دانلود رایگان ترجمه مقاله توسعه منیسک مصنوعی با استفاده از پلی وینیل الکل-هیدروژل (سال 2003)

توسعه منیسک های مصنوعی زانو با استفاده از هیدروژل های الکلی پلی ونیل برای بازگشت و تداوم سریع به زندگی ورزشی در افراد ورزشکار که به آسیب های شدید منیسک مبتلا هستند. I : ارزیابی مکانیکی

Development of an artificial meniscus using polyvinyl alcohol-hydrogel for early return to, and continuance of, athletic life in sportspersons with severe meniscus injury. I: mechanical evaluation

Abstract

The importance of knee meniscus function is now recognized, and the treatment of meniscus injury has been changing from resection to repair. However, depending on the type of injury, meniscectomy sometimes cannot be avoided. The young athlete might undergo meniscectomy in order to return to sports life as early as possible. However, in such a knee, it is important to anticipate the future problem of degenerative change or osteoarthrosis. In consideration of the prognosis and circumstances in such patients, we have developed an artificial meniscus using polyvinyl alcohol-hydrogel (PVA-H) and performed mechanical tests for compression and stress–relaxation. We found that the human meniscus has unique viscoelastic properties and a high water content. PVA-H showed viscoelastic behaviour similar to that of human meniscus in mechanical tests. These results suggest that an artificial meniscus using PVA-H with a high water content can compensate for meniscal function and might be clinically applicable.

1 Introduction

Meniscectomy of the knee is most commonly performed for injuries resulting from traffic accidents or sports. Recent experimental studies on knee meniscus function have shown an important role for the meniscus in relaxing and dispersing impact stress during loading and in stabilizing the joint lubrication mechanism w1– 3x. There have also been many clinical reports on articular degeneration in patients who have undergone meniscectomy w4–7x. Thus, the treatment method for meniscus injury has changed from meniscectomy to repair. In particular, for peripheral meniscal tears where circulation is present, repair is the preferred surgical option. Sometimes, however, depending on the type of meniscus injury, meniscectomy cannot be avoided. For such cases, experimental and clinical studies have provided several approaches to the reconstruction of meniscus function, such as allograft meniscal transplantation w8,9x, meniscal tissue regeneration using an artificial biomaterial w10–12x and implant replacement w13,14x. Each method has problems and cannot be used clinically.

Most patients with meniscus injury are active young sports players, for whom there is a strong incentive to avoid long-term immobilization, rehabilitation or major surgery so that they may continue their sporting activities. We may assume that the transplantation of regenerated meniscus induced from autograft by tissue engineering will become the most effective therapy in the future. But even if this method does become established, in some cases the patient will not be able to undergo this operation immediately. For these patients, an effective ‘salvage’ treatment may be direct meniscus replacement with a biomaterial that does not cause immune reactions, thus allowing the earliest possible return to athleticlife while preventing a delayed arthrosis. We have developed an artificial meniscus using polyvinyl alcohol-hydrogel (PVA-H), which has been studied in our laboratory as an artificial cartilage, and we have now performed some mechanical experiments in relation to its clinical application.