修复运动性肌腱损伤组织工程化肌腱及种子细胞和支架材料

doi:10.3969/j.issn.2095-4344.2015.51.024

摘要/Abstract

摘要：

背景：获得大规模、具有再生活力的种子细胞以及具有与正常人体肌腱组织相接近的力学性能的理想支架材料是当前组织工程化肌腱研究面临的最为关键的限制性因素。
目的：总结和分析组织工程肌腱研究中的种子细胞和支架材料的研究进展。
方法：查阅近年来肌腱组织工程研究的相关文献，综合国内外最新研究成果，就肌腱组织工程中合适的种子细胞来源、研究更为理想的支架材料及组织相容性等方面的进展进行概述。
结果与结论：肌腱组织工程中常用的种子细胞有间充质干细胞、肌腱干细胞及胚胎干细胞等，可以向骨、软骨和脂肪分化，修复肌腱损伤的理想细胞。肌腱组织工程支架材料有天然材料及人工合成材料等，肌腱组织工程支架材料应有良好的生物相容性和适度的机械性能，复合材料将是肌腱组织工程支架材料研究的重点。

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

关键词: 组织构建, 组织工程, 组织工程化肌腱, 肌腱, 运动损伤, 间质干细胞, 胚胎干细胞, 成脂分化, 生物相容性

Abstract:

BACKGROUND: To harvest a large amount of seed cells with regenerative viability and ideal scaffold materials with mechanical properties similar to the human tendon is crucial for current tissue-engineered tendon research.
OBJECTIVE: To summarize and analyze the progress in seed cells and scaffold materials for tissue-engineered tendon.
METHODS: Literatures addressing tendon tissue engineering published in recent years were retrieved and combined with latest achievements to analyze the research progress in seed cell sources, ideal scaffold materials, and histocompatibility for tendon tissue engineering.
RESULTS AND CONCLUSION: Commonly used seed cells for tendon tissue engineering include mesenchymal stem cells, tendon stem cells and embryonic stem cells, all of which are ideal cells that can differentiate to bone, cartilage and fat so as to repair damaged tendons. Tendon tissue engineering scaffolds are made of natural materials and synthetic materials, which should have good biocompatibility and appropriate mechanical properties. In the future, composite materials will be the research focus of tendon tissue engineering scaffold materials.

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

中图分类号:

R318

杨健，葛建忠. 修复运动性肌腱损伤组织工程化肌腱及种子细胞和支架材料[J]. 中国组织工程研究, 2015, 19(51): 8333-8337.

Yang Jian, Ge Jian-zhong. Seed cells and scaffold materials for construction of tissue-engineered tendon to repair exercise-induced tendon injury[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(51): 8333-8337.

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引言

肌腱的主要功能是在肌肉与骨骼之间传递力量并带动关节活动，因此常会承受高强度的机械负荷，而这样的机械负荷易会导致肌腱损伤并最终影响其功能[1]。运动性肌腱损伤属于临床工作中十分常见的外伤，可分为无缺损损伤和有缺损损伤两大类[2]。形成运动肌腱损伤的成因：人体的肌肉、关节的力量博弱，超负荷的运动，可引起运动肌腱损伤；人体在运动前准备活动不充分，练习时动作不正确，可引起运动肌腱损伤；运动场地不规范，存在安全隐患，练习者麻痹大意，可引起运动肌腱损伤。肌腱损伤的愈合十分缓慢并易形成瘢痕组织，降低肌腱的韧性，从而影响肌腱的机械性能[3]。运动员在训练和比赛当中，由于运动量过大所造成的肌腱运动缺损若不予以及时修复会引起肢体功能障碍，将可能给运动员留下严重的后遗症，而且经损伤修复后的肌腱容易再次受伤。而慢性损伤可导致肌腱出现诸多退行性改变，包括单独或者合并出现的脂质沉积、蛋白多糖积累以及组织钙化等，最终导致肌腱病的发生[4]。由于肌腱自身的特殊结构及功能，不具备完全再生能力[5]，多年来众多国内外学者对肌健的解剖、生理及愈合过程进行了大量的研究，探索了许多促进肌健愈合的治疗方法[6]。
自体肌腱移植具有取材容易，方法简单，无免疫排斥反应等优点，可用于临床，但自体供体或供区肌腱组织缺乏、来源十分有限，且切取肌腱会导致供区功能和力学稳定性产生一定损失，并会增加新的创伤制约，因而应用受到限制[7]。而异体肌腱则存在不同程度的免疫排斥反应，并且肌腱修复后的组织和功能特性与正常肌腱相距甚远，常伴随有腱粘连、组织形态不佳，力学性能差，易二次损伤。因此这些传统的肌腱损伤修复方法发展前景有限，寻找肌腱再生修复新手段具有重要的临床意义。有关组织工程化肌腱的研究为修复肌腱缺损开辟了一条新途径。
近年来，组织工程化肌腱的研究逐渐增加，但仍面临着两方面挑战，一是种子细胞细胞来源及在体外快速增殖问题，二是特殊力学强度和降解性能支架材料的制备和筛选的问题[8]。自体肌腱细胞是肌腱组织的基本功能单位，最方便作为种子细胞，但它是分化成熟的功能细胞，体外培养时，增殖缓慢，且传代后会丧失增殖能力，同时也存在供体限制[9]。组织工程化肌腱种子细胞应具备成脂、成骨和成软骨分化的能力。组织工程化肌腱所选用的支架材料不仅要对人体无不良反应，还要求其易于细胞黏附，能诱导胶原沉积，新腱形成，并具有接近正常肌腱的力学性能[10]。因此，如何获得大规模、具有再生活力的种子细胞以及具有与正常人体肌腱组织相接近的力学性能的理想支架材料是当前组织工程化肌腱研究面临的最为关键的限制性因素。
本文将组织工程肌腱研究中的种子细胞和生物材料在肌腱运动损伤修复的研究进展做以综述。

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