低强度脉冲超声促进骨与软骨再生的研究与临床应用

摘要

背景:低强度脉冲超声是一种无热力无创伤的力学刺激,临床利用低强度脉冲超声治疗骨与软骨缺损已经取得了一定的疗效.目的:回顾分析低强度脉冲超声在骨与软骨再生过程中的作用及机制,并对低强度脉冲超声参与调节的分子信号、组织再生机制以及临床应用的现状进行综述,为临床提供科学理论依据.方法:由第一作者运用计算机检索计算机检索 Cochrane Library、PubMed、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI),以及万方数据资源系统中1990年1月至2017年2月发表的低强度脉冲超声治疗促进骨与软骨再生的相关研究,以"低强度脉冲超声,钙离子,整合素,一氧化氮,前列腺素,骨形成蛋白"为中文检索词,以"LIPUS,calcium,integrin,nitric oxide,prostaglandin,BMP"为英文检索词.同一领域相关研究则选择权威杂志或近期发表的文献,从检索结果中共选择了80篇文章进行进一步分析.结果与结论:①低强度脉冲超声的基础研究涉及细胞力学以及组织再生等多个领域,尤其在分子生物学技术的支持下,促进骨与软骨再生的研究取得了突破性的进展;②研究发现,低强度脉冲超声通过机械波能引起细胞或组织内产生相应的力学信号,使信号通路中相关分子变化,进而加速受作用区域的血供和新陈代谢,促进骨与软骨组织的再生,并取得了一定的临床疗效.%BACKGROUND: Low-intensity pulsed ultrasound (LIPUS) is a non-thermal and non-invasive mechanical stimulation, which has achieved certain curative efficacy on bone and cartilage defects. OBJECTIVE: To retrospectively analyze the effects and mechanisms of LIPUS in bone and cartilage regeneration process, and to review the related cellular signals and tissue regeneration mechanism involved in the current achievement of basic research and clinical application, thus providing theoretical basis for clinics. METHODS: The first author retrieved Cochrane Library, PubMed, CBM, CNKI and WanFang databases using compute for the articles addressing LIPUS promoting bone and cartilage regeneration published from January 1990 to February 2017. The keywords were "LIPUS, calcium, integrin, nitric, oxide, prostaglandin, BMP" in English and Chinese, respectively. The articles published in authoritative magazines or recently published were preferred, and finally 80 articles were selected for result analysis. RESULTS AND CONCLUSION: The basic research concerning LIPUS involves cellular mechanics and tissue engineering. Especially with the support of molecular biology, there has been a major breakthrough in promoting bone and cartilage regeneration. LIPUS can stimulate cells and tissues to produce mechanical signals by mechanical wave, lead to changes in cytokines in the signaling pathways, further accelerate blood supply and metabolism, and finally promote the regeneration of bone and cartilage. Therefore, LIPUS is an effective treatment method.