可吸收聚合物材料制作椎间融合器的临床应用

Clinical application of bioabsorbable polymer interbody fusion cage

背景:可吸收聚合物材料用于制作椎体间融合器目前是研究的热点,且存在争议。目的:综述可吸收聚合物材料椎间融合器的基础研究及临床应用进展。方法:以"椎间融合器,可吸收性,动物实验,临床研究;spine,bioabsorbable,intervertebral fusion"为关键词,应用计算机检索维普数据库、万方数据库和PubMed数据库1989年1月至2012年6月与可吸收聚合物材料椎间融合器相关的文献,总结可吸收聚合物材料椎间融合器基础研究和应用方面的最新进展。结果与结论:基础研究显示,可吸收聚合物材料椎间融合器可有效促进椎间融合,最主要的缺陷是植入体内产生的迟发型炎症反应和大块侵蚀作用,以及降解与融合速度,机械强度与孔隙率等方面尚待进一步研究。目前,聚乳酸及其衍生的混合共聚物正应用于临床且相关研究正逐步开展。该材料最主要的优势在于其应用于融合器时可针对不同需要灵活改变参数,但融合器周围组织良好的血运和成血管作用十分重要,而且支架孔隙率和其他关键参数可影响融合器的机械强度,要求其在能承受必要压力载荷的同时也可提供足够的空间,满足细胞迁移、血管生成,从而促进骨融合,因此寻找最优化的参数组合在骨组织工程研究领域仍是一项挑战。

BACKGROUND：Bioabsorbable polymer materials used in interbody fusion are currently a hot research, and there is stil no consensus. OBJECTIVE：To summarize the basic research and clinical application of bioabsorbable polymer interbody fusion cages. METHODS：A search of literatures in the database of Wanfang, VIP and PubMed databases from January 1989 to June 2012 was performed with the key words of“intervertebral fusion;bioabsorbable;spine;animal experiment;clinical research”in Chinese and English, respectively. Al the literatures concerning bioabsorbable polymer interbody fusion cage were extensively reviewed, and current developments in the basic research and the clinical application of bioabsorbable polymer interbody fusion cage were investigated. RESULTS AND CONCLUSION：Basic researches show that bioabsorbable polymer cage can effectively promote interbody fusion, the main defect is the delayed inflammatory response and bulk erosion, and the degradation and fusion speed, mechanical strength and porosity need further studies. At present, the hybrid copolymer of polylactic acid and its derivatives is used in clinic and relevant research is being carried out. The main advantage of the material is that it is of flexibility to change parameters when used in fusion for different needs, but a good blood supply to tissues around the fusion cage and the osteogenesis effect are very important. Scaffold porosity and other key parameters can affect the mechanical properties of fusion cage to provide sufficient space to meet the requirement of cellmigration, angiogenesis, thereby promoting bone fusion, under the necessary pressure load. So, to find the optimal combination of parameters in the field of bone tissue engineering is stil a challenge.