聚醚醚酮髋股骨头假体置换术后股骨近段的力学分析

[目的]探讨复合材料住全髋股骨头假体中的应用前景，旨在寻找能与股骨紧密结合、增加股骨近端应力传递的新型假体，期望进一步提高全髋关节置换术的远期疗效。[方法]5对人体新鲜尸体股骨平均分成左右2组，1组行钴铬钼合金（CoCrMo）股骨头假体置换术，另1组行碳纤维增强聚醚醚酮（CF／PEEK）假体置换术。在假体和近端股骨表面粘贴应变片，模拟单肢站立施加载荷。首先记录正常股骨产生的应变分布，然后行2种假体的股骨头置换术，再记录2组标本所产生的应变分布。[结果]股骨应变在假体植入后，从近端到远端逐渐增加，变化形式与完整股骨的应变形式相似，并且在假体远端最大。2种假体植入后，股骨内外侧表面的应变皆减少；但CF／PEEK假体组产生的应变形式和大小比CoCrMo合金假体组更接近正常股骨。[结论]CF／PEEK复合材料股骨头假体能提供术后即刻稳定性和良好的近端载荷传递，因此能进一步减少应力遮挡、骨吸收、骨萎缩，最终避免假体松动失败。     

Experimental study on interbody fusion with CFR/PEEK

Polyetheretherketone(PEEK)isanewsemi-crys-talthermal-contouredpolymer,whichhasidenticalphysical-chemistrycapability,electricalconductivitycapabilityandmechanicsstabilitywithinawiderangeoftemperature.Studyhaveshowedthatwhenpoly-etheretherketonecompositematerialswerereinforcedbycarbonfiber,theirmechanicalstrengthandelasticmoduluscouldkeepstableeitherinphysiologicalsalineofavarietyoftemperaturesorafterimplantedintheanimals'muscles[1].CFR/PEEKhadgoodbiocom-patibilityｉｎｖｉｔｒｏandinthequant…     

光固定明胶修饰的聚醚醚酮(PEEK)表面促进细胞增殖及成骨性研究

目的聚醚醚酮(PEEK)具有与骨骼相似的弹性模量,但PEEK作为骨修复材料的应用受到其表面生物惰性及缺乏促成骨性的限制。为了解决这个问题,我们通过表面修饰光固定明胶增强PEEK生物活性。方法我科研团队合成的光固定明胶可通过紫外照射粘附于多种材料表面,并可增强材料的生物相容性。进行SEM、静态水接触角、细胞增殖、细胞形态、碱性磷酸酶分化等表征学及细胞学系统研究。结果研究表明光固定明胶可固定于PEEK表面,改变了PEEK等高分子材料的表面性质。在细胞学研究中,光固定明胶改性后相对于普通PEEK,成骨细胞增殖、伸展、基质分泌及分化能力明显增强。结论通过光固定明胶对PEEK表面进行改性,可明显增强其生物活性,是一种有潜力的骨科内植入物及医疗器械材料。     

计算机辅助设计与制作一体化聚醚醚酮可摘局部义齿不同形态组件的适合性评价

目的: 评价用聚醚醚酮(polyetheretherketone,PEEK)制作可摘局部义齿不同形态组件的适合性。方法: 选取已进行基牙预备的下颌牙列缺损超硬石膏标准模型进行三维扫描,获得牙列缺损数字模型,联合牙科计算机辅助设计软件与逆向工程软件分别设计13个完整的可摘局部义齿,用计算机辅助制作技术制作PEEK一体化可摘局部义齿,在超硬石膏模型上试戴。用硅橡胶印模材复制义齿各组件与模型之间的间隙,采用三维偏差分析法测量牙合支托、基托和大连接体处的间隙大小,通过单因素方差分析、配对t检验分别比较各组件之间以及各组件内部的间隙差异是否有统计学意义。结果: PEEK一体化可摘局部义齿在超硬石膏模型上就位良好。单因素方差分析表明牙合支托、基托和大连接体处间隙的差异有统计学意义(P<0.01)。牙合支托处平均间隙[(84.3±23.6) μm]大于基托[(32.5±27.8) μm]和大连接体处[(49.9±47.0) μm] (P<0.01),但均满足临床需求;基托与大连接体处间隙差异无统计学意义(P>0.05)。游离端与非游离端基托处平均间隙为(25.1±55.3) μm和(41.5±17.7) μm,两者差异无统计学意义(P>0.05)。远离缺牙间隙牙合支托与靠近缺牙间隙牙合支托的平均间隙为(80.8±42.1) μm和(86.1±29.8) μm,两者差异无统计学意义(P>0.05)。结论: 数字化设计的全组件可摘局部义齿可用PEEK切削为一体化可摘局部义齿,该义齿不同形态组件均有良好的适合性,有良好的应用前景。     

