-up is indispensable for the objective assessmentof its long-term efficacy, with a view to the extensive promotion of this technology in the clinical practice.