Thomopoulos S, Genin G M, Galatz L M
Washington University, Department of Orthopaedic Surgery, St Louis, MO 63110, USA.
J Musculoskelet Neuronal Interact. 2010 Mar;10(1):35-45.
The attachment of dissimilar materials is a major challenge because of the high levels of stress that develop at such interfaces. An effective solution to this problem develops at the attachment of tendon (a compliant "soft tissue") to bone (a stiff "hard tissue"). This tissue, the "enthesis", transitions from tendon to bone through gradations in structure, composition, and mechanical properties. These gradations are not regenerated during tendon-to-bone healing, leading to a high incidence of failure after surgical repair. Understanding the development of the enthesis may allow scientists to develop treatments that regenerate the natural tendon-to-bone insertion. Recent work has demonstrated that both biologic and mechanical factors drive the development and morphogenesis of the enthesis. A cascade of biologic signals similar to those seen in the growth plate promotes mineralization of cartilage on the bony end of the enthesis and the formation of fibrocartilage on the tendon end of the enthesis. Mechanical loading is also necessary for the development of the enthesis. Removal of muscle load impairs the formation of bone, fibrocartilage, and tendon at the developing enthesis. This paper reviews recent work on the development of the enthesis, with an emphasis on the roles of biologic and mechanical factors.
不同材料的附着是一项重大挑战，因为在这些界面处会产生高水平的应力。解决这一问题的有效方法体现在肌腱（一种柔顺的“软组织”）与骨骼（一种坚硬的“硬组织”）的附着过程中。这种组织，即“附着点”，通过结构、成分和力学性能的渐变从肌腱过渡到骨骼。在肌腱与骨骼愈合过程中，这些渐变不会再生，导致手术修复后失败的发生率很高。了解附着点的发育过程可能使科学家们开发出能够再生天然肌腱与骨骼附着的治疗方法。最近的研究表明，生物因素和机械因素都驱动着附着点的发育和形态发生。一系列类似于生长板中所见的生物信号促进了附着点骨端软骨的矿化以及附着点肌腱端纤维软骨的形成。机械负荷对于附着点的发育也是必需的。去除肌肉负荷会损害发育中的附着点处骨、纤维软骨和肌腱的形成。本文综述了关于附着点发育的最新研究，重点关注生物因素和机械因素的作用。
