结核性骨缺损重建材料应用现状
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摘要
背景:结核性骨缺损的成功修复对骨关节结核的外科治疗至关重要,现有结核性骨缺损修复材料种类繁多,但各有不足。目的:对结核性骨缺损修复材料的应用现状做一综述。方法:由第一作者检索2000至2018年PubMed数据库、中国知网、维普中国期刊网等收录的与结核性骨缺损修复相关的文献,优先选择近期发表或发表在权威杂志上的文章。英文检索词为"spinal tuberculosis;bone defect;biomaterials;scaffold",中文检索词为"骨关节结核;骨缺损;支架;植骨材料",初检得到91篇文章,根据纳入标准选择其中的48篇进行综述。结果与结论:结核性骨缺损的成功修复对骨关节结核的治疗至关重要,现有结核性骨缺损修复材料种类繁多,主要有自体骨和同种异体骨、人工合成骨材料、人工椎体、钛网、聚甲基丙烯酸甲酯骨水泥、抗结核活性植入材料等,但上述材料都存在各自不足:譬如自体骨和同种异体骨来源有限,人工合成骨的使用还缺乏长期随访资料,人工椎体和钛网尚缺乏在局部结核病灶运用的权威安全性评估,聚甲基丙烯酸甲酯不具备生物活性,具有缓释功能的新型抗结核活性材料降解时间与骨诱导时间未能完全匹配且相关材料机械性能亦有待提高等,尚无法完全适应临床使用需要,用于结核性骨缺损的新型修复材料尚待进一步研究和开发。
BACKGROUND: Successful repair of tuberculous bone defects is very important in the surgical treatment of osteoarticular tuberculosis. There are many kinds of repair materials for tuberculous bone defects available in surgery; however, none of them meet the needs of clinical practice nowadays.OBJECTIVE: To review the application of repair materials for tuberculous bone defects. METHODS: The first author searched the articles related to tuberculous bone defect repair in PubMed, CNKI, WanFang, CQVIP databases published from 2000 to 2018. The priority was the articles published recently or in authoritative journals. The search keywords were "spinal tuberculosis; bone defect; biomaterials; scaffold; bone grafting material" in Chinese and English. Ninety-one articles were initially searched, and 48 of them were finally selected for review. RESULTS AND CONCLUSION: Successful repair of tuberculous bone defect is absolutely vital to the surgical treatment of osteoarticular tuberculosis. There are many kinds of repair materials for tuberculous bone defects available in surgery, including autologous bone and allogeneic bone, artificial bone material, artificial vertebral body, titanium mesh, polymethyl methacrylate bone cement, and anti-tuberculosis active implant materials. However, none of them allow for complete bone reconstruction. For example, the source of autologous bone and allogeneic bone is limited; the use of artificial bone materials lacks long-term follow-up data; artificial vertebral bodies and titanium mesh have not been confirmed by the authoritative safety assessment for use in the treatment of local tuberculosis; polymethyl methacrylate does not have bioactivity; and new anti-tuberculosis active materials with sustained release function have no full match between bone induction time and degradation time, and moreover, the mechanical properties of related materials need to be improved and are still unable to fully meet the needs of clinical use. Further research on a new repair material for tuberculous bone defects is warranted.
BACKGROUND: Successful repair of tuberculous bone defects is very important in the surgical treatment of osteoarticular tuberculosis. There are many kinds of repair materials for tuberculous bone defects available in surgery; however, none of them meet the needs of clinical practice nowadays.OBJECTIVE: To review the application of repair materials for tuberculous bone defects. METHODS: The first author searched the articles related to tuberculous bone defect repair in PubMed, CNKI, WanFang, CQVIP databases published from 2000 to 2018. The priority was the articles published recently or in authoritative journals. The search keywords were "spinal tuberculosis; bone defect; biomaterials; scaffold; bone grafting material" in Chinese and English. Ninety-one articles were initially searched, and 48 of them were finally selected for review. RESULTS AND CONCLUSION: Successful repair of tuberculous bone defect is absolutely vital to the surgical treatment of osteoarticular tuberculosis. There are many kinds of repair materials for tuberculous bone defects available in surgery, including autologous bone and allogeneic bone, artificial bone material, artificial vertebral body, titanium mesh, polymethyl methacrylate bone cement, and anti-tuberculosis active implant materials. However, none of them allow for complete bone reconstruction. For example, the source of autologous bone and allogeneic bone is limited; the use of artificial bone materials lacks long-term follow-up data; artificial vertebral bodies and titanium mesh have not been confirmed by the authoritative safety assessment for use in the treatment of local tuberculosis; polymethyl methacrylate does not have bioactivity; and new anti-tuberculosis active materials with sustained release function have no full match between bone induction time and degradation time, and moreover, the mechanical properties of related materials need to be improved and are still unable to fully meet the needs of clinical use. Further research on a new repair material for tuberculous bone defects is warranted.
