【摘要】 目的:总结近年来骨形态发生蛋白在骨组织工程中应用研究的文献,阐明骨形态发生蛋白在骨科的临床应用前景及尚待解决的问题。资料来源:应用计算机检索Medline 1997-01/2005-12期间与骨形态发生蛋白在骨科临床试验研究有关的文章,检索词“BMP,fracture,bone”,并限定文章语言种类为“English”。同时检索清华同方中文系列数据库2000-01/2005-12期间相关文章,检索词“骨形态发生蛋白”。资料选择:对资料进行初筛,选取近年发表的针对性强的文献,同一领域的文献则选择近期发表或权威杂志的文章,排除较陈旧的和重复研究的文章。资料提炼:收集到54篇相关文章,其中35篇属于重复性研究文献,对其余19篇进行分类整理用于综述。资料综合:①骨形态发生蛋白具有促成骨活性:骨形态发生蛋白具有强大的促成骨活性,能够诱导间充质细胞不可逆地分化为骨、软骨组织。②骨形态发生蛋白用于治疗新鲜骨折、骨不连、股骨头坏死及脊柱融合的临床试验:美国食品和药物管理局于2004年认可骨形态发生蛋白2与可吸收胶原海绵复合物用于临床治疗开放性胫骨骨折,2001年正式批准骨形态发生蛋白7植入物(3.5mg骨形态发生蛋白7与1g胶原载体复合)上市用于治疗长骨骨不连,2002年批准美敦力公司的INFUSE/LT-CAGE腰椎融合装置用于前路腰椎融合。③骨形态发生蛋白的载体材料及基因治疗:目前骨形态发生蛋白仍没有最理想的载体,需要根据临床要求选择合适的材料,并对载体材料进行大量的试验研究以不断改进;基因治疗与直接应用骨形态发生蛋白同样具有促进骨缺损修复的能力,且前者具有后者所不具备的一些特点。结论:骨形态发生蛋白在一些国家已进入大规模的临床实验阶段,展现出良好的应用前景。骨形态发生蛋白的载体尚需不断改进。骨形态发生蛋白的基因治疗方法在动物实验阶段已初显成效,用于临床还需研究的进一步深入。更多还原

【Abstract】 OBJECTIVE:To review the literatures published in recent years on the application of bone morphogenetic protein(BMP)in bone tissue engineering,and explain the prospect of BMP application in orthopedic surgery and some problems need to be tackled.DATA SOURCES:A computer-based search was conducted in Medline for articles related to the BMP in orthopedic clinical trials published between January l 997 and December 2005 with the of "BMP,fracture,bone",and the language was limited in English.Meanwhile,relevant Chinese articles published from January 2000 to December 2005 were searched in CNKI database with key words of "BMP" in Chinese.STUDY SELECTION:Data were checked in the first trial,and literatures with strong aim published in recent years were selected.Literatures in the same field published lately or published in authoritative journals were included,while old articles or repetitive studies were excluded. DATA EXTRACTION:A total of 54 relevant articles were collected,including 35 repeated research literatures,and the rest 19 articles were classified and reviewed.DATA SYNTHESIS:① The osteoinductive potentiality of BMP:There was a strong osteoinductive potentiality in BMP,which could induce the irreversible differentiation of mesenchymal cells into tissues of bone and cartilage.② Clinical trials have been performed to assess the efficacy of BMP in the treatment of newly fractures,bone nonunion,osteonecrosis of the femoral head and enhancement of primary spinal fusion in human:The American food and drug administration(FDA)granted the use of BMP-2(BMP-2 in a collagen carrier)for acute open tibial fractures in 2004,approved the BMP-7(3.5 mg of BMP-7 compounded with 1 g of collagen carrier)to treat nonunion of long bone in 2001 and approved the use of BMP in anterior spinal fusion with the INFUSE/LT-CAGE from Medtronic Sofamor Danek.③The carrier systems and gene therapy of BMP:There are no ideal carrier materials for BMP nowadays.Additional research is still required to determine the optimal type of carrier material for particular clinical indications.Studies have shown that gene therapy has the same efficacy in inducing bone formation as that by using BMP directly in animal models and this strategy has a number of superiorities.CONCLUSION:Researches on BMP has enormously entered the period of clinical experiment in some countries,representing a excellent application prospect in the field of Orthopaedic surgery.However,more word must be done on the carrier of BMP.Primary effect of BMP gene therapy is found in the experiment period,while research on its clinical application still needs to be further probed into.更多还原