复合材料人工骨在骨缺损修复中的应用

Artificial composite bone in repairing bone defects

目的:研制理想的人工骨材料修复骨缺损,已经成为医学和生物材料领域的研究重点。介绍几种单一及复合材料人工骨,以了解其生物相容性及其在骨缺损修复中应用的特点。方法:应用计算机检索中国期刊全文数据库1999-01/2007-06有关人工骨的性能、生物相容性及其在骨缺损修复中应用的相关研究文章,检索词"纳米羟基磷灰石人工骨,珊瑚羟基磷灰石人工骨,磷酸钙人工骨,陶瓷人工骨,复合材料,生物相容性,骨缺损",限定文献语言种类为中文。纳入标准:①单一及复合材料人工骨在骨缺损修复中应用。②不同材料人工骨的研制、性能、安全性、生物相容性评价的研究文章。排除标准:重复研究。最终纳入27篇符合标准的文献。结果:①纳米羟基磷灰石人工骨具有良好成骨能力和生物相容性,然而单一材料很难以满足骨缺损修复及骨组织工程细胞外基质材料的要求,将几种单一材料进行适当组合形成的纳米羟基磷灰石复合材料人工骨在实际应用中取得良好的效果。②珊瑚羟基磷灰石人工骨作为骨移植替代物具有骨引导作用,但具有脆性大,机械强度低的缺点,通过改变理化条件,使其性质发生改变,可以提高其成骨能力,降低移植后的炎症反应和排斥反应,无毒副作用。③磷酸钙骨水泥人工骨具有良好的生物相容性和生物降解性,rhBMP-2/PLGA微球/磷酸钙骨水泥新型复合人工骨与单纯rhBMP-2/磷酸钙骨水泥材料相比有较高的可降解性和成骨活性,并可作为细胞因子、抗菌素等的理想载体。④陶瓷人工骨具有生物活性和骨传导作用,但存在成形不理想、强度低、韧性差等缺点。与不同材料进行不同形式复合后的陶瓷人工骨,其性质与人骨相近,可取得较好的骨修复效果。结论:单一类型材料人工骨具有良好的生物相容性、生物活性及成骨能力,但存在机械强度低、脆性大、韧性差等缺点,将不同性质的材料经过复合加工形成的复合材料人工骨,可以提高人工骨的生物学性能,便于临床骨缺损修复的应用。

AIM： To develop ideal artificial bone material to repair bone defect has become the research focus in medical and biomaterial fields. This study introduced several single and composite artificial bones to explore their biocompatibility and application characters in bone defect repair. METHODS： A computer-based online search of CNKI was undertaken for articles about the properties, biocompatibility and application of artificial bone in defect repair published in Chinese from January 1999 to June 2007 with the keywords of ＂nanometer hydroxyapatite ceramic bone, coral hydroxyapatite bone, calcium phosphate bone, ceramic bone, composite, biocompatibility, bone defect＂ in Chinese. Articles about （1）the application of artificial bone made of single and composite material in bone defect repair, and （2）the development, properties, safety and biocompatibility of artificial bone made of different materials were selected. Repetitive studies were excluded. Finally 27 articles accorded with the inclusive criteria were selected. RESULTS： （1）Artificial bone of nanometer hydroxyapatite ceramic has good osteogenesis and biocompatibility. Because single material could not meet the requirement for bone defect repair and extracellular matrix material in bone tissue engineering, the composite nanometer hydroxyapatite ceramic bone with several single materials achieves better effect in application, （2）As a bone substitute, coral hydroxyapatite bone is fragile with low mechanical strength. But its osteogenesis could be improved by changing the physiochemical condition and properties, and the inflammatory reaction and rejection could be reduced, with no toxic or adverse effect. （3）Calcium phosphate bone has good biocompatibility and biodegradation. Compared with simple rhBMP-2/calcium phosphate bone, rhBMP-2/PLGA microsphere/calcium phosphate bone shows higher degradability and osteogenesis, and can serve as the ideal vector of cytokine and antibiotic. （4）Ceramic bone possesses bioactive and osteoconductive properties. But the osteogenesis is not satisfactory with low density and poor tenacity. The ceramic artificial bone becomes similar to natural bone, and can better repair bone defect after processing with different materials. CONCLUSION： Although single material artificial bone has biocompatibility, bioactivity and good osteogenesis and osteoconduction, it is of low mechanical strength, great fragility and poor tenacity. The composite bone could improve the biological performance of artificial bone and better the application in clinic for bone defect repair.