Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head.
Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head.
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DOI：
10.1186/scrt98
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发表时间：
2012-02-22
影响因子：
7.5
通讯作者：
Nöth U
中科院分区：
文献类型：
--
作者：
Rackwitz L;Eden L;Reppenhagen S;Reichert JC;Jakob F;Walles H;Pullig O;Tuan RS;Rudert M;Nöth U
股骨头缺血性坏死(AVN)是一种多因素致衰性疾病，多见于年轻患者，常导致继发性骨关节炎。不断发展的再生医学领域提供了使用细胞、生物材料支架和生物活性因子的有前途的治疗策略，这可能会改善临床结果。保留软骨下板结构完整性的早期AVN可以进行逆行手术，如髓芯减压，以降低骨内压力和诱导骨重建。浓缩骨髓抽提物、体外扩增的间充质干细胞和成骨或血管生成生长因子(或两者)的添加应用具有促进骨再生的巨大潜力。相反，晚期AVN伴软骨下骨质塌陷需要骨软骨重建以保留生理关节功能。类似于膝关节骨软骨重建的策略，顺行外科技术，如骨软骨移植(马赛克成形术)，基于基质的自体软骨细胞植入，或单独使用脱细胞支架，可能会保留关节功能，减少髋关节置换的需要。本文综述了再生医学领域应用细胞、生长因子和基质来解决动静脉肾炎临床问题的最新实验成果和初步临床发现。
Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN.
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DOI：
10.1302/0301-620x.77b1.7822394
发表时间：
1995-01-01
影响因子：
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作者：
FAIRBANK, AC;BHATIA, D;HUNGERFORD, DS
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