引文
[1]Hogan JI,Hurtado RM,Nelson SB.Mycobacterial Musculoskeletal Infections.Infect Dis Clin North Am.2017;31(2):369-382.
[2]Dunn RN,Ben Husien M.Spinal tuberculosis.Bone Joint J.2018;100-B(4):425-431.
[3]Jain AK,Dhammi IK.Tuberculosis of the spine:a review.Clin Orthop Relat Res.2007;460:39-49.
[4]周朝玺,崔旭.脊柱结核的诊疗进展[J].中国骨与关节损伤杂志,2017,32(9):1006-1008.
[5]施建党,杨宗强.局部药物缓释材料在脊柱结核骨缺损修复中的应用[J].中国组织工程研究,2015,19(53):8643-8643.
[6]Shi J,Wang Z,Wang P,et al.Application and comparison of allograft and autograft bone for interbody fusion in cervical tuberculosis.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2011;25(11):1290-1293.
[7]董健,李熙雷,万涛林,等.Osteoset人工骨修复四肢骨缺损及脊柱融合中的应用[J].中华外科杂志,2005,10(20):1334-1335.
[8]张闻力,刘浩,李坛珠,等.医用硫酸钙人工骨在脊柱结核黏中的应用[J].中国矫形外科杂志,2007,15(9):652-655.
[9]Navarro M,Michiardi A,Casta?o O,et al.Biomaterials in orthopaedics.J R Soc Interface.2008;5(27):1137-1158.
[10]Hasegawa S,Neo M,Tamura J,et al.In vivo evaluation of a porous hydroxyapatite/poly-DL-lactide composite for bone tissue engineering.J Biomed Mater Res A.2007;81(4):930-938.
[11]Ronca A,Ambrosio L,Grijpma DW.Design of porous three-dimensional PDLLA/nano-hap composite scaffolds using stereolithography.J Appl Biomater Funct Mater.2012;10(3):249-258.
[12]Chen QZ,Boccaccini AR.Poly(D,L-lactic acid)coated 45S5Bioglass?‐based scaffolds:Processing and characterization.JBiomed Mater Res A.2006;77(3):445-457.
[13]Jensen T,Jakobsen T,Baas J,et al.Hydroxyapatite nanoparticles in poly-D,L-lactic acid coatings on porous titanium implants conducts bone formation.J Biomed Mater Res A.2010;95(3):665-672.
[14]董军峰.载利福平多孔复合物作为结核性骨缺损修复材料的研究[D].武汉:华中科技大学,2014.
[15]Farage L,Martins JW,Farage Filho M.Anterior instrumentation of spine in tuberculous spondylitis:Pott's disease:case report.Arq Neuropsiquiatr.2002;60(1):142-144.
[16]王永清,夏仁云,卢世璧,等.可调式人工椎体的改进及其在胸腰椎脊柱结核中的应用[J].中华骨科杂志,2005,25(2):92-96.
[17]王群波.应用纳米轻基磷灰石/聚酞胺66复合人工椎体治疗脊椎结核[J].四川医学,2006,27(4):391-392.
[18]Sundararaj GD,Amritanand R,Venkatesh K,et al.The use of titanium mesh cages in the reconstruction of anterior column defects in active spinal infections:can we rest the crest?Asian Spine J.2011;5(3):155-161.
[19]Katsikogianni M,Missirlis YF.Concise review of mechanisms of bacterial adhesion to biomaterials and of techniques used in estimating bacteria-material interactions.Eur Cell Mater.2004;8:37-57.
[20]周劲松,陈建庭,金大地,等.结核分枝杆菌对材料粘附能力的体外实验研究[J].中国脊柱脊髓杂志,2003,13(11):670-673.
[21]Kanayama M,Cunningham BW,Haggerty CJ,et al.In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices.J Neuro surg.2000;93(2Suppl):259-265.
[22]王彪,郝定均,郭华,等.颈胸段脊柱结核的手术治疗策略[J].中国脊柱脊髓杂志,2017,27(2):97-103.
