组织工程修复颞下颌关节的关键因素研究进展

颞下颌关节骨关节炎（TMJOA）主要表现为颞下颌关节盘（TMJD）穿孔以及髁突骨软骨复合体（COCC）破坏。近年来，组织工程技术成为修复颞下颌关节的有效策略之一。随着支架材料技术的不断进步，结合天然材料与人工合成材料优势的复合支架成为优化支架性能的重要手段。近年来，微创理念下的原位成胶方法极大地解决了手术创伤以及材料吻合的问题，有利于组织工程向临床转化。细胞外基质支架技术在解决支架来源问题的同时最大程度地模拟了细胞外环境，为颞下颌关节组织工程向动物水平的转化提供了重要的手段。由于肋软骨细胞来源与扩增的限制，采用不同来源的间充质干细胞成为颞下颌关节组织工程的广泛选择，其中从关节软骨表面分离得到的纤维软骨干细胞可能更为合适。转化生长因子β超家族由于其明确的骨软骨活性，富血小板衍生物作为一种制备便捷的复合生物因子，同时结合间充质干细胞外泌体和应力刺激的形式调控细胞外微环境等方法均在颞下颌关节组织工程中得到运用。未来，通过复合生物活性因子并结合一定的应力刺激可能成为颞下颌关节组织工程研究的重要趋势之一。本文就组织工程技术修复颞下颌关节骨软骨复合体及关节盘的进展，尤其是在支架材料、种子细胞以及刺激因子方面的研究进展作一综述，以期为未来的研究设计和临床干预提供指导。

Research progress on tissue engineering in repairing temporo-mandibular joint

Temporomandibular joint osteoarthritis (TMJOA) is mainly manifested as perforation of temporomandibular joint disc (TMJD) and destruction of condylar osteochondral complex (COCC). In recent years, tissue engineering technology has become one of the effective strategies in repairing this damage. With the development of scaffold material technology, composite scaffolds have become an important means to optimize the performance of scaffolds with the combined advantages of natural materials and synthetic materials. The in situ gelling method with the minimally invasive concept can greatly solve the problems of surgical trauma and material anastomosis, which is beneficial to the clinical transformation of temporomandibular joint tissue engineering. Extracellular matrix scaffolds technology can solve the problem of scaffold source and maximize the simulation of the extracellular environment, which provides an important means for the transformation of temporomandibular joint tissue engineering to animal level. Due to the limitation of the source and amplification of costal chondrocytes, the use of mesenchymal stem cells from different sources has been widely used for temporomandibular joint tissue engineering. The fibrochondral stem cells isolated from surface layer of articular cartilage may provide one more suitable cell source. Transforming growth factor β superfamily, due to its osteochondrogenesis activity has been widely used in tissue engineering, and platelet-rich derivative as a convenient preparation of compound biological factor, gradually get used in temporomandibular joint tissue engineering. With the deepening of research on extracellular microenvironment and mechanical stimulation, mesenchymal stem cells, exosomes and stress stimulation are increasingly being used to regulate the extracellular microenvironment. In the future, the combination of complex bioactive factors and certain stress stimulation may become a trend in the temporomandibular joint tissue engineering research. In this article, the progress on tissue engineering in repairing COCC and TMJD, especially in scaffold materials, seed cells and bioactive factors, are reviewed, so as to provide information for future research design and clinical intervention.