Department of Orthopedic Surgery, EpiCURA Hospital, Baudour.
ORTHOCA, Antwerp.
Arthroscopy. 2022 Feb;38(2):643-656. doi: 10.1016/j.arthro.2021.08.032. Epub 2021 Sep 8.
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the hip, including osteonecrosis (aseptic necrosis) involving bone marrow, bone, and cartilage, and chondral injuries involving articular cartilage, synovium, and bone marrow. Promising and established treatment modalities for osteonecrosis include nonweightbearing; pharmacological treatments including low molecular-weight heparin, prostacyclin, statins, bisphosphonates, and denosumab, a receptor activator of nuclear factor-kB ligand inhibitor; extracorporeal shock wave therapy; pulsed electromagnetic fields; core decompression surgery; cellular therapies including bone marrow aspirate comprising mesenchymal stromal cells (MSCs aka mesenchymal stem cells) and bone marrow autologous concentrate, with or without expanded or cultured cells, and possible addition of bone morphogenetic protein-2, vascular endothelial growth factor, and basic fibroblast growth factor; and arterial perfusion of MSCs that may be combined with addition of carriers or scaffolds including autologous MSCs cultured with beta-tricalcium phosphate ceramics associated with a free vascularized fibula. Promising and established treatment modalities for chondral lesions include autologous platelet-rich plasma; hyaluronic acid; MSCs (in expanded or nonexpanded form) derived from bone marrow or other sources such as fat, placenta, umbilical cord blood, synovial membrane, and cartilage; microfracture or microfracture augmented with membrane containing MSCs, collagen, HA, or synthetic polymer; mosaicplasty; 1-stage autologous cartilage translation (ACT) or 2-stage ACT using 3-dimensional spheroids; and autologous cartilage grafting; chondral flap repair, or flap fixation with fibrin glue. Hip pain is catastrophic in young patients, and promising therapies offer an alternative to premature arthroplasty. This may address both physical and psychological components of pain; the goal is to avoid or postpone an artificial joint. LEVEL OF EVIDENCE: Level V, expert opinion.
正位再生被定义为一种针对骨科疾病的解决方案,它利用生物学的优势来改善愈合、减轻疼痛、提高功能,并优化组织再生的环境。选择包括药物、手术干预、支架、细胞产物的生物制品以及物理和电磁刺激。再生医学的目标是增强肌肉骨骼损伤后的组织愈合能力,既可以作为单一治疗方法,也可以作为手术管理的辅助手段,使用新疗法来改善恢复和结果。各种骨科生物制品(orthobiologics)已被用于治疗涉及髋关节的病理学,包括涉及骨髓、骨和软骨的骨坏死(无菌性坏死)以及涉及关节软骨、滑膜和骨髓的软骨损伤。有前途和已确立的骨坏死治疗方法包括非负重;药物治疗包括低分子量肝素、前列环素、他汀类药物、双膦酸盐和 denosumab(核因子-kB 配体抑制剂的受体激活剂);体外冲击波治疗;脉冲电磁场;核心减压手术;细胞疗法包括骨髓抽吸液,其中包含间充质基质细胞(MSCs,即间充质干细胞)和骨髓自体浓缩物,有或没有扩增或培养的细胞,以及可能添加骨形态发生蛋白-2、血管内皮生长因子和碱性成纤维细胞生长因子;以及可能与添加载体或支架(包括与游离血管化腓骨相关的培养有β-磷酸三钙陶瓷的自体 MSCs)相结合的 MSCs 动脉灌注。有前途和已确立的软骨病变治疗方法包括自体富血小板血浆;透明质酸;MSCs(扩增或未扩增形式)来源于骨髓或其他来源,如脂肪、胎盘、脐带血、滑膜和软骨;微骨折或微骨折加含 MSCs、胶原、HA 或合成聚合物的膜增强;马赛克plasty;1 期自体软骨平移(ACT)或使用 3 维球体的 2 期 ACT;以及自体软骨移植;软骨瓣修复或纤维蛋白胶固定瓣。髋关节疼痛对年轻患者来说是灾难性的,有前途的治疗方法为提前进行关节置换提供了替代方案。这可能解决疼痛的身体和心理两个方面;目标是避免或推迟人工关节。证据水平:5 级,专家意见。
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