Ye Ken, Di Bella Claudia, Myers Damian E, Choong Peter F M
Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia.
ANZ J Surg. 2014 Apr;84(4):211-7. doi: 10.1111/ans.12108. Epub 2013 Mar 4.
The management of articular cartilage defects remains challenging and controversial. Hyaline cartilage has limited capacity for self-repair and post-injury cartilage is predominantly replaced by fibrocartilage through healing from the subchondral bone. Fibrocartilage lacks the key properties that characterize hyaline cartilage such as capacity for compression, hydrodynamic permeability and smoothness of the articular surface. Many reports relate compromised function associated with repaired cartilage and loss of function of the articular surface. Novel methods have been proposed with the key aim to regenerate hyaline cartilage for repair of osteochondral defects. Over the past decade, with many exciting developments in tissue engineering and regenerative cell-based technologies, we are now able to consider new combinatorial approaches to overcome the problems associated with osteochondral injuries and damage. In this review, the currently accepted surgical approaches are reviewed and considered; debridement, marrow stimulation, whole tissue transplantation and cellular repair. More recent products, which employ tissue engineering approaches to enhance the traditional methods of repair, are discussed. Future trends must not only focus on recreating the composition of articular cartilage, but more importantly recapitulate the nano-structure of articular cartilage to improve the functional strength and integration of repair tissue.
关节软骨缺损的治疗仍然具有挑战性且存在争议。透明软骨的自我修复能力有限，损伤后的软骨主要通过软骨下骨的愈合被纤维软骨替代。纤维软骨缺乏透明软骨的关键特性，如抗压能力、流体动力渗透性和关节表面的光滑度。许多报告指出修复后的软骨功能受损以及关节表面功能丧失。人们提出了新的方法，其主要目标是再生透明软骨以修复骨软骨缺损。在过去十年中，随着组织工程和基于细胞的再生技术取得了许多令人振奋的进展，我们现在能够考虑采用新的组合方法来克服与骨软骨损伤和破坏相关的问题。在这篇综述中，对目前公认的手术方法进行了回顾和探讨，包括清创术、骨髓刺激、全组织移植和细胞修复。还讨论了采用组织工程方法来改进传统修复方法的最新产品。未来的趋势不仅要专注于重建关节软骨的组成，更重要的是要重现关节软骨的纳米结构，以提高修复组织的功能强度和整合度。
