关节牵张修复退变关节软骨的研究进展  

Advances in research on joint distraction for repairing degenerative articular cartilage

作　　者：王硕[1,3] 马剑雄[2] 杜育任[1] 黄洪超 马信龙 Wang Shuo;Ma Jianxiong;Du Yuren;Huang Hongchao;Ma Xinlong(Department of Orthopaedics, Tianjin University Tianjin Hospital, Tianjin 300211, China;Tianjin Insititute of Orthopaedics, Tianjin 300050, China;Department of Orthopaedics, Tianjin Rehabilitaion and Sanatorium Center of People’s Liberation Army, Tianjin 300381, China)

机构地区：[1]天津大学天津医院骨科,300211 [2]天津市骨科研究所,300050 [3]中国人民解放军天津康复疗养中心骨科,300381

出　　处：《中华实验外科杂志》2019年第8期1508-1513,共6页Chinese Journal of Experimental Surgery

基　　金：中国博士后科学基金面上资助项目(2017M621087);国家自然科学基金(11772226、81572154);天津市博士后创新项目择优资助项目(TJQYBSH2017017).

摘　　要：退行性骨关节炎是一类以关节软骨退变、软骨下骨异常改建为主要病理特征,以疼痛和关节功能障碍为主要临床表现,严重影响患者生活质量的慢性进展性关节疾病.其外科治疗策略可归结为关节成形术和关节软骨修复两大类,前者以关节软骨切除为代价.关节软骨修复的优势在于挽救关节软骨,推迟甚至避免关节成形,包括以微骨折、自体骨软骨移植为代表的关节内治疗和楔形截骨为代表的关节外治疗.关节内治疗主要受限于软骨缺损的面积;关节外楔形截骨虽通过力线调整间接保护了病变软骨,但被转移侧软骨退变加快.关节牵张是一种借助骨外固定装置,将关节两端逐渐分离一定程度并维持一段时间,促进软骨自身修复的关节外治疗技术.关节牵张所调动的软骨修复,可明显延缓关节软骨的自然退变进程,并增加关节软骨的结构和功能性参数,间接提供了关节软骨可能自身修复的证据.牵张早期,关节间隙的增加有效降低了关节内静水压,为静水压间歇性波动提供了必要条件,利于间充质干细胞等募集及炎性介质稀释,改善了关节软骨、软骨下骨的生物力学和生物化学环境;牵张中后期,良好的力学信号可能刺激包括Wnts、低氧诱导因子-1α/血管内皮生长因子等化学信号途径,促进软骨细胞的功能性转化,表达有效的软骨基质成分(Ⅱ型胶原、蛋白聚糖),实现牵张性间隙向结构性间隙转化.Degenerative osteoarthritis is a kind of chronic progressive joint disease with articular cartilage degeneration, subchondral bone abnormality as the main pathological feature, pain and joint dysfunction as the main clinical manifestations, which seriously affect the quality of life of patients. The surgical treatment strategy can be mainly attributed to arthroplasty and articular cartilage repair, but arthroplasty comes at the cost of articular cartilage resection. The advantage of articular cartilage repair is to save articular cartilage, delay or even avoid joint formation, including intra-articular treatment represented by microfracture, autologous osteochondral transplantation and extra-articular treatment represented by wedge osteotomy. Intra-articular treatment is mainly limited by the area of cartilage defects;although the extra-articular wedge osteotomy indirectly protects the diseased cartilage by force line adjustment, the cartilage degeneration of the metastatic side is accelerated. Joint distraction (JD) is a surgical technique that gradually separates both sides of the joint to a certain extent and maintains it for a period of time to promote articular cartilage damage repair. The cartilage repair mobilized by joint distraction can significantly delay the natural degeneration process of articular cartilage, and increase the structural and functional parameters of articular cartilage, indirectly providing evidence that the articular cartilage may repair itself. In the early stage of JD, the increase of joint space effectively reduced the HP in the joint, it provided the necessary conditions for the intermittent fluctuation of HP, which was beneficial to the recruitment of MSCs and the dilution of inflammatory mediators, and improved the biomechanical and biochemical environment of articular cartilage and subchondral bone;In the middle and late stages of JD, good mechanical signals may activate chemical signaling pathways including Wnts pathways and hypoxia-inducible factor-1α/vascular endothelial gr

关 键 词：关节牵张 关节软骨 骨关节炎 退行性 修复机制 

分 类 号：R684[医药卫生—骨科学]