椎间置入充满碎骨的聚乳酸-聚羟基乙酸腰椎间融合器与自体骨:影响脊柱节段稳定性吗?  

Polylactic acid-polyglycolic acid lumbar interbody fusion cage full of broken bones versusautologous bone: an influence on the spinal stability?

作　　者：宋宏阁 李学涛 郝光辉[1] 张勤安[1] 韩冰[1] 陈莉[1] 海玉杰 刘华丰[1] 陈彦超[1] 王佳爽[1] 

机构地区：[1]郑州市第六人民医院骨科,河南省郑州市450000 [2]郑州市第十六人民医院骨科,河南省郑州市450000

出　　处：《中国组织工程研究》2017年第22期3445-3451,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着生物降解材料在医学领域的广泛应用以及对生物力学研究的深入,传统的医学金属材料弊端日益显现。近年来,国内外研究员把焦点集中到以高分子聚乳酸为代表的可降解材料上,旨在脊柱失稳领域寻求新的突破。目的:观察聚乳酸-聚羟基乙酸腰椎间融合器在体内的生物力学变化,探讨其治疗脊柱节段失稳的可行性。方法:将42只9月龄猪随机分为2组(n=21),均摘除L4/5椎间盘髓核,实验组在椎间置入充满碎骨的聚乳酸-聚羟基乙酸腰椎间融合器,对照组植入自体骨。术后4,12,72周拍摄X射线片观察手术节段的融合情况,通过脊柱三维运动实验检测融合节段的稳定性,组织学观察植骨融合及材料降解情况。结果与结论:(1)影像学检查结果:术后4周,两组动物植骨区均未见融合迹象。术后12周,实验组可见融合器有增大迹象;对照组可见部分骨桥,其中有1例融合。术后72周,实验组可见融合器降解,有1例融合,对照组有2例融合;(2)生物力学测试结果:术后4周两组在各个状态下的脊柱活动度差异无显著性意义(P>0.05);术后72周大部分状态脊柱活动度较4周时显著减小;(3)组织学观察结果:随着时间的推移,实验组材料逐渐降解,新生骨组织生长先快后慢,实现逐步融合,融合效果与对照组相似;(4)结果表明,聚乳酸-聚羟基乙酸腰椎间融合器具有良好的生物相容性,除个别状态(左屈)外其力学性能与自体骨相当,最大程度地重建了猪脊柱节段稳定性。BACKGROUND： Along with the widespread application of biodegradable materials in the field of medicine and the in-depth research of biomechanics, the drawbacks of traditional medical metal materials are increasingly appearing. In recent years, researchers at home and abroad focus on biodegradable materials that are represented by high molecular polymer to seek new breakthroughs in the field of spinal instability. OBJECTIVE： To investigate biomechanical changes of polylactic acid-polyglycolic acid （PLGA） lumbar interbody fusion cage in the body and discusses its feasibility for treating segmental instability of the spine. METHODS： Forty-two healthy pigs （9 months old） were randomly divided into two groups （n=21）, and L4/5 intervertebral disc nucleus pulposus was removed in all animals. In experimental group, PLGA lumbar interbody fusion cage filled with broken bone was implanted; and in control group, autologous bone was implanted. X-ray was performed to observe the fusion of operation segments at 4, 12 and 72 weeks postoperatively. Feasibility of fibrous fusion was measured by biomechanical test. Histologically, bone graft fusion at the surgical site and material degradation were detected. RESULTS AND CONCLUSION： （1） Imaging examination： Bone graft fusion in two groups was not visible at 4 weeks after operation. Evidence of increasing fusion was found in the experimental group at 12 weeks after operation; a visible part of the bone bridge was found in the control group, in which there was one case of fusion. Degradation of the fusion cage with one case of fusion in experimental group was found after 72 weeks after operation, and two cases of fusion in the control group. （2） Biomechanical test： There was no difference in the spinal range of motion between the two groups in different states at 4 weeks after operation （P 〉 0.05）. The spinal range values of motion at most of the states at 72 weeks after operation were significantly lower than those at 4 weeks after operation. �

关 键 词：生物材料 骨生物材料 聚乳酸聚酯 腰椎间融合器 脊柱节段失稳 

分 类 号：R318[医药卫生—生物医学工程]