Murrell William D, Anz Adam W, Badsha Humeira, Bennett William F, Boykin Robert E, Caplan Arnold I
Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates 391203; and Fort Belvoir Community Hospital, Department of Orthopaedics, Podiatry, Physical Therapy, and Rehabilitation, Ft. Belvoir, VVA 22060.
Andrews Reseach & Education Institute, Gulf Breeze, FL.
PM R. 2015 Apr;7(4 Suppl):S41-S52. doi: 10.1016/j.pmrj.2015.01.015.
In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair.
在骨科手术领域，人们一直在不断追求改善手术效果和患者体验。手术技术和器械的改进以及后来诊断成像能力（特别是磁共振成像）的增强标志着这一进程的发展。随着时间的推移，实现了植入物的优化，同时还发展了创新的微创关节镜技术，以利用经典手术和植入物的新版本来改善患者的短期发病率以及初期、中期和长期治疗效果。为了持续改进，人们开始使用再生和/或生物辅助手段来促进愈合过程，基础科学的重大突破显著揭示了关键愈合和再生途径的机制。各种各样的主要和辅助再生治疗方法越来越多，包括血液制品、生长因子、骨髓制品和干细胞。这是生物活性材料应用的新时代，它通过在初次手术时或术后提供有效的支持性治疗来改变临床实践。目前，再生治疗正积极应用于骨科手术的多个领域，以提高成功率和治疗效果。在本综述中，我们全面概述了经过同行评审的循证文献，重点介绍了在肩袖、半月板、韧带和关节软骨手术修复领域中涉及再生制剂的临床前数据和人体临床试验在人类身上取得的临床结果。
