Chao Edmund Y S, Inoue Nozomu
Biomechanics Laboratory, Department of Orthopaedic Surgery Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205-2196, USA.
Eur Cell Mater. 2003 Dec 31;6:72-84; discussion 84-5. doi: 10.22203/ecm.v006a07.
Biophysical stimulation to enhance bone fracture repair and bone regenerate maturation to restore its structural strength must rely on both the biological and biomechanical principle according to the local tissue environment and the type of mechanical stress to be born by the skeletal joint system. This paper reviews the possible interactions between biophysical stimuli and cellular responses in healing bone fractures and proceeds to speculate the prospects and limitations of different experimental models in evaluating and optimising such non-invasive interventions. It is important to realize that bone fracture repair has several pathways with various combinations of bone formation mechanisms, but there may only be one bone remodeling principle regulated by the hypothesis proposed by Wolff. There are different mechanical and biophysical stimuli that could provide effective augmentation of fracture healing and bone regenerate maturation. The key requirements of establishing these positive interactions are to define the precise cellular response to the stimulation signal in an in vitro environment and to use well-established animal models to quantify and optimise the therapeutic regimen in a time-dependent manner. This can only be achieved through research collaboration among different disciplines using scientific methodologies. In addition, the specific forms of biophysical stimulation and its dose effect and application timing must be carefully determined and validated. Technological advances in achieving focalized stimulus delivery with adjustable signal type and intensity, in the ability to monitor healing callus mechanical property non-invasively, and in the establishment of a robust knowledge base to develop effective and reliable treatment protocols are the essential pre-requisites to make biophysical stimulation acceptable in the main arena of health care. Finally, it is important to bear in mind that successful fracture repair or bone regeneration through callus distraction without adequate remodeling process through physiological loading would seriously undermine the value of biophysical stimulation in meeting the biomechanical demand of a long bone.
根据局部组织环境和骨骼关节系统所承受的机械应力类型，通过生物物理刺激来促进骨折修复以及骨骼再生成熟以恢复其结构强度，必须依赖生物学和生物力学原理。本文综述了生物物理刺激与骨折愈合过程中细胞反应之间可能存在的相互作用，并进而推测不同实验模型在评估和优化此类非侵入性干预措施方面的前景和局限性。必须认识到，骨折修复有多种途径，涉及不同组合的骨形成机制，但可能只有一种由沃尔夫提出的假说所调控的骨重塑原理。存在不同的机械和生物物理刺激可有效促进骨折愈合和骨骼再生成熟。建立这些积极相互作用的关键要求是在体外环境中明确细胞对刺激信号的精确反应，并使用成熟的动物模型以时间依赖的方式量化和优化治疗方案。这只能通过不同学科利用科学方法进行研究合作来实现。此外，必须仔细确定并验证生物物理刺激的具体形式及其剂量效应和应用时机。在实现具有可调节信号类型和强度的聚焦刺激传递、无创监测愈合骨痂力学性能以及建立强大知识库以制定有效且可靠的治疗方案方面取得的技术进步，是使生物物理刺激在医疗保健主要领域被接受的必要先决条件。最后，必须牢记，若通过骨痂牵张实现成功的骨折修复或骨再生，但未通过生理负荷进行充分的重塑过程，将严重损害生物物理刺激在满足长骨生物力学需求方面的价值。