[23]崔新刚.可靠的骨性融合与脊柱结核修复[J].中国组织工程研究,2015,19(53):8653-8653.
[24]Dvorak MF,Kwon BK,Fisher CG,et al.Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection.Spine(Phila Pa1976).2003;28(9):902-908.
[25]Lu DC,Wang V,Chou D.The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis.Neurosurgery.2009;64(1):122-129 discussion129-130.
[26]Crocker M,James G,Ibrahim A,et al.Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction:indications and techniques based on eight cases.Br J Neurosurg.2008;22(2):235-240.
[27]Bhatia K,Frydenberg E,Steel TJ,et al.An anterior expandable titanium cage in Mycobacterium avium vertebral osteomyelitis.Clin Neuro Sci.2011;18(3):431-434.
[28]梁利川,赵晨,罗磊,等.术后复发性胸腰椎结核的病例特点及临床意义[J].实用骨科杂志,2018,24(7):581-588.
[29]周长民,赵勇,丁八一,等.骨水泥椎体成形术在胸椎结核治疗中的应用[J].山东医药,2010,50(10):24-25.
[30]Jun W,Yi-Jun K,Fei C,et al.Application of an antibiotic crescentshaped polymethylmethacrylate strut in thoracic vertebral tuberculosis.Turk Neurosurg.2013;23(1):107-112.
[31]刘尚礼,陈燕涛.人工关节置换术中不可忽视的原则问题--人工髋关节置换术中严重骨水泥反应综合征[J].中国医师进修杂志(外科版),2006,29(7):1-3.
[32]Wits?E,Persen L,Benum P,et al.Cortical allograft as a vehicle for antibiotic delivery.Acta Orthopaedica.2005;76(4):481-486.
[33]张泽华.同种异体骨复合纤维蛋白多聚体作为利福平缓释载体的实验研究[D].重庆:第三军医大学,2009.
[34]孙建英,王德平,姚爱华,等.利福平/磷酸八钙骨水泥载药体系的制备及体外释放特性[J].硅酸盐学报,2011,39(7):1184-1188.
[35]王德平,黄文旵,周萘,等.多孔微晶玻璃作为缓释药物载体的体外实验研究[J].中国修复重建外科杂志,2002,16(5):322-324.
[36]钱志松,黄山虎,刘志礼,等.乙胺丁醇-磷酸钙骨水泥复合体药物缓释的研究[J].江西医药,2009,44(7):657-659.
[37]徐华梓,应小樟,吴银生,等.利福平硫酸钙植入剂的活体内药代动力学研究[J].脊柱外科杂志,2007,5(5):290-292.
[38]吴银生,潘骏,应小樟,等.利福平硫酸钙植入剂修复动物骨缺损的体内实验研究[J].浙江创伤外科,2008,13(3):189-191.
[39]叶向阳,孙湘,贾会文,等.利福平/聚乳酸-聚羟基乙酸缓释微球的制备及特性[J].中国组织工程研究与临床康复,2011,15(51):9608-9612.
[40]叶向阳,甄平,李晓飞,等.新型抗结核多孔磷酸钙骨水泥缓释载体的制备与性能研究[J].中国矫形外科杂志,2010,18(23):1981-1986.
[41]伍卫刚,郑启新,郭晓东.利福平-异烟肼-控释型载药人工骨的实验研究[J].中国生物医学工程学报,2010,29(1):137-142.
[42]Zhu M,Wang H,Liu J,et al.A mesoporous silica nanoparticulate/β-TCP/BG composite drug delivery system for osteoarticular tuberculosis therapy.Biomaterials.2011;32(7):1986-1995.
[43]杨智贤,彭小忠,武振国,等.脊柱结核外科治疗骨缺损的修复[J].中国组织工程研究与临床康复,2011,15(30):5665-5668.
[44]Jain AK,Jaggi KR,Bhayana H,et al.Drug-resistant Spinal Tuberculosis.Indian J Orthop.2018,52(2):100-107.
[45]Dong J,Zhang S,Liu H,et al.Novel alternative therapy for spinal tuberculosis during surgery:reconstructing with anti-tuberculosis bioactivity implants.Expert Opin Drug Deliv.2014;11(3):299-305.
[46]Dong J,Zhang S,Ma J,et al.Preparation,characterization,and in vitro cytotoxicity evaluation of a novel anti-tuberculosis reconstruction implant.PLoS One.2014;9(4):e94937.
