1 Department of Orthopedics, University of Colorado Anschutz Medical Campus , Aurora, Colorado.
2 Department of Bioengineering, University of Colorado Anschutz Medical Campus , Aurora, Colorado.
Tissue Eng Part B Rev. 2018 Apr;24(2):85-97. doi: 10.1089/ten.TEB.2017.0274. Epub 2017 Sep 28.
The physis, or growth plate, is a cartilaginous region at the end of children's long bones that serves as the primary center for longitudinal growth and characterizes the immature skeleton. Musculoskeletal injury, including fracture, infection, malignancy, or iatrogenic damage, has risk of physeal damage. Physeal injuries account for 30% of pediatric fractures and may result in impaired bone growth. Once damaged, cartilage tissue within the physis is often replaced by unwanted bony tissue, forming a "bony bar" that can lead to complications such as complete growth arrest, angular or rotational deformities, and altered joint mechanics. Children with a bony bar occupying <50% of the physis usually undergo bony bar resection and insertion of an interpositional material, such as a fat graft, to prevent recurrence and allow the surrounding uninjured physeal tissue to restore longitudinal bone growth. Clinical success for this procedure is <35% and often the bony bar and associated growth impairments return. Children who are not candidates for bony bar resection due to a physeal bar occupying >50% of their physis undergo corrective osteotomy or bone lengthening procedures. These approaches are complex and have variable success rates. As such, there is a critical need for regenerative approaches to not only prevent initial bony bar formation but also regenerate healthy physeal cartilage following injury. This review describes physeal anatomy, mechanisms of physeal injury, and current treatment options with associated limitations. Furthermore, we provide an overview of the current research using cell-based therapies, growth factors, and biomaterials in the different animal models of injury along with strategic directions for modulating intrinsic injury pathways to inhibit bony bar formation and/or promote physeal tissue formation. Pediatric physeal injuries constitute a unique niche within regenerative medicine for which there is a critical need for research to decrease child morbidity related to this injurious process.
骺板，又称生长板，是儿童长骨末端的软骨区域，是纵向生长的主要中心，也是未成熟骨骼的特征。肌肉骨骼损伤，包括骨折、感染、恶性肿瘤或医源性损伤，都有骺板损伤的风险。骺板损伤占儿童骨折的 30%，可能导致骨生长受损。一旦受损，骺板内的软骨组织通常会被不需要的骨组织取代，形成“骨条”，可导致完全生长停滞、角度或旋转畸形以及关节力学改变等并发症。骺板内骨条占据<50%的儿童通常行骨条切除术，并插入间置物，如脂肪移植物，以防止复发，并允许周围未受伤的骺板组织恢复纵向骨生长。该手术的临床成功率<35%，且骨条和相关生长障碍常复发。骺板内骨条占据>50%的儿童因不适合行骨条切除术，而行矫正性截骨术或骨延长术。这些方法复杂，成功率不一。因此，迫切需要再生方法，不仅预防初始骨条形成，而且在损伤后再生健康的骺板软骨。本综述描述了骺板解剖、骺板损伤机制以及当前的治疗选择及其相关局限性。此外，我们概述了使用细胞疗法、生长因子和生物材料在不同损伤动物模型中的当前研究，并提供了调节内在损伤途径以抑制骨条形成和/或促进骺板组织形成的战略方向。儿科骺板损伤在再生医学中具有独特的地位，迫切需要开展相关研究，以降低与该损伤过程相关的儿童发病率。