聚醚醚酮-羟基磷灰石-碳纤维复合材料的体外细胞相容性研究

将大鼠成骨细胞与聚醚醚酮-羟基磷灰石-碳纤维(PEEK-HA-CF)复合材料间接和直接培养,通过CCK-8对复合材料的细胞毒性进行评价;流式细胞仪测定材料对细胞增殖指数的影响;测定复合培养后成骨细胞的碱性磷酸酶活性变化;应用扫描电镜(SEM)观察成骨细胞形态学变化。结果表明PEEK-HA-CF复合材料无细胞毒性,复合材料组胞增殖指数与空白对照组比无差异,3d时高于钛合金组。第7d时,PEEK-HA-CF组的碱性磷酸酶活性升高。SEM下,细胞在复合材料上生长良好。PEEK-HA-CF复合材料具有良好的细胞相容性,有希望成为一种新的骨科植入材料。     

MRI and dental implantology: Two which do not exclude each other

Currently, histological techniques are used to analyse implant-tissue-interactions. However, these methods are destructive and time-consuming. Furthermore, they require a large number of animals as longitudinal observations in one individual are not possible. The evaluation by non-destructive imaging techniques provides the opportunity to study the osseous integration with a reduced number of animals and a decreased biological variability.The present study examined the suitability of magnetic resonance imaging (MRI) to assess peri-implant bone formation exemplarily for a dental implant in a minipig model. Due to its compatibility to MR imaging polyetheretherketone (PEEK) coated with a thin layer of titanium was applied as implant material. Osseointegration was analysed within different peri-implant regions quantifying bone volume density and soft tissue content, which were assessed by MRI and histology, likewise.It could be proven that the examined regions showed differences in bone formation; the region adjacent to the implant apex turned out to be the most dynamic. Both methods led to comparable results with no significant differences regarding to the assessed parameters.Moreover, it was demonstrated that titanium coated PEEK showed a sufficient osseointegration and MRI provides a promising application in monitoring bone formation.     

聚醚醚酮表面多孔羟基化改性对MC3T3-E1细胞黏附、增殖的影响

目的对聚醚醚酮(polyetheretherketone,PEEK)薄片表面进行多孔化和羟基化改性,观察PEEK表面形貌和生物活性的变化,并探讨该改性方法对前成骨MC3T3-E1细胞黏附、增殖的影响。方法超声波环境下浓硫酸处理PEEK表面,在其表面形成大量微孔结构;经湿化学法将PEEK表面的酮类基团还原成羟基基团,改善其表面化学活性,提升PEEK薄片的生物相容性。利用扫描电子显微镜(SEM)、傅里叶变换红外光谱仪(FTIR)及静态水接触角检测改性前后材料表面形貌、化学基团及亲水性的变化。未处理PEEK、多孔化PEEK、羟基化PEEK、多孔羟基化PEEK与MC3T3-E1细胞共培养,评价表面改性后PEEK薄片对细胞黏附、增殖的影响。结果 SEM结果显示浓硫酸处理后的PEEK薄片表面形成密集的空隙大小均匀的微孔结构,FT-IR结果证实羟基化改性成功地在PEEK表面还原出了大量羟基基团。同时,表面多孔化和羟基化改性均可有效提升PEEK材料表面的亲水性能。在体外细胞实验中,不同改性的PEEK材料与MC3T3-E1细胞共培养后结果显示,多孔化、羟基化和多孔羟基化改性均可显著促进细胞黏附和伸展,同时随着时间的延长,其促进细胞增殖的功能也逐步增强。结论表面多孔羟基化改性能有效提高PEEK材料表面的生物学活性和亲水性能,进而显著促进细胞的黏附和增殖。     

Cage containing a biphasic calcium phosphate ceramic (Triosite) for the treatment of cervical spondylosis

