神经支配与种植体骨结合和骨感知的相关性

Correlation of innervation to osseointegration and osseoperception of implants

背景:完善的神经支配在骨形成过程中起决定性的作用。神经损伤后可能影响正常的骨代谢,而骨的再生在一定程度上依赖其支配区域神经的再生。通过改良种植体表面结构或局部使用生长因子等可促进骨结合。目的:对神经系统支配骨代谢、失神经支配对骨骼重建的影响以及种植体植入后骨结合过程中神经支配的建立、骨感知等方面的研究进行回顾分析。方法:由第一作者检索1990/2008PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关神经系统支配骨代谢、失神经支配对骨骼重建的影响以及种植体植入后骨结合过程中神经支配的建立、骨感知等方面的文献,英文检索词为"bonemetabolism,innervation,osseointegrationosseoperception",中文检索词为"骨代谢,神经支配,骨结合,骨感知"。排除重复性研究。计算机初检得到54篇文献,根据纳入标准保留28篇进一步归纳总结。结果与结论:神经系统发出的信号对破骨细胞和成骨细胞功能施加强有力的作用。骨膜表面普遍存在神经支配,其功能紊乱将影响骨骼的重建。骨骼中可检测出多种神经肽、神经激素、神经递质及其相关受体,揭示神经系统参与了骨的代谢和再生。种植体周围软硬组织神经支配的建立可能与骨结合、骨感知的形成密切相关。未来的研究需要进一步探索骨感知形成的解剖和神经生理病理学基础。

BACKGROUND： Consummate innervation plays an important role in bone formation. Nerve injury can impact normal bone metabolism, whereas bone regeneration depends on nerve regeneration in the innervation site to some degrees. Modified implant surface structure or usage of growth factors in local region can promote osseointegration. OBJECTIVE： To retrospectively analyze effects of nervous system dominance bone metabolism and denervation on bone remodeling, innervated establishment and osseoperception during osseointegration following implantation. METHODS： The first author retrieved Pubmed database （http：//www.ncbi.nlm.nih.gov/PubMed） and Wanfang database （http：//www.wanfangdata.com.cn） （1990/2008） for publications of effects of nervous system dominance bone metabolism and denervation on bone remodeling, innervated establishment and osseoperception during osseointegration following implantation, with the key words of ＂bone metabolism,innervation,osseointegration osseoperception＂. Articles of repetitive contents were excluded. A total of 54 literatures were primarily obtained. According to inclusion criteria, 28 literatures were selected for summary. RESULTS AND CONCLUSION： Signals derived from the nervous system exert potent effects on osteoclast and osteoblast function. A ubiquitous innervation of all periosteal surfaces exists and its disruption affects bone remodeling. Several neuropeptides, neurohormones, nerotransmitters and their receptors are detectable in bone, and make it clear that nervous system is involved in bone metabolism and regeneration. Establishment of innervation of soft and hard tissue around implants may play an important role in osseointegration and osseoperception. Further studies will be required to explore the basic of anatomy, neurophysiology and neuropathology, which forms osseoperception.