牵张成骨过程中骨愈合及血管生成的机制  

Mechanism of bone healing and angiogenesis during distraction osteogenesis

作　　者：吕梓宸 涂振兴 许奥 程康 王红涛 王斌[1] Lyu Zichen;Tu Zhenxing;Xu Ao;Cheng Kang;Wang Hongtao;Wang Bin(Department of Hand Surgery,Tangshan Second Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市第二医院手外科,河北省唐山市063000

出　　处：《中国组织工程研究》2022年第36期5881-5888,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:牵张成骨技术已经成为全世界范围内骨科、颌面外科及修复重建科医生不可缺少的技术手段之一,但牵张成骨过程中骨愈合及血管生成机制还不十分清楚。目的:对在牵张成骨过程中骨愈合及血管生成的微观结构及分子机制进行综述。方法:对近些年PubMed及中国知网数据库中关于牵张成骨过程中骨愈合及血管生成的机制文献进行查阅,排除重复文献及重复研究,对纳入的文献进行综述分析。结果与结论:①在牵张成骨中存在不同于单纯骨折愈合的第3种骨化机制“经软骨成骨”。②在牵张成骨的愈合过程中,骨断端两侧形成微柱形成区,并最终通向纤维间区,并在巩固期完成新生骨的矿化与重塑。③白细胞介素、骨形态发生蛋白及RANKL/OPG系统等因子在牵张成骨过程中的空间时间分布不尽相同,但均在骨的形成过程中发挥促进骨形成或重塑的作用。④牵张成骨过程中伴随着大量的新生血管生成,并且与骨生成周期高度一致,而新生血管的生成与矿化是骨再生的开端。⑤内皮祖细胞及血管内皮生长因子等细胞因子在新生血管生成中起到了促牵张区血管再生与矿化的作用,血管内皮生长因子受截骨后炎症反应及牵张力作用调控表达,而内皮祖细胞被诱导归巢至骨再生部位是牵张成骨血管生成的重要因素。⑥目前牵张成骨过程中骨愈合及血管生成的机制可解释为:骨愈合与血管生成互相促进,耦合;截骨两端在牵张力的作用下逐步向牵张区形成胶原纤维束,最终推进至纤维间区,成骨细胞排列其中逐渐骨化,经过巩固和重塑形成成熟的、带骨髓的板层骨;血管生成先于骨的愈合,在截骨后即可发生,截骨两端骨膜和骨内膜表面的血管逐渐增生并通向纤维间区,随后牵张部位骨膜血管网和髓质血管网完全连通。⑦目前的研究尚不能完整地解释牵张成骨的宏观及微观过BACKGROUND:Ilizarov technology has become one of the indispensable technological tools for orthopedic,maxillofacial surgery and prosthetic and reconstructive surgeons worldwide,but the mechanism of bone healing and angiogenesis in the process of distraction osteogenesis is not very clear.OBJECTIVE:To review the microstructure and molecular mechanisms of bone healing and angiogenesis during distraction osteogenesis.METHODS:The articles on the mechanisms of bone healing and angiogenesis in the distraction osteogenesis process in recent years were reviewed on PubMed and CNKI.Duplicate articles and duplicate studies were excluded,while the included articles were reviewed and analyzed.RESULTS AND CONCLUSION:(1)There is a 3rd ossification mechanism in distraction osteogenesis distinct from simple fracture healing,“transchondral osteogenesis”.(2)During the healing process of distraction osteogenesis,bone stumps form microcolumn forming zones on both sides and eventually lead to interfibrillar zones,and complete mineralization and remodeling of the newly formed bone during the consolidation phase.(3)Factors such as interleukins,bone morphogenetic proteins and the RANKL/OPG system have different spatiotemporal distributions during distraction osteogenesis,but all play a role in promoting bone formation or remodeling.(4)The process of distraction osteogenesis is accompanied by substantial neoangiogenesis and is highly consistent with the osteogenic cycle,whereas neovascularization and mineralization are the beginnings of bone regeneration.(5)Endothelial progenitor cells and cytokines such as vascular endothelial growth factor play a role in neoangiogenesis by promoting revascularization and mineralization in the distraction area,and their expression is regulated by the inflammatory response and stretch after osteotomy,whereas the induced homing of endothelial progenitor cells to the site of bone regeneration is an important factor in the angiogenesis of distraction osteogenesis.(6)Bone healing is mutually promoted and

关 键 词：牵张成骨 骨折愈合 血管生成 纤维间区 内皮祖细胞 细胞因子 骨形态发生蛋白 血管内皮生长因子 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]