CAJ | 학술논문

背景：骨缺损甚至骨不连的修复重建是矫形外科急待解决的问题，需要临床综合分析，优化复合人工骨的选择。 　　目的：对复合骨移植替代物的临床应用现状、实验室研究和新型治疗方法进行阐述，探讨各种骨移植替代物的优势与不足，从而合理优化选择。 　　方法：应用PubMed和EMBASE数据库检索2001年1月至2012年11月关于复合骨移植替代物相关方面的文献，在英文标题、及MeSH词中以“bone regeneration；bone graft substitute；growth factors；biomaterials ”为检索主题词。排除无关及重复性研究，同一领域则选择权威杂志近期发表文献，共保留47篇进一步归纳总结。 　　结果与结论：自体骨材料虽有不可替代的优点，但是供应有限，且损害取骨部位；异体骨疾病感染风险高。而复合骨移植替代物种类丰富，性状良好，可通过不同的材料选取骨再生重建的过程，主要包括生物材料、合成高分子材料、生长因子及干细胞等组织工程材料。理想的植骨取代物要有稳定的生物力学特性，在合适的时间内降解，具有骨诱导、骨传导及成骨性。具体而言，骨传导性取决于植骨材料的类型、内部结构和表面性质，而骨诱导和成骨性可经生长因子与多能间充质干细胞介导而重塑骨组织。不同植骨材料选用各有利弊，要根据适应证及效果评估选择合适的优化组合，克服植骨自身局限性，使骨重建过程尽可能符合自然生长过程。
　　배경：골결손심지골불련적수복중건시교형외과급대해결적문제，수요림상종합분석，우화복합인공골적선택。 　　목적：대복합골이식체대물적림상응용현상、실험실연구화신형치료방법진행천술，탐토각충골이식체대물적우세여불족，종이합리우화선택。 　　방법：응용PubMed화EMBASE수거고검색2001년1월지2012년11월관우복합골이식체대물상관방면적문헌，재영문표제、급MeSH사중이“bone regeneration；bone graft substitute；growth factors；biomaterials ”위검색주제사。배제무관급중복성연구，동일영역칙선택권위잡지근기발표문헌，공보류47편진일보귀납총결。 　　결과여결론：자체골재료수유불가체대적우점，단시공응유한，차손해취골부위；이체골질병감염풍험고。이복합골이식체대물충류봉부，성상량호，가통과불동적재료선취골재생중건적과정，주요포괄생물재료、합성고분자재료、생장인자급간세포등조직공정재료。이상적식골취대물요유은정적생물역학특성，재합괄적시간내강해，구유골유도、골전도급성골성。구체이언，골전도성취결우식골재료적류형、내부결구화표면성질，이골유도화성골성가경생장인자여다능간충질간세포개도이중소골조직。불동식골재료선용각유리폐，요근거괄응증급효과평고선택합괄적우화조합，극복식골자신국한성，사골중건과정진가능부합자연생장과정。
BACKGROUND:Bone defects or non-unions, resulting from osteomyelitis, tumor resection or metabolic disorders, are stil a most pressing issue in orthopedic reconstructions which are treated with required bone graft substitutes after clinical comprehensive analysis. OBJECTIVE:To review the selection and clinical application, experimental research and novel therapeutic approaches for bone graft substitutes and to optimize the applications. METHODS:PubMed and EMBASE databases were retrieved online for relative articles about the clinical and basic research on bone graft substitute published from 2001-01 to 2012-11, with the key words of“bone regeneration;bone graft substitute;growth factors;biomaterials”in title, abstract and MeSH terms. Articles published recently in authorized journals were preferred, while unrelated and repeated were excluded. Final y, 47 articles were included. RESULTS AND CONCLUSION:Except for the limitation of graft availability and donor site impairments, autografts exhibit ideal features of bone graft substitutes. On the other hand, allograft harbors the high risk of disease transmission. However, the diversified combined use of bone graft substitutes is considered a more feasible alternative to augmenting bone regeneration process in which exhibits refined properties, including biomaterials, biodegradable polymers and growth factors and stem cells. Selection and combination of various materials perform multiple effects in bone repair. With good characters of osteoconduction, osteogenesis, and osteoinduction, an ideal bone graft substitutes should possess favorable properties in biomechanical stability and degradation within appropriate duration. Specifically, osteoconduction is determined by composition, structure and surface character. And the other ones embody advantages largely by growth factors and mesenchymal stem cells. Thus, evaluation and indication of bone graft substitutes need to be well weighted to overcome the limitation and to optimize its effect as identical to the normal bone remodeling process as possible.