Steinwachs M R, Waibl B, Niemeyer P
Zentrum für Orthobiologie & Knorpelregeneration, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2011 Jul;54(7):797-802. doi: 10.1007/s00103-011-1302-5.
Articular cartilage defects have virtually no self-healing capacity. As a consequence, a surgical approach for symptomatic grade III/IV defects is required. The application of bone marrow-stimulating techniques (Pridie drilling, microfracture) is only able to reproduce mechanically inferior fibrous cartilage tissue. The minimally invasive surgical technique and low cost with acceptable results in the medium term are the main reasons for the application of these techniques. The combination of microfracture and biomaterials, i.e., the AMIC technique, has not yet proved that the disadvantages of the marrow stimulation techniques can be overcome. At present, only laboratory cultivated autologous chondrocytes are able to restore a biomechanically superior cartilage layer. By selecting the appropriate cell fraction in conjunction with the controlled release of differentiating growth factors, sufficient cartilage regeneration also appears to be achievable on the basis of bone marrow aspirate. This is the subject of experimental studies of bone marrow aspirates and autologous growth factors with encouraging initial results.
关节软骨缺损几乎没有自我修复能力。因此,对于有症状的III/IV级缺损需要采取手术方法。骨髓刺激技术(普里迪钻孔术、微骨折术)的应用仅能产生机械性能较差的纤维软骨组织。这些技术应用的主要原因是其微创性、低成本以及中期可接受的效果。微骨折术与生物材料的联合应用,即AMIC技术,尚未证明能够克服骨髓刺激技术的缺点。目前,只有实验室培养的自体软骨细胞能够恢复生物力学性能优越的软骨层。通过选择合适的细胞组分并结合分化生长因子的控释,基于骨髓抽吸物似乎也能够实现充分的软骨再生。这是骨髓抽吸物和自体生长因子实验研究的主题,初步结果令人鼓舞。