摘要
背景:骨缺损甚至骨不连的修复重建是矫形外科急待解决的问题,需要临床综合分析,优化复合人工骨的选择。目的:对复合骨移植替代物的临床应用现状、实验室研究和新型治疗方法进行阐述,探讨各种骨移植替代物的优势与不足,从而合理优化选择。方法:应用PubMed和EMBASE数据库检索2001年1月至2012年11月关于复合骨移植替代物相关方面的文献,在英文标题、摘要及MeSH词中以"bone regeneration;bone graft substitute;growth factors;biomaterials"为检索主题词。排除无关及重复性研究,同一领域则选择权威杂志近期发表文献,共保留47篇进一步归纳总结。结果与结论:自体骨材料虽有不可替代的优点,但是供应有限,且损害取骨部位;异体骨疾病感染风险高。而复合骨移植替代物种类丰富,性状良好,可通过不同的材料选取骨再生重建的过程,主要包括生物材料、合成高分子材料、生长因子及干细胞等组织工程材料。理想的植骨取代物要有稳定的生物力学特性,在合适的时间内降解,具有骨诱导、骨传导及成骨性。具体而言,骨传导性取决于植骨材料的类型、内部结构和表面性质,而骨诱导和成骨性可经生长因子与多能间充质干细胞介导而重塑骨组织。不同植骨材料选用各有利弊,要根据适应证及效果评估选择合适的优化组合,克服植骨自身局限性,使骨重建过程尽可能符合自然生长过程。
BACKGROUND： Bone defects or non-unions, resulting from osteomyelitis, tumor resection or metabolic disorders, are still a most pressing issue in orthopedic reconstructions which are treated with required bone graft substitutes after clinical comprehensive analysis. OBJECTIVE： To review the selection and clinical application, experimental research and novel therapeutic approaches for bone graft substitutes and to optimize the applications. METHODS： PubMed and EMBASE databases were retrieved online for relative articles about the clinical and basic research on bone graft substitute published from 2001-01 to 2012 11, with the key words of＂bone regeneration; bone graft substitute; growth factors; biomaterials＂ in title, abstract and MeSH terms. Articles published recently in authorized journals were preferred, while unrelated and repeated were excluded. Finally, 47 articles were included. RESULTS AND CONCLUSION： Except for the limitation of graft availability and donor site impairments, autografts exhibit ideal features of bone graft substitutes. On the other hand, allograft harbors the high risk of disease transmission. However, the diversified combined use of bone graft substitutes is considered a morefeasible alternative to augmenting bone regeneration process in which exhibits refined properties, including biomaterials biodegradable polymers and growth factors and stem cells. Selection and combination of various materials perform multiple effects in bone repair. With good characters of osteoconduction, osteogenesis, and osteoinduction, an ideal bone graft substitutes should possess favorable properties in biomechanical stability and degradation within appropriate duration. Specifically, osteoconduction is determined by composition, structure and surface character. And the other ones embody advantages largely by growth factors and mesenchymal stem cells. Thus, evaluation and indication of bone graft substitutes need to be well weighted to overcome the limitation and to optimize its effect as identical
出处
《中国组织工程研究》
CAS
CSCD
2013年第34期6207-6214,共8页
Chinese Journal of Tissue Engineering Research
基金
博士后特别基金资助项目(2012T50381)
上海市卫生系统新优青计划资助项目(2011032)
上海市人事局人才发展基金资助项目(2009003)~~
关键词
生物材料
生物材料综述
骨再生
骨移植替代物
生长因子
生物力学
干细胞
骨组织工程
省级基金
biomaterials
biomaterial review
bone regeneration
bone graft substitute
growth factors
biomechanics
stem cells
bone tissue engineering
provincial grants-supported paper
