CAJ | 학술논문

背景：膜引导骨再生技术已成为骨缺损修复中的重要方法，随着相关研究的深入，膜引导骨再生的相关概念和机制已经逐渐确定，但仍然存在一些未解决的问题。 　　目的：综述引导骨再生技术中膜管的分类、性能和优缺点及此技术的应用与研究中的问题。 　　方法：由第一作者检索1963至2013年PubMed数据及CNKI数据库有关膜引导性骨再生的发现及其在骨缺损治疗的相关概念与膜管分类、性能和优缺点方面的文献。英文检索词为“guided bone regeneration，guided tissue regeneration，bone defect treatment”，中文检索词为“膜引导性骨再生，引导性组织再生，骨缺损治疗”。 　　结果与结论：膜引导骨再生技术是治疗骨缺损的最有前景方法，但对于长管状骨缺损的修复使用还处于试验阶段，目前临床上还没有可以使用的长段骨缺损修复膜管。根据材料来源可将膜管分为：非生物性材料，如聚四氟乙烯、聚乳酸、硅胶、钛膜等；生物性材料，如胶原膜、几丁质膜、聚羟基丁酸酯等。按材料能否降解又可分为非降解性材料与降解性材料。可降解性材料具有组织相容性好、无细胞毒性特点，植入后可在一定时期内降解，部分膜还可以允许组织液和营养物质自由交换，但存在降解时间不易控制、膜管下容积难以维持的缺陷。新骨完全形成于非降解性材料内，成骨过程中膜管组织相容性好，引导性骨再生效果较好，但不能被组织吸收或替代，需二次手术取出膜管。今后应进一步改进膜管性能，使膜管可以兼聚固定和引导性骨再生作用；进一步进行一系列动物实验研究应力对膜管和膜管内骨整合的影响，掌握膜管骨整合的规律，为膜管在人体长管状骨缺损的研究和应用提供依据。
배경：막인도골재생기술이성위골결손수복중적중요방법，수착상관연구적심입，막인도골재생적상관개념화궤제이경축점학정，단잉연존재일사미해결적문제。 　　목적：종술인도골재생기술중막관적분류、성능화우결점급차기술적응용여연구중적문제。 　　방법：유제일작자검색1963지2013년PubMed수거급CNKI수거고유관막인도성골재생적발현급기재골결손치료적상관개념여막관분류、성능화우결점방면적문헌。영문검색사위“guided bone regeneration，guided tissue regeneration，bone defect treatment”，중문검색사위“막인도성골재생，인도성조직재생，골결손치료”。 　　결과여결론：막인도골재생기술시치료골결손적최유전경방법，단대우장관상골결손적수복사용환처우시험계단，목전림상상환몰유가이사용적장단골결손수복막관。근거재료래원가장막관분위：비생물성재료，여취사불을희、취유산、규효、태막등；생물성재료，여효원막、궤정질막、취간기정산지등。안재료능부강해우가분위비강해성재료여강해성재료。가강해성재료구유조직상용성호、무세포독성특점，식입후가재일정시기내강해，부분막환가이윤허조직액화영양물질자유교환，단존재강해시간불역공제、막관하용적난이유지적결함。신골완전형성우비강해성재료내，성골과정중막관조직상용성호，인도성골재생효과교호，단불능피조직흡수혹체대，수이차수술취출막관。금후응진일보개진막관성능，사막관가이겸취고정화인도성골재생작용；진일보진행일계렬동물실험연구응력대막관화막관내골정합적영향，장악막관골정합적규률，위막관재인체장관상골결손적연구화응용제공의거。
BACKGROUND:Membrane guided bone regeneration technology has become an important method in repairing bone defects. With the deepening of the research, related concept and the mechanism of membrane guided bone regeneration have been gradual y confirmed, but there are stil some unresolved issues. OBJECTIVE: To review the classification of membrane tubes, performance, disadvantages and advantages in membrane guided bone regeneration, as wel as some unresolved issues in application and research. METHODS:The first author searched PubMed and CNKI databases to retrieve articles about the discovery of membrane guided bone regeneration and the concepts, classification of membrane tubes, performance, disadvantages and advantages during bone defect treatment, which were published from 1963 to 2013. The key words were“guided bone regeneration, guided tissue regeneration, bone defect treatment”in English and Chinese, respectively. RESULTS AND CONCLUSION:Membrane guided bone regeneration technique is a most promising treatment for bone defects, but for the treatment of long tubular bone defects, it is stil in the experimental stage. Currently, there is no membrane tube for long-segment bone defects. According to the material sources, the membrane tubes can be divided into:non-biological material, such as polytetrafluoroethylene, polylactic acid, silica gel, titanium film;biological materials, such as col agen membrane, chitin membrane, polyhydroxybutyrate. The membrane tubes can also be classified into nondegradable materials and biodegradable materials. Biodegradable materials have good histocompatibility and no cytotoxicity, which can degrade in a certain period after implantation;part of the membrane can also al ow free exchange of tissue fluid and nutritional substances. But there are stil some shortcomings that the degradation time is difficult to control and the volume is difficultly maintained under the membrane tube. New bone formation in non-biodegradable materials is complete. In the process of osteogenesis, the membrane tube cannot be absorbed and has to be removed secondarily, though it has good histocompatibility and better therapeutic outcomes. In the future, we should further improve membrane performance, so that the membrane tube can play a dual role, fixation and guided bone regeneration;a series of animal studies should be conducted to study the effect of stress on the membrane tube and osseointegration within the membrane tube, to master the law of osseointegration of membrane tubes, thereby providing evidence for repair of long tubular bone defects.