Osteochondral Injury, Management and Tissue Engineering Approaches.
Osteochondral Injury, Management and Tissue Engineering Approaches.
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DOI：
10.3389/fcell.2020.580868
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发表时间：
2020
影响因子：
5.5
通讯作者：
Nakamura N
中科院分区：
文献类型：
--
作者：
Jacob G;Shimomura K;Nakamura N
骨软骨损伤（OL）是全世界骨科医生常见的临床问题，与从创伤到骨坏死的多种临床情况相关。OL与软骨损伤不同，因为它们涉及软骨下骨和软骨表面，使其管理比孤立的软骨损伤更复杂。软骨下骨参与允许来自身体的自然愈合反应，因为骨髓成分能够与缺损部位接触。然而，这种修复是不充分的，导致纤维瘢痕组织。OL的第二个区别特征是软骨下骨的损伤对软骨关节表面的机械强度和营养能力具有有害影响。因此，临床解决方案必须解决关节软骨及其下方的软骨下骨，以恢复和保持关节健康。软骨和软骨下骨都有独特的功能要求，因此它们的物理和生物学特性非常不同，但它们必须作为一个单位一起工作，以实现理想的关节功能。在过去，明显的解决方案是自体移植物转移，其中从关节的非承重部分收集骨软骨骨栓并植入缺损部位。同种异体移植物已被类似地用于消除与自体技术相关的供体部位发病率，总体结果良好，但两种技术都有其缺点和局限性。因此，组织工程已成为一个有吸引力的选择，创造多相支架和植入物。双相和三相植入物已被探索，并具有软骨和软骨下组件，两者之间具有界面，以提供生物相容性的植入物，并作为一个整体模拟骨软骨单位。开发这样的植入物是一个挑战，并且已经利用许多制造技术将两种不同的材料结合在一起，并将它们与细胞疗法联合收割机结合。我们总结了骨软骨单位的功能，并描述了目前可用的管理技术正在研究中。
Osteochondral lesions (OL) are a common clinical problem for orthopedic surgeons worldwide and are associated with multiple clinical scenarios ranging from trauma to osteonecrosis. OL vary from chondral lesions in that they involve the subchondral bone and chondral surface, making their management more complex than an isolated chondral injury. Subchondral bone involvement allows for a natural healing response from the body as marrow elements are able to come into contact with the defect site. However, this repair is inadequate resulting in fibrous scar tissue. The second differentiating feature of OL is that damage to the subchondral bone has deleterious effects on the mechanical strength and nutritive capabilities to the chondral joint surface. The clinical solution must, therefore, address both the articular cartilage as well as the subchondral bone beneath it to restore and preserve joint health. Both cartilage and subchondral bone have distinctive functional requirements and therefore their physical and biological characteristics are very much dissimilar, yet they must work together as one unit for ideal joint functioning. In the past, the obvious solution was autologous graft transfer, where an osteochondral bone plug was harvested from a non-weight bearing portion of the joint and implanted into the defect site. Allografts have been utilized similarly to eliminate the donor site morbidity associated with autologous techniques and overall results have been good but both techniques have their drawbacks and limitations. Tissue engineering has thus been an attractive option to create multiphasic scaffolds and implants. Biphasic and triphasic implants have been under explored and have both a chondral and subchondral component with an interface between the two to deliver an implant which is biocompatible and emulates the osteochondral unit as a whole. It has been a challenge to develop such implants and many manufacturing techniques have been utilized to bring together two unalike materials and combine them with cellular therapies. We summarize the functions of the osteochondral unit and describe the currently available management techniques under study.