生物材料修复肩袖损伤的最新研究热点

Research progress of biomaterials for repair of rotator cuff tear

背景:肩袖损伤是导致成人肩部功能障碍的主要原因,单纯手术缝合后的再撕裂率非常高,而生物材料修复可增加肩袖损伤术后的生物力学性能。目的:阐述肩袖损伤生物修复材料的最新研究及临床应用现状。方法:通过计算机检索PubMed、web of science数据库中关于肩袖损伤修复材料的最新研究,检索词为"Rotator Cuff Injuries;Biological materials;autograft;Extracellular matrix materials;Synthetic materials;biological scaffold;Biological patch;augmentation"。对纳入的57篇文献进行分类比较,探讨各类修复材料的优缺点。结果与结论:目前肩袖损伤的生物修复材料大体可分为未经处理的人体自身组织移植材料、细胞外基质材料和人工合成材料3大类。对于未经处理的人体自身组织移植材料,最新的临床报道显示该种材料常常出现不同的临床效果;细胞外基质材料中,来源于同种异体人源性真皮材料目前报道的效果尚可,大多学者不建议使用猪的小肠黏膜下层补片,同种异体移植物的结果可能优于异种移植物;最新的三维胶原支架和人工合成可吸收材料因其较好的孔隙率及可诱导腱骨组织的愈合,具有较好的应用前景,但大多仍停留在动物实验阶段,需要更多的临床试验来证实其安全性及有效性。目前尚无一种十分安全有效的生物修复材料来治疗肩袖撕裂。随着组织工程技术和材料学的发展,利用生物支架或合成材料的宏观性能结合干细胞或细胞因子的微观性能,有望在未来找到一种令人满意的材料。

BACKGROUND: Rotator cuff injury is the main cause of shoulder dysfunction in adults. The rate of retear is very high in patients with rotator cuff tear treated with simple surgical suture. Biological materials can optimize the biomechanical property after rotator cuff injury.OBJECTIVE: To review the latest research and clinical application of biomaterials in the repair of rotator cuff injury. METHODS: PubMed and Web of science databases were retrieved for the latest researches on the biomaterials for repair of rotator cuff. The search terms were "rotator cuff injuries;biological materials;autograft;extracellular matrix materials;synthetic materials;biological scaffold;biological patch;augmentation". Fifty-seven articles were classified and compared to discuss the advantages and disadvantages of various repair biomaterials. RESULTS AND CONCLUSION: Currently, the biomaterials for repair of rotator cuff injury can be divided into three categories: untreated human tissue transplantation materials, extracellular matrix materials and synthetic materials. The latest clinical reports show that untreated human tissue transplantation materials often have different clinical effects. The results of extracellular matrix materials derived from human allogenic dermal materials are still acceptable. Most scholars do not recommend the use of small intestinal submucosal grafts from pigs. The latest three-dimensional collagen scaffolds and synthetic absorbable materials have good application prospects due to their good porosity and the ability to induce the healing of tendon and bone tissues. However, most of them are still in the stage of animal experiments, and more clinical trials are needed to confirm their safety and effectiveness. There is no safe and effective biomaterial to treat rotator cuff tear. With the development of tissue engineering technology and materials science, it is expected to find a satisfactory material in the future by combining the macroscopic properties of biological scaffolds or synthetic materials with the microscopic properties of stem cells or cytokines.