水凝胶在骨质疏松性骨缺损治疗中面临的挑战与应对策略  

Challenges and countermeasures for the application of hydrogels in the treatment of osteoporotic bone defects

作　　者：李庆达 补亚忠 夏亚一[2] 贺宝荣[1] Li Qingda;Bu Yazhong;Xia Yayi;He Baorong(Department of Spinal Surgery,Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China;Second Hospital(Second School of Clinical Medicine),Lanzhou University,Lanzhou 730030,China;Institute of Medical Engineering,School of Basic Medical Sciences,Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学医学院附属红会医院脊柱外科,西安710054 [2]兰州大学第二医院(第二临床医学院),兰州730030 [3]西安交通大学基础医学院医学工程研究所,西安710061

出　　处：《中华创伤杂志》2025年第4期339-344,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(82360436);甘肃省自然科学基金(23JRRA1500);兰州大学第二医院“萃英科技创新”计划(CY2022‑MS‑A19);陕西省重点研发计划项目(2023‑ZDLSF‑03)。

摘　　要：骨质疏松性骨缺损(OBD)是指在骨质疏松基础上发生骨折后,骨结构完整性遭到破坏所导致的严重骨缺损,不仅会导致患者骨折风险增加、骨愈合延迟、功能丧失和长期疼痛,还会造成患者生活质量显著下降,甚至增加患者死亡风险。目前,常采用全身药物和局部植入骨移植物治疗OBD。然而,药物治疗具有不良反应大、生物利用度低、骨靶向性能差等缺点,而骨移植则存在供区感染率高、骨源有限、免疫排斥反应严重等局限,故亟需制备新的骨修复材料以改善骨微环境和刺激骨再生。生物活性分子在调节OBD治疗过程中显示出巨大潜力,但由于生物活性分子的生物利用度低、半衰期短,其在生物体内的应用受到限制。水凝胶已经成为解决这些问题的理想载体,可延长生物活性分子在损伤部位的滞留时间与半衰期、减少不良反应,并在生理条件下促进细胞黏附。这些优势共同促进骨细胞的增殖和分化,为治疗OBD提供了一个有效的选择。但目前水凝胶仍存在降解速度不可控、机械性能不足、骨整合能力差等诸多问题。为此,笔者系统阐述水凝胶在OBD治疗中面临的挑战,针对挑战提出应对策略,为水凝胶的研究和临床应用提供参考。Osteoporotic bone defect(OBD)is a serious bone defect resulting from the disruption of the bone structural integrity due to fractures in osteoporotic conditions.OBD not only leads to increased risk of fractures,delayed bone healing,functional loss,and chronic pain,but also reduces patients′quality of life and even elevates the risk of death.Currently,OBD is primarily treated with systemic medications and local bone grafting.However,drug therapy is often associated with serious side effects,low bioavailability and poor bone targeting performance,while bone grafting is limited by high infection rate in donor areas,scarce bone source and severe immune rejection.Therefore,there is an urgent need for new bone repair materials to improve the bone microenvironment and stimulate bone regeneration.Bioactive molecules have shown great potential in modulating OBD treatment,but their application in organisms is hindered by their low bioavailability and short half‑life.Hydrogels have emerged as an ideal vehicle to address these limitations by prolonging the retention time and half‑life of bioactive molecules at the site of injury,reducing side effects and promoting cell adhesion under physiological conditions.All these advantages promote osteoblast proliferation and differentiation,providing a promising solution for OBD treatment.However,hydrogels still face challenges such as uncontrolled degradation rate,inadequate mechanical properties and poor osseointegration ability.To this end,the authors systematically elucidated the challenges of hydrogels in OBD treatment and proposed countermeasures,aiming to provide a reference for the research and clinical application of hydrogels.

关 键 词：骨质疏松 骨治疗 水凝胶 

分 类 号：R683[医药卫生—骨科学] R681[医药卫生—外科学] R274.1[医药卫生—临床医学]