膝关节牵伸术修复膝关节软骨的研究进展

Progress on knee cartilage repair by knee joint distraction

膝关节牵伸术是近年来治疗膝骨关节炎的新技术,它能减轻膝关节疼痛和改善膝关节功能,这与其修复软骨的作用密不可分。膝关节牵伸术修复软骨的作用机制和影响因素作为当前研究的热点,本文通过回顾文献发现,膝关节牵伸术能减轻膝关节负荷为软骨修复提供适宜的力学环境,引起的膝关节流体静水压波动不仅能帮助软骨吸收营养,还能促进软骨形成基因和抑制软骨基质降解酶基因表达。此外,膝关节牵伸术为滑液间充质干细胞募集到软骨损伤处创造了条件,并提升了滑液间充质干细胞增殖、分化为成软骨谱系的能力。膝关节牵伸术还能通过减少膝关节内部炎性因子含量和抑制炎性基因表达,减轻膝关节炎症反应和软骨损伤。目前已知的影响膝关节牵伸术修复软骨的因素包括适当增加膝关节负重活动、牵伸高度和牵伸时间有助于软骨修复,男性患者、膝关节炎严重程度更高的患者膝关节牵伸术后软骨修复效果更好。而膝关节牵伸术后第1年软骨修复疗效越好,预示着膝关节牵伸术保留膝关节的远期生存率越高。但目前对上述热点的研究只停留在初期阶段,仍需进行更深入的探索,才能对膝关节牵伸术的临床应用起到更好的指导。

Knee joint distraction is a new technology for the treatment of knee osteoarthritis in recent years.It could reduce knee pain and improve knee function,which is inseparable from the role of cartilage repair.The mechanism and influencing factors of knee joint distraction in repairing cartilage are the focus of current research.In this paper,the author reviewed literature and found that knee joint distraction could reduce knee joint load and provide a appropriate mechanical environment for cartilage repair,and it is resulting hydrostatic pressure fluctuation in the knee joint not only helps cartilage to absorb nutrients,but also promotes cartilage formation genes and inhibits cartilage matrix degrading enzyme gene expression.In addition,knee joint distraction creates conditions for synovial mesenchymal stem cells to be collected to cartilage injury,and improves ability of synovial mesenchymal stem cells to proliferate and differentiate into a chondrogenic lineage.Knee joint distraction could reduce inflammatory reaction and cartilage injury of knee joint by reducing content of inflammatory factors and inhibiting expression of inflammatory genes.At present,it is known that the factors affect repair of cartilage by knee joint distraction include,increasing weight-bearing activity and height and time of distraction is helpful for cartilage repair,male patients and patients with higher severity of knee osteoarthritis have better cartilage repair effect after knee joint distraction.The better efficacy of cartilage repair on the first year after knee joint distraction predicts a higher long-term survival rate of knee joint distraction with knee preservation.However,the research on the above hot spots is only at the initial stage and further exploration is still needed,in order to better guide clinical application of knee joint distraction.