膝关节粘连：治疗和预防研究新进展  

Progress in the treatment and prevention of knee intra-articular adhesion

作　　者：吴海啸 王鹏[3] 张超 Egiazaryan KA Ratyev AP Melnichenko SY Kuzin VV Skoroglyadov AV 

机构地区：[1]俄罗斯联邦国立医科大学,俄罗斯莫斯科1179972 [2]俄罗斯联邦国立医科大学第一附属医院,俄罗斯莫斯科1179972 [3]河北省中医院,河北省石家庄市050011 [4]天津医科大学肿瘤医院,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津市300070

出　　处：《中国组织工程研究》2017年第36期5879-5885,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:膝关节粘连严重影响了患者术后的日常生活,而传统的治疗方式疗效有限。降低膝关节粘连发生率是提高手术预期疗效的关键,也是临床医学上需要急待解决的重要问题。目的:对膝关节粘连的各类研究文献进行分析,总结近10年的研究成果,为防治膝关节粘连提供新的思路和方法。方法:由第一作者检索Pub Med数据库,查找2006至2016年的文献,英文检索词为"tissue adhesions,arthrofibrosis,joint stiffness,prevent,treatment",共检索到1 500余篇相关文献,59篇符合纳入标准。结果与结论:(1)近年来大量学者研究发现,创伤/手术引起膝关节出血、炎症反应,造成血管内皮细胞生长因子和白细胞介素6高表达,增加了成纤维细胞的活性,导致大量胶原蛋白沉积,发生粘连;(2)改进传统治疗方式和运用微创技术治疗膝关节粘连取得了一定的疗效,但仍存在再粘连风险;(3)关节腔内用药预防膝关节粘连在基础研究方面获得了显著成果,可成为预防膝关节粘连的一种有效方案,但临床可行性存在争议,需进一步深入研究,寻找疗效确切、不良反应小的药物。BACKGROUND:Knee intra-articular adhesion has a serious impact on the postoperative patient’s daily life,but the efficacy of traditional treatment is limited.To reduce knee intra-articular adhesion is the key to improve the expectations of surgery,which is an urgent problem to be solved.OBJECTIVE:To analyze various articles concerning knee intra-articular adhesion,and summarize the research achievements in the last decade,so as to provide new ideas and methods for the prevention of knee intra-articular adhesion.METHODS:The first author retrieved PubMed database using computer and searched the relevant articles published from2006to2016.The keywords were“tissue adhesions,arthrofibrosis,joint stiffness,prevent,treatment”.Totally1500articles were retrieved,and finally59eligible articles were included in accordance with the inclusion criteria.RESULTS AND CONCLUSION:In recent years,a large number of scholars have found that trauma or surgery can cause knee joint bleeding and inflammation,which result in the increased expression of vascular endothelial growth factor and interleukin-6,enhance the activity of fibroblasts and secrete a large amount of collagen deposition,thereby causing knee intra-articular adhesion.The modification of traditional methods and application of minimally invasive technology have achieved a certain effect on the knee intra-articular adhesion,but there is still a risk for re-adhesion.A remarkable achievement has been obtained in the basic research of preventing knee adhesion with intra-articular drug that can become an effective method for preventing intra-articular adhesion,but its clinical feasibility is still controversial,and further investigation is needed to find the drug possessing exact effect and less adverse reactions.

关 键 词：组织构建 组织工程 组织粘连 纤维化 僵直 伤口愈合 血管内皮生长因子 治疗 预防 

分 类 号：R318[医药卫生—生物医学工程]