人工腰椎间盘假体设计原理与研究进展

Design principle and research development of artificial lumbar disc prosthesis

背景:人工腰椎间盘置换作为治疗腰椎间盘退行性疾病的新选择,由于在消除患者疼痛的同时保留了腰椎原有的生物力学状态,得到了临床的广泛关注,对于假体结构和材料设计尚需进一步研究和验证。目的:对现有人工腰椎间盘假体结构和材料的设计情况进行了综述,并对未来的优化设计趋势进行了展望,可为今后开发以及评估新的人工腰椎间盘假体提供指导。方法:计算机检索PubMed、CNKI、中国生物医学文献数据库,纳入包含人工腰椎间盘的结构设计、材料设计以及体内、体外生物力学评价的文章,排除观点重复和陈旧的文章,最后对46篇文献进行归纳与讨论。结果与结论:人工腰椎间盘已经历了近30年的发展,对于假体的结构和生物材料的设计也经历了不断的发展与改进,文章对现有人工腰椎间盘假体的运动保留设计、运动限制设计、即刻固定设计、基体材料、负重面材料、涂层材料的研究现状进行了归纳总结,并结合现有的体内、外生物力学实验结果对各种设计进行评价。最后结合最新的研究趋势,对腰椎间盘假体未来在结构仿生设计、材料改进、假体和辅助植入器械的优化设计等发展方向进行了展望。

BACKGROUND：Artificial Lumbar disc replacement as a new choice for the treatment of degenerative disc disease has aroused widespread concern by clinicians because of the preservation of lumbar vertebra’s biomechanical characteristics during pain eliminating. While the design of the prosthesis structure and material needs further study and validation. OBJECTIVE：To review the structure and material types of several newly designed artificial lumbar discs, then to discuss the trends in the optimization design of prosthesis, in order to provide instruction for the design and assessment of new lumbar artificial disc prosthesis. METHODS：The PubMed database, CNKI database and SinoMed database were searched for related articles. New articles related to artificial lumbar disc structure, material, in vivo and in vitro biomechanics were included. Repetitive studies and stale perspectives were excluded. A total of 46 articles were summarized and discussed in the end. RESULTS AND CONCLUSION：Artificial lumbar disc has developed for nearly 30 years, the design of structure and biological material has been in continuous improvement. At first, we summarized the principle and current situation in the design of movement reservation, movement constraint, instant fixation, base material, weight-bearing material and coating material of artificial lumbar disc prosthesis, then combined with the exist newly in vivo and in vitro biomechanical results to evaluate different kinds of design with the recent research trend to prospect the development of biomimetic design, material improvement, the optimization design of prosthesis and assisted devices.