盆底修复材料生物力学特征比较

The preliminary study on biomechanical properties of four synthetic implants for reconstructive surgery of pelvic floor dysfunction

为探讨盆底修复材料的生物力学特征,本试验选取用于女性盆底重建手术的4种盆底修复材料,分别是全盆底修复系统(PROLIFT)、经闭孔无张力阴道悬吊系统(TVT-O)、经阴道悬吊置入系统(IVS)和脱细胞异体真皮基质医用组织补片(Renov)。将4种盆底修复材料分别在Instron4302万能材料试验机上进行拉伸力学试验,记录极限应力强度、弹性模量、最大负荷和最大伸长量。结果显示:4种盆底修复材料的最大负荷依次为TVT-O>IVS>PROLIFT>Renov,TVT-O最大负荷显著高于PROLIFT和Renov(P<0.05);极限应力强度依次为TVT-O>IVS>PROLIFT>Renov,但4种材料组间比较差异无统计学意义(P>0.05);最大伸长量依次为TVT-O>PROLIFT>IVS>Renov,TVT-O和PROLIFT的最大伸长量均显著高于Renov(P<0.05);弹性模量依次为IVS>Renov>TVT-O>PROLIFT,但4种材料组间比较差异无统计学意义(P>0.05)。可见,4种盆底修复材料中,IVS的弹性模量最高;TVT-O的力学强度最高;Renov的最大负荷、极限应力强度以及最大伸长量均最低;PROLIFT材料的力学性能最稳定,弹性模量最低,具有良好的延展性和弹性。因此,综合临床盆底重建手术的实际需要,在开发新型盆底修复材料时应注重其生物力学性能的考量。

This study aimed to investigate biomechanical properties of synthetic implants for reconstructive surgery of pelvic floor dysfunction. In this dissertation, we chose four synthetic implants, i.e. total pelvic floor repair system （PROLIFT）, gynecone TVT obtutator system （TVT-O）, intra-vaginal sling placement device （IVS） and acellular dermal matrix （Renov）, for tensile test respectively. The biomechanical properties of four synthetic implants were measured and analyzed using a material testing machine （Instron 4302 versatile material testing machine）. The biomechanical parameters included ultimate stress strength, modulus of elasticity, maximum load and maximum elongation. The results showed that the maximum load of the four symthetic implants was TVT-O 〉 IVS 〉 PROLIFT 〉 Renov, and the maximum load of TVT-O was significantly higher than PROLIFT and Renov （P 〈 0.05）. The ultimate stress strength was TVT-O 〉 IVS 〉 PROLIFT 〉 Renov, with no significant differences among them （P 〉 0.05）. The maximum elongation of the four implants was TVT-O 〉 PROLIFT 〉 IVS 〉 Renov, and the maximum elongation of TVT- O and PROLIFT were both significantly higher than Renov （P 〈 0.05）. The modulus of elasticity was IVS 〉 Renov 〉 TVT- O 〉 PROLIFT, with no significant differences among them （P 〉 0.05）. Taken together, the present study demonstrates that the modulus of elasticity of IVS was the highest in the four synthetic implants; TVT-O had the highest mechanical strength; The maximum load, ultimate stress strength and maximum elongation of Renov were all the lowest; The mechanical properties of PROLIFT was the most stable, and its modulus of elasticity was the lowest in the four syntheticimplants, which had good extensibility and elasticity. Therefore, it is necessary to pay attention to the biomechanical properties of new pelvic reconstructive materials for the clinical pelvic reconstructive surgery.