组织工程技术修复半月板损伤的替代策略

Alternative strategies for tissue engineering repair of meniscus injury

背景:目前的手术方法不能提供半月板再生和替换的长期解决方案,但组织工程技术可以提供替代的治疗策略。目的:就半月板损伤修复的临床策略及组织工程研究现状作一综述。方法:应用计算机检索PubMed数据库、MEDLINE数据库、Google学术数据库、CNKI中国期刊全文数据库、万方医学网数据库收录的文献,英文引文检索词为"meniscus injury;tissue engineering;meta-analysis;allografts;meniscus repair;scaffold;polymers;hydrogels;polyurethane;intestinal submucosa;polycaprolactone;polylactic;self-assembly;bone marrow MSC;meniscus derived stem cells;synovium derived MSCs;adipose derived MSC;co-culture;growth factor;transforming growth factor-beta;basic fibroblast growth factor;Insulin growth factor",中文引文检索词为"半月板;间充质干细胞;支架;生长因子;组织工程;压缩模量;拉伸模量;水凝胶;静电纺丝",检索期限为2005-01-01/2020-10-01。结果与结论:半月板组织工程作为半月板治疗研究的热点方向,虽然在各个方面都取得了丰富的研究成果,但均缺乏大量长期的临床试验来验证结论的准确性。生物分子作为组织工程不可或缺的工具,目前仍然需要更多的人或动物实验来确定不同生物分子准确的作用信号通路、应用的最佳浓度和组合方式及生物分子的递送方式。尽管已发现很多种具有半月板表型分化潜力的干细胞,但对于各种干细胞在组织工程中的作用仍待深入研究,最具优势或最适合半月板组织工程的干细胞种类依然颇具争议。与此同时,半月板在细胞组成、细胞外基质成分及生物力学特性上与关节软骨和椎间盘等组织相似,并且关节软骨和椎间盘的修复再生策略同样备受关注,相似领域的研究进展可以相互借鉴、相互促进。

BACKGROUND:Current surgical methods do not provide a long-term solution for meniscus regeneration and replacement,but tissue engineering techniques can provide alternative therapeutic strategies.OBJECTIVE:To review the clinical strategy and tissue engineering research status of meniscus injury repair.METHODS:The literature collected on PubMed database,Medline database,Google academic database,CNKI,and Wanfang was searched by computer.Keywords were"meniscus injury;tissue engineering;meta-analysis;allografts;meniscus repair;scaffold;polymers;hydrogels;polyurethane;intestinal submucosa;polycaprolactone;polylactic;self-assembly;bone marrow MSC;meniscus derived stem cells;synovium derived MSCs;adipose derived MSC;coculture;growth factor;transforming growth factor beta;basic fibroblast growth factor;insulin growth factor"in English,and"meniscus;mesenchymal stem cells;scaffold;growth factor;tissue engineering;compression modulus;tensile modulus;hydrogels;electrospinning"in Chinese.Retrieval period was from January 1,2005 to October 1,2020.RESULTS AND CONCLUSION:As a hot research direction of meniscus treatment,meniscus tissue engineering has achieved abundant research results in all aspects,but there is a lack of a large number of long-term clinical trials to verify the accuracy of the conclusions.Biomolecules are indispensable tools in tissue engineering.At present,more human or animal experiments are needed to determine the exact action signal pathway of different biomolecules,the optimal concentration and combination mode of application,and the delivery mode of biomolecules.Although many kinds of stem cells with the phenotypic differentiation potential of meniscus have been found,the role of various stem cells in tissue engineering is still to be further studied,and the most dominant stem cell type or most suitable for meniscus tissue engineering is still controversial.Simultaneously,meniscus is similar to articular cartilage and intervertebral disc in terms of cell composition,extracellular matrix composition and biomechanical properties,and the repair and regeneration strategies of articular cartilage and intervertebral disc have also attracted much attention.Research progress in similar fields can learn from each other and promote each other.