人工髓核假体的研究进展及其发展方向

Research process and development direction of artificial nucleus pulposus

背景:人工髓核置换是治疗腰椎间盘疾病以及重建椎间稳定和微动功能的最佳方法之一,理想的人工髓核材料的研究是当前研究的热点和难点。目的:简要回顾国内外治疗腰椎间盘突出症尝试的不同方法以及取得的成绩,重点分析人工髓核材料的发展历史及现状,并对预制型和原位聚合型两种人工髓核基本特性进行综述。方法:由第一作者检索1995/2010 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)、万方数据库(http://www.wanfangdata.com.cn)、书籍《腰椎间盘突出症》有关腰椎间盘退变治疗方法、髓核置换材料选择及置入方法等方面的文献。英文检索词为"nucleus replacement,biocompatibility,disc degenerative",中文检索词为"髓核置换,生物相容性,间盘退变"。检索文献量总计90篇,排除重复性研究,共保留其中的36篇归纳总结。结果与结论:目前髓核置换假体可以分为两种:预制型和原位聚合型。预制型假体与生理髓核组织的生物力学更相近,但是报道有不同并发症。原位聚合材料由不同的单体在置入后聚合、硬化形成弹性体,这就使手术创伤降到最小,减少内植物移位的风险,但是这些材料仍在初步评估节段。提示作为治疗腰椎间盘突出症的新方法之一,不同材料的人工髓核目前正处于不同研制阶段中,并且取得了一些有意义的早期研究成果,人工髓核置换作为常规手术的补充和改进,是一种具有潜力的治疗方式。

BACKGROUND： Artificial nucleus pulposus replacement is one of the best treatments for lumbar disc degeneration and reestablishing the interverteberal stability and function of sparing motion, an approved artificial material is the focus and difficult problem in current studies. OBJECTIVE： To review the methods and achievements in treating lumbar intervertebral disc protrusion, analyze the history and current situation of artificial nucleus pulposus, and to review the features of prefabricatel and in-situ polymerizated artificial nucleus pulposus. METHODS： PubMed （http：//www.ncbi.nlm.nihgov/PubMed）, Wangfang （http：//www.wanfangdata.com.cn） and Lumbar Intervertebral Disc Protrusion were searched by the first author using key words of ＂nucleus replacement, biocompatibility, disc degenerative＂ both in English and Chinese for documents of treating methods, material selection and implantation approaches in treating lumbar disc degeneration. Totally 90 manuscripts were searched, and 36 papers were included in this review. RESULTS AND CONCLUSION： Two kinds of prosthesis are used in artificial nucleus pulposus replacement, namely, prefabricatel and in-situ polymerizated. The former is more similar to normal nucleus pulposus in biomechanics; however, it is thought to be arouse various complications. In-situ polymerizated material is an elastic body that polymerize and stiffen after implantation with various monomers, which can maximum reduce the surgical trauma and decline the risk of graft dislocation. But it is still need assessment. It suggest that as one of the new alternative in treating lumber disc herniation, many kinds of materials are under investigation, and have gain some early achievement. Artificial nucleus replacement is a potential surgical technique as a recruitment and improvement of traditional surgery.