椎间盘全层纤维环修复与再生治疗

Repair and regenerative therapies of the annulus fibrosus

背景:当椎间盘纤维环的完整性遭到破坏时会加剧髓核组织突出、加快椎间盘退行性病变,最终导致相应疾病的发生,因此恢复纤维环的完整性对于疾病的预防和治疗具有重要意义。目的:将国内外椎间盘纤维环修复与再生的研究进展作一综述。方法:系统检索中国知网(CNKI)、万方、PubMed数据库,以“纤维环,修复再生,组织工程,凝胶,细胞治疗;annulus fibrosus,repair and regeneration,tissue engineering,hydrogel,cell”等为关键词,收集从各数据库建立至2020年12月发表的相关文献。结果与结论:椎间盘的纤维环修复与再生在机械与生物方面均取得了一定进展,目前认为机械修复纤维环(纤维环缝合术、纤维环成形器及射频热凝术等)只能部分修复椎间盘外层纤维环,且恢复组织结构杂乱,不值得进一步研究。生物修复再生椎间盘纤维环包括凝胶、组织工程、生物补片等方法,相较于机械修复,生物治疗可更好地恢复全层纤维环,且恢复组织相对有序,接近天然椎间盘纤维环的结构与功能,但仍存在许多问题:①材料的选择及植入;②椎间盘纤维环细胞表型难以确认;③长期生物力学的稳定性无法得知;④缺乏人体试验等。因此可以从上述方面入手,将细胞学、生物化学、材料学、力学等多学科进行联合,以期早日实现受损椎间盘纤维环的修复再生,早日应用于临床。

BACKGROUND: When the integrity of the annulus fibrosus is destroyed and the annulus fibrosus breaks, it will aggravate the protrusion of nucleus pulposus, and accelerate the degeneration of intervertebral disc, which finally lead to the occurrence of corresponding diseases. Therefore, restoring the integrity of the annulus is of great significance for the prevention and treatment of diseases.OBJECTIVE: To review the research progress of annulus fibrosus repair and regeneration at home and abroad.METHODS: A comprehensive search was conducted for the studies published until December 2020 with the key words of "annulus fibrosus, repair and regeneration, tissue engineering, gel, cell therapy" in Chinese and "annulus fibrosus, repair and regeneration, tissue engineering, hydrogel, cell" in English on the CNKI, Wanfang and Pub Med databases. RESULTS AND CONCLUSION: Some progresses have been made in the mechanics and biology of annulus fibrosus repair and regeneration. At present, it is considered that mechanical repair of annulus fibrosus(annulus fibrosus suture, annulus fibroplasty and radiofrequency thermocoagulation) can only partially repair the outer annulus fibrosus and restore the disordered tissue structure, which is not worthy of further study. Biological methods of repairing and regenerating annulus fibrosus include gel, tissue engineering, biological patch and so on. Compared with mechanical repair, biological treatment can better restore full-thickness annulus fibrosus and restore relatively ordered structure, which is close to the structure and function of natural annulus fibrosus. However, there are still many problems:(1) selection and implantation of materials;(2) phenotype of annulus fibrosus cell is difficult to be confirmed;(3) the stability of long-term biomechanics is unknown;(4) lack of human experiments. Therefore, we can start from the above aspects and combine the cytology, biochemistry, materials science, mechanics and other disciplines to realize the repair and regeneration of damaged annulus fibrosus and its application in clinic as soon as possible.