[47]袁凯,陈建庭.脊柱结核外科治疗植骨材料的临床运用与研究进展[J].中国矫形外科杂志,2012,20(21):1957-1959.
[48]桂钱欢,李波.载药抗结核人工骨的研究现状[J].广东医学,2016,37(24):3776-3778.
[2]Dunn RN,Ben Husien M.Spinal tuberculosis.Bone Joint J.2018;100-B(4):425-431.
[3]Jain AK,Dhammi IK.Tuberculosis of the spine:a review.Clin Orthop Relat Res.2007;460:39-49.
[4]周朝玺,崔旭.脊柱结核的诊疗进展[J].中国骨与关节损伤杂志,2017,32(9):1006-1008.
[5]施建党,杨宗强.局部药物缓释材料在脊柱结核骨缺损修复中的应用[J].中国组织工程研究,2015,19(53):8643-8643.
[6]Shi J,Wang Z,Wang P,et al.Application and comparison of allograft and autograft bone for interbody fusion in cervical tuberculosis.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2011;25(11):1290-1293.
[7]董健,李熙雷,万涛林,等.Osteoset人工骨修复四肢骨缺损及脊柱融合中的应用[J].中华外科杂志,2005,10(20):1334-1335.
[8]张闻力,刘浩,李坛珠,等.医用硫酸钙人工骨在脊柱结核黏中的应用[J].中国矫形外科杂志,2007,15(9):652-655.
[9]Navarro M,Michiardi A,Casta?o O,et al.Biomaterials in orthopaedics.J R Soc Interface.2008;5(27):1137-1158.
[10]Hasegawa S,Neo M,Tamura J,et al.In vivo evaluation of a porous hydroxyapatite/poly-DL-lactide composite for bone tissue engineering.J Biomed Mater Res A.2007;81(4):930-938.
[11]Ronca A,Ambrosio L,Grijpma DW.Design of porous three-dimensional PDLLA/nano-hap composite scaffolds using stereolithography.J Appl Biomater Funct Mater.2012;10(3):249-258.
[12]Chen QZ,Boccaccini AR.Poly(D,L-lactic acid)coated 45S5Bioglass?‐based scaffolds:Processing and characterization.JBiomed Mater Res A.2006;77(3):445-457.
[13]Jensen T,Jakobsen T,Baas J,et al.Hydroxyapatite nanoparticles in poly-D,L-lactic acid coatings on porous titanium implants conducts bone formation.J Biomed Mater Res A.2010;95(3):665-672.
[14]董军峰.载利福平多孔复合物作为结核性骨缺损修复材料的研究[D].武汉:华中科技大学,2014.
[15]Farage L,Martins JW,Farage Filho M.Anterior instrumentation of spine in tuberculous spondylitis:Pott's disease:case report.Arq Neuropsiquiatr.2002;60(1):142-144.
[16]王永清,夏仁云,卢世璧,等.可调式人工椎体的改进及其在胸腰椎脊柱结核中的应用[J].中华骨科杂志,2005,25(2):92-96.
[17]王群波.应用纳米轻基磷灰石/聚酞胺66复合人工椎体治疗脊椎结核[J].四川医学,2006,27(4):391-392.
[18]Sundararaj GD,Amritanand R,Venkatesh K,et al.The use of titanium mesh cages in the reconstruction of anterior column defects in active spinal infections:can we rest the crest?Asian Spine J.2011;5(3):155-161.
[19]Katsikogianni M,Missirlis YF.Concise review of mechanisms of bacterial adhesion to biomaterials and of techniques used in estimating bacteria-material interactions.Eur Cell Mater.2004;8:37-57.
[20]周劲松,陈建庭,金大地,等.结核分枝杆菌对材料粘附能力的体外实验研究[J].中国脊柱脊髓杂志,2003,13(11):670-673.
[21]Kanayama M,Cunningham BW,Haggerty CJ,et al.In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices.J Neuro surg.2000;93(2Suppl):259-265.
[22]王彪,郝定均,郭华,等.颈胸段脊柱结核的手术治疗策略[J].中国脊柱脊髓杂志,2017,27(2):97-103.
[23]崔新刚.可靠的骨性融合与脊柱结核修复[J].中国组织工程研究,2015,19(53):8653-8653.
[24]Dvorak MF,Kwon BK,Fisher CG,et al.Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection.Spine(Phila Pa1976).2003;28(9):902-908.
