人工椎间盘及髓核假体的生物力学

背景：全椎间盘或髓核假体是否符合人的椎间盘的解剖特点、生物力学是目前关注的焦点。目的：综述目前存在的人工椎间盘及髓核假体的类型及其生物力学特征。方法：由第一作者用计算机检索万方数据库、中国期刊全文数据库和PubMed数据库,检索时间：1989/2011,检索词分别为“椎间盘、髓核、人工假体、生物力学”和“intervertebral diac,nucleus pulposus,artificial prosthesis,biomechanics”,语言分别设定为中文和英文。纳入与人工椎间盘及髓核假体的材料类型及其生物力学特性相关的研究,排除重复性研究。共检索到72篇文章,按纳入和排除标准对文献进行筛选,共纳入26篇文章进行分析。结果与结论：目前应用于人工椎间盘的材料有钴铬合金、钛合金、不锈钢、陶瓷和超高分子量聚乙烯等。应用不同材料制备的人工椎间盘假体校多,其中Bryan假体在临床中最常用,体外实验、三维有限元分析及临床研究均证实其具有良好的生物力学特性,置换成功率高。目前存在的人工髓核假体有预制型和原位聚合型,由于其手术损伤小,是目前研究的热点,但仍很难达到人体髓核的生物力学功能。发掘新型材料和设计个性化假体是将来的发展方向。 

Biomechanics of artificial intervertebral disk and nucleus prosthesis

BACKGROUND: Whether total intervertebral disk or nucleus prosthesis accorded with anatomical characteristics and biomechanics of human intervertebral disk was a focus of recent studies. OBJECTIVE: To summarize the types and biomechanical characteristics of artificial intervertebral disk and nucleus prosthesis. METHODS: The first author retrieved Wanfang Database, China National Knowledge Infrastructure and PubMed Database for literatures published from 1989 to 2011. The key words were “intervertebral diac, nucleus pulposus, artificial prosthesis, biomechanics”. Articles regarding types and biomechanical characteristics of artificial intervertebral disk and nucleus prosthesis were included, and repetitive studies were excluded. Totally 72 articles were retrieved. In accordance with inclusion and exclusion criteria, 26 articles were included. RESULTS AND CONCLUSION: At present, materials for artificial intervertebral disk included cobalt-chromium alloy, titanium alloy, stainless steel, ceramics and ultrahigh molecular weight polyethylene. Bryan prosthesis was widely used in clinic. In vitro study, three dimensional finite element analysis and clinical study have confirmed good biomechanical characteristics and high success replacement rate. Artificial nucleus pulposus prosthesis contained prefabricated type and in situ polymerization type. It could obtain small surgery injury, and was a focus of recent studies. However, it is difficult to reach biomechanical function of human nucleus pulposus. To discover novel materials and to design individual prosthesis are future development directions.