中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (36): 5879-5885.doi: 10.3969/j.issn.2095-4344.2017.36.024

• 组织构建综述 tissue construction review • 上一篇    下一篇

膝关节粘连：治疗和预防研究新进展

吴海啸1，2，王  鹏3，张  超1，2，4，Egiazaryan KA 1，2，Ratyev AP1，2，Melnichenko SY2，Kuzin VV1，2, Skoroglyadov AV1，2   

  1. 1俄罗斯联邦国立医科大学，俄罗斯莫斯科  1179972；2俄罗斯联邦国立医科大学第一附属医院，俄罗斯莫斯科  1179972；3河北省中医院，河北省石家庄市   050011；4天津医科大学肿瘤医院，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究中心，天津市  300070
  • 收稿日期:2017-11-13 出版日期:2017-12-28 发布日期:2018-01-04
  • 通讯作者: 张超，博士，天津医科大学肿瘤医院骨肿瘤科，天津市 300070
  • 作者简介:吴海啸，男，1985年生，河北省石家庄人，汉族，俄罗斯联邦国立医科大学在读博士，主要从事骨与关节损伤方面的研究。 并列第一作者：王鹏，河北省中医院骨伤科副主任医师，副教授，主要从事脊柱损伤方面的研究。

Progress in the treatment and prevention of knee intra-articular adhesion

Wu Hai-xiao1, 2, Wang Peng3, Zhang Chao1, 2, 4, Egiazaryan KA 1,2, Ratyev AP1,2, Melnichenko SY2, Kuzin VV1. 2, Skoroglyadov AV1,2   

  1. 1Department of Orthopedics, Pirogov Russian National Research Medical University, Moscow 1179972, Russian Federation; 2Department of Traumatology Orthopedics, Clinical City Hospital, Pirogov Russian National Research Medical University, Moscow 117049, Russian Federation; 3Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050011, Hebei Province, China; 4Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300070, China
  • Received:2017-11-13 Online:2017-12-28 Published:2018-01-04
  • Contact: Tissue Adhesion; Fibrosis; Wound Healing; Vascular Endothelial Growth Factors; Tissue Engineering
  • About author:Wu Hai-xiao, Studying for doctorate, Department of Orthopedics, Pirogov Russian National Research Medical University, Moscow 1179972, Russian Federation; Department of Traumatology Orthopedics, Clinical City Hospital, Pirogov Russian National Research Medical University, Moscow 117049, Russian Federation Wang Peng, Associate chief physician, Associate professor, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050011, Hebei Province, China Wu Hai-xiao and Wang Peng contributed equally to this work.

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摘要：

文章快速阅读：

文题释义：
膝关节粘连：为膝关节手术或创伤后引起的一种严重并发症。临床症状多表现为膝关节活动范围受限、慢性关节疼痛，最终引起关节软骨退行性病变和膝关节僵直等多种后遗症。
膝关节粘连的主要致病机制：①创伤/手术造成了早期局部软组织出血、激活了炎症反应，引起纤维蛋白和炎性细胞渗出；②随着纤溶和抗纤溶系统的平衡被破坏，直接导致纤维蛋白沉积形成暂时的粘连基质，形成过量的炎性细胞-胶原-纤维蛋白复合物，随着微血管的长入，产生了大量肉芽组织并集聚于滑膜及关节囊周围；③胶原纤维增粗，微血管闭合消失，导致了肉芽组织纤维化，滑膜和关节囊进而萎缩，降低了关节腔的空间和透明质酸的分泌，形成了关节内粘连的同时造成了关节软骨的退行性病变；④后期膝关节周围肌肉组织萎缩纤维化、韧带短缩和屈伸装置的废用性改变，形成了关节外粘连。
摘要
背景：膝关节粘连严重影响了患者术后的日常生活，而传统的治疗方式疗效有限。降低膝关节粘连发生率是提高手术预期疗效的关键，也是临床医学上需要急待解决的重要问题。
目的：对膝关节粘连的各类研究文献进行分析，总结近10年的研究成果，为防治膝关节粘连提供新的思路和方法。
方法：由第一作者检索PubMed数据库，查找2006至2016年的文献，英文检索词为“tissue adhesions, arthrofibrosis, joint stiffness, prevent, treatment”，共检索到1 500余篇相关文献，59篇符合纳入标准。
结果与结论：①近年来大量学者研究发现，创伤/手术引起膝关节出血、炎症反应，造成血管内皮细胞生长因子和白细胞介素6高表达，增加了成纤维细胞的活性，导致大量胶原蛋白沉积，发生粘连；②改进传统治疗方式和运用微创技术治疗膝关节粘连取得了一定的疗效，但仍存在再粘连风险；③关节腔内用药预防膝关节粘连在基础研究方面获得了显著成果，可成为预防膝关节粘连的一种有效方案，但临床可行性存在争议，需进一步深入研究，寻找疗效确切、不良反应小的药物。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程
ORCID: 0000-0001-7096-8488(张超)，0000-0002-2699-466X(吴海啸)

关键词: 组织构建, 组织工程, 组织粘连, 纤维化, 僵直, 伤口愈合, 血管内皮生长因子, 治疗, 预防

Abstract:

BACKGROUND: Knee intra-articular adhesion has a serious impact on the postoperative patient’s daily life, but the efficacy of traditional treatment is limited. To reduce knee intra-articular adhesion is the key to improve the expectations of surgery, which is an urgent problem to be solved.
OBJECTIVE: To analyze various articles concerning knee intra-articular adhesion, and summarize the research achievements in the last decade, so as to provide new ideas and methods for the prevention of knee intra-articular adhesion.
METHODS: The first author retrieved PubMed database using computer and searched the relevant articles published from 2006 to 2016. The keywords were “tissue adhesions, arthrofibrosis, joint stiffness, prevent, treatment”. Totally 1 500 articles were retrieved, and finally 59 eligible articles were included in accordance with the inclusion criteria.
RESULTS AND CONCLUSION: In recent years, a large number of scholars have found that trauma or surgery can cause knee joint bleeding and inflammation, which result in the increased expression of vascular endothelial growth factor and interleukin-6, enhance the activity of fibroblasts and secrete a large amount of collagen deposition, thereby causing knee intra-articular adhesion. The modification of traditional methods and application of minimally invasive technology have achieved a certain effect on the knee intra-articular adhesion, but there is still a risk for re-adhesion. A remarkable achievement has been obtained in the basic research of preventing knee adhesion with intra-articular drug that can become an effective method for preventing intra-articular adhesion, but its clinical feasibility is still controversial, and further investigation is needed to find the drug possessing exact effect and less adverse reactions.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Tissue Adhesion, Fibrosis, Wound Healing, Vascular Endothelial Growth Factors, Tissue Engineering

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