Melrose James, Smith Susan M, Little Christopher B, Moore Robert J, Vernon-Roberts Barrie, Fraser Robert D
Raymond Purves Research Laboratory, Institute of Bone & Joint Research, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
Eur Spine J. 2008 Sep;17(9):1131-48. doi: 10.1007/s00586-008-0712-z. Epub 2008 Jun 27.
The objective of this study was to assess the impact of a landmark annular lesion model on our understanding of the etiopathogenesis of IVD degeneration and to appraise current IVD repairative strategies. A number of studies have utilised the Osti sheep model since its development in 1990. The experimental questions posed at that time are covered in this review, as are significant recent advances in annular repair strategies. The ovine model has provided important spatial and temporal insights into the longitudinal development of annular lesions and how they impact on other discal and paradiscal components such as the NP, cartilaginous end plates, zygapophyseal joints and vertebral bone and blood vessels. Important recent advances have been made in biomatrix design for IVD repair and in the oriented and dynamic culture of annular fibrochondrocytes into planar, spatially relevant, annular type structures. The development of hyaluronan hydrogels capable of rapid in situ gelation offer the possibility of supplementation of matrices with cells and other biomimetics and represent a significant advance in biopolymer design. New generation biological glues and self-curing acrylic formulations which may be augmented with slow delivery biomimetics in microcarriers may also find application in the non-surgical repair of annular defects. Despite major advances, significant technical challenges still have to be overcome before the biological repair of this intractable connective tissue becomes a realistic alternative to conventional surgical intervention for the treatment of chronic degenerate IVDs.
本研究的目的是评估一种标志性的椎间盘纤维环损伤模型对我们理解椎间盘退变病因发病机制的影响,并评估当前的椎间盘修复策略。自1990年Osti绵羊模型建立以来,已有多项研究使用该模型。本综述涵盖了当时提出的实验问题,以及近期椎间盘纤维环修复策略的重大进展。绵羊模型为椎间盘纤维环损伤的纵向发展及其如何影响其他椎间盘和椎间盘周围结构(如髓核、软骨终板、关节突关节、椎骨、血管)提供了重要的空间和时间方面的见解。近期在用于椎间盘修复的生物基质设计以及将纤维环软骨细胞定向动态培养成平面的、与空间相关的环状结构方面取得了重要进展。能够快速原位凝胶化的透明质酸水凝胶的开发为用细胞和其他仿生材料补充基质提供了可能性,代表了生物聚合物设计的重大进展。新一代生物胶水和可在微载体中缓慢释放仿生材料的自固化丙烯酸配方也可能应用于椎间盘纤维环缺损的非手术修复。尽管取得了重大进展,但在这种难治性结缔组织的生物修复成为治疗慢性退变椎间盘的传统手术干预的现实替代方案之前,仍必须克服重大的技术挑战。