摘要
肩袖修补术后再撕裂发生率很高,主要原因是术后腱-骨结合部为瘢痕愈合。针对该问题,近年研究主要集中在移植物的应用方面,包括细胞移植、骨膜移植、软骨移植、生物合成物移植。细胞移植主要是来源不同的各种干细胞,目前研究已证实可取得较好效果,外泌体与干细胞的联合应用可能是以后发展方向;骨膜移植是一种比较有前景的干预手段,但目前临床应用少,且其存在取材来源有限、取材的二次创伤等问题,组织工程骨膜及人工仿生骨膜可能是骨膜的替代选择;软骨移植可促进腱-骨结合部软骨再生,利于腱-骨愈合,但也存在取材有限、二次损伤可能,该问题目前未见较好解决策略;无机合成物移植由于降解速度慢、单用效果不佳等问题,限制了其应用;生物衍生物存在免疫原性、生物力学欠佳等问题,目前未见妥善解决方法;有机合成移植物更注重模拟生理腱-骨结合区结构,在腱-骨愈合中表现出较好的效果,具有良好的应用前景。此外,上述不同移植物的应用研究大多停留在细胞、动物水平,应用临床还需更多研究。本文对上述不同移植物的应用现状、优缺点及发展趋势做一简要综述,以期为肩袖撕裂的临床治疗提供一定的指导。
The incidence of re-tearing after rotator cuff repair is very high.The main reason is that the tendon-osseous junction after the operation is scar healed.In response to this problem,research in recent years has focused on the application of grafts,including cell transplantation,periosteum transplantation,cartilage transplantation,and biosynthetic transplantation Cell transplantation is mainly a variety of stem cells from different sources.The current research has confirmed that it can achieve better results.The combined application of exosomes and stem cells may be the future development direction.Periosteum transplantation is a promising intervention method,but few clinical applications at present,and there are problems such as limited sources of materials and secondary trauma from the materials.Tissue engineered periostium and artificial bionic periostium may be alternatives to periosteal;cartilage transplantation can promote the regeneration of cartilage at the tendon-osseous junction and facilitate tendon-bone healing.However,there are also limited materials and secondary damage.There is no better solution to this problem.The slow degradation of inorganic composites and the poor effect of single use limit its application;biological derivatives have immunogenicity,poor biomechanics and other issues,there is currently no proper solution;organic synthetic grafts pay more attention to simulating the structure of the physiological tendon-osseointegration zone,and show good results in tendon-bone healing,and have good application prospects.In addition,most of the above-mentioned application research of different grafts stays at the cellular and animal level,and more research is needed in clinical application.This article briefly reviews the application status,advantages,disadvantages and development trends of the above-mentioned different grafts,in order to provide certain guidance for the clinical treatment of rotator cuff tears.
作者
张明涛
刘嘉鑫
贾耀飞
张广瑞
周建平
吴定
韵向东
ZHANG Ming-tao;LIU Jia-xin;JIA Yao-fei;ZHANG Guang-rui;ZHOU Jian-ping;WU Ding;YUN Xiang-dong(不详;Department of Orthopaedics,the Second Hospital of Lanzhou University,Lanzhou 730030,Gansu,China)
出处
《中国骨伤》
CAS
CSCD
2022年第7期697-702,共6页
China Journal of Orthopaedics and Traumatology
基金
兰州大学第二医院“萃英科技创新”计划临床拔尖技术研究项目(编号:CY2019-BJ04)。
关键词
肩袖损伤
腱-骨愈合
纤维软骨
移植物
Rotator cuff injuries
Tendon bone healing
Fibrocartilage
Transplants