[25]Lu DC,Wang V,Chou D.The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis.Neurosurgery.2009;64(1):122-129 discussion129-130.
[26]Crocker M,James G,Ibrahim A,et al.Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction:indications and techniques based on eight cases.Br J Neurosurg.2008;22(2):235-240.
[27]Bhatia K,Frydenberg E,Steel TJ,et al.An anterior expandable titanium cage in Mycobacterium avium vertebral osteomyelitis.Clin Neuro Sci.2011;18(3):431-434.
[28]梁利川,赵晨,罗磊,等.术后复发性胸腰椎结核的病例特点及临床意义[J].实用骨科杂志,2018,24(7):581-588.
[29]周长民,赵勇,丁八一,等.骨水泥椎体成形术在胸椎结核治疗中的应用[J].山东医药,2010,50(10):24-25.
[30]Jun W,Yi-Jun K,Fei C,et al.Application of an antibiotic crescentshaped polymethylmethacrylate strut in thoracic vertebral tuberculosis.Turk Neurosurg.2013;23(1):107-112.
[31]刘尚礼,陈燕涛.人工关节置换术中不可忽视的原则问题--人工髋关节置换术中严重骨水泥反应综合征[J].中国医师进修杂志(外科版),2006,29(7):1-3.
[32]Wits?E,Persen L,Benum P,et al.Cortical allograft as a vehicle for antibiotic delivery.Acta Orthopaedica.2005;76(4):481-486.
[33]张泽华.同种异体骨复合纤维蛋白多聚体作为利福平缓释载体的实验研究[D].重庆:第三军医大学,2009.
[34]孙建英,王德平,姚爱华,等.利福平/磷酸八钙骨水泥载药体系的制备及体外释放特性[J].硅酸盐学报,2011,39(7):1184-1188.
[35]王德平,黄文旵,周萘,等.多孔微晶玻璃作为缓释药物载体的体外实验研究[J].中国修复重建外科杂志,2002,16(5):322-324.
[36]钱志松,黄山虎,刘志礼,等.乙胺丁醇-磷酸钙骨水泥复合体药物缓释的研究[J].江西医药,2009,44(7):657-659.
[37]徐华梓,应小樟,吴银生,等.利福平硫酸钙植入剂的活体内药代动力学研究[J].脊柱外科杂志,2007,5(5):290-292.
[38]吴银生,潘骏,应小樟,等.利福平硫酸钙植入剂修复动物骨缺损的体内实验研究[J].浙江创伤外科,2008,13(3):189-191.
[39]叶向阳,孙湘,贾会文,等.利福平/聚乳酸-聚羟基乙酸缓释微球的制备及特性[J].中国组织工程研究与临床康复,2011,15(51):9608-9612.
[40]叶向阳,甄平,李晓飞,等.新型抗结核多孔磷酸钙骨水泥缓释载体的制备与性能研究[J].中国矫形外科杂志,2010,18(23):1981-1986.
[41]伍卫刚,郑启新,郭晓东.利福平-异烟肼-控释型载药人工骨的实验研究[J].中国生物医学工程学报,2010,29(1):137-142.
[42]Zhu M,Wang H,Liu J,et al.A mesoporous silica nanoparticulate/β-TCP/BG composite drug delivery system for osteoarticular tuberculosis therapy.Biomaterials.2011;32(7):1986-1995.
[43]杨智贤,彭小忠,武振国,等.脊柱结核外科治疗骨缺损的修复[J].中国组织工程研究与临床康复,2011,15(30):5665-5668.
[44]Jain AK,Jaggi KR,Bhayana H,et al.Drug-resistant Spinal Tuberculosis.Indian J Orthop.2018,52(2):100-107.
[45]Dong J,Zhang S,Liu H,et al.Novel alternative therapy for spinal tuberculosis during surgery:reconstructing with anti-tuberculosis bioactivity implants.Expert Opin Drug Deliv.2014;11(3):299-305.
[46]Dong J,Zhang S,Ma J,et al.Preparation,characterization,and in vitro cytotoxicity evaluation of a novel anti-tuberculosis reconstruction implant.PLoS One.2014;9(4):e94937.
[47]袁凯,陈建庭.脊柱结核外科治疗植骨材料的临床运用与研究进展[J].中国矫形外科杂志,2012,20(21):1957-1959.
[48]桂钱欢,李波.载药抗结核人工骨的研究现状[J].广东医学,2016,37(24):3776-3778.