BACKGROUND: We evaluated the fusion efficacy and clinical outcomes of a cage containing a biphasic calcium phosphate ceramic (Triosite) in treating cervical spondylosis. METHODS: We randomly divided 100 patients with cervical spondylosis undergoing anterior discectomy with interbody polyetheretherketone (PEEK) fusion into 2 groups in the past 2 years: group A (n = 50), PEEK cage containing a biphasic calcium phosphate ceramic (Triosite), and group B (n = 50), PEEK cage containing an autogenous iliac bone graft. We compared the fusion rate, fusion time, spinal curvature, and neuroforamen size between the 2 groups. We also compared excess operation time, excess blood loss, hospital stay, complications, and neurological recovery status between the groups. RESULTS: The fusion rates were 57%, 67%, 77%, 82%, 92%, and 100% in group A and 81%, 86%, 95%, 95% 100%, and 100% in group B in the first 6 postoperative months. The fusion rate in group A was significantly lower than that in group B in the first 5 months after the procedure (P < .05 and P < .01, respectively), but the fusion rate reached 100% in both groups by the sixth month. Within the first 6 months, as the fusion level increased, the fusion rates reduced and time to fusion was delayed in both groups. There were no donor site complications in group A. However, 3 patients (6%) from group B experienced complications (1, wound infection; 1, numbness of thigh; and 1, subcutaneous hematoma) (P < .001). The hospital stay was shorter in group A (4.43 +/- 2.36 days) than in group B (7.00 +/- 3.77 days) (P = .001). The mean excessive blood loss and excessive operative time for an iliac bone graft in group B were 15 +/- 5 mL and 10 +/- 6 minutes. There was no statistical significance in spinal curve correction, neuroforamen enlargement, and neurological recovery. CONCLUSIONS: A cage containing a biphasic calcium phosphate ceramic resulted in complete fusion by the sixth postoperative month, although the fusion rate was lower than that in a cage containing an autograft during the first 5 months after the operation and the time to fusion was delayed. Using a cage containing a biphasic calcium phosphate ceramic leads to a shorter hospital stay, less blood loss, shorter operative time, and no donor site complications. It seemed to be a good substitute for cervical spondylotic fusion.     

聚醚醚酮棒半刚性椎弓根钉内固定在腰椎非融合术中的应用

目的:探讨聚醚醚酮（polyetheretherketone,PEEK）棒半刚性椎弓根钉内固定系统在腰椎非融合手术中的疗效。方法:将2017年3月至2019年12月接受手术治疗的双节段腰椎退行性疾病74例患者按手术方式分为PEEK棒组和钛棒组。其中PEEK棒组34例,男13例,女21例,年龄51～79（62.4±6.8）岁;L₁-L₃节段1例,L₂-L₄节段7例,L₃-L₅节段20例,L₄-S₁节段6例。钛棒组40例,男17例,女23例,年龄52～81（65.2±7.3）岁;L₁-L₃节段3例,L₂-L₄节段11例,L₃-L₅节段19例,L₄-S₁节段7例。分别记录两组手术时间、术中出血量、术后引流量;比较两组术前及术后3、12个月及末次随访时视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（Oswestry disability index,0-DI）;通过腰椎过伸过屈X线观察椎间活动度（range of motion,ROM）变化情况。结果:所有患者顺利完成手术,随访时间22～34（26.8±5.6）个月。PEEK棒组手术时间（142.2±44.7） min和术中出血量（166.5±67.4） ml,低于钛棒组的（160.7±57.3） min和（212.8±85.4） ml（P<0.05）,两组术后引流量差异无统计学意义（P>0.05）。末次随访时,PEEK棒组和钛棒组患者腰痛VAS[（0.8±0.4）分vs （1.0±0.5）分]、腿痛VAS[（0.7±0.4）分vs （0.8±0.5）分]和ODI[（9.8±1.6）%vs （12.1±1.5）%],与术前[（5.8±1.1）分vs （6.0±1.1）分]、[（7.2±1.7）分vs （7.0±1.6）分]、[（68.5±8.9）%vs（66.3±8.2）%]比较,差异有统计学意义（P<0.05）,两组术后各时间点VAS评分比较差异无统计学意义（P>0.05）。术后3个月,两组ODI比较差异无统计学意义（P>0.05）;PEEK棒组和钛棒组术后12个月ODI[（15.5±2.1）%vs（18.4±2.4）%]及末次随访[（9.8±1.6）%vs（12.1±1.5）%]比较,差异有统计学意义（P<0.05）。两组腰椎整体活动度术后均有下降,术后12个月及末次随访时PEEK棒组腰椎整体活动度与同时期钛棒组相比,差异有统计学意义（P<0.05）。两组术后固定节段活动度均有下降,PEEK棒组固定节段活动度由术前（9.5±4.6）°降至末次随访时的（4.1±1.9）°,钛棒组固定节段活动度由术前（9.8±4.3）°降至末次随访时的（0.9±0.5）°,差异均有统计学意义（P<0.05）。两组术后上位椎间活动度均有增加,术后12个月及末次随访时,两组上位椎间活动度比较,差异无统计学意义（P>0.05）。随访周期内两组均无螺钉松动断裂。结论:PEEK棒半刚性椎弓根钉内固定用于腰椎非融合手术,可保留固定节段部分活动度,近期临床疗效不劣于同期钛棒融合,是治疗腰椎退行性疾病的可行选择,长期疗效有待进一步随访观察。