骨修复替代材料修复骨缺损的选择与应用

背景：在骨缺损治疗方面,近几年集中在骨修复替代材料领域出现了一系列重大科研突破,催生了很多全新的骨修复替代材料。目前临床上可供选择的骨修复替代材料种类繁多,各种材料的特性不同,各有优势和缺点。如何正确选择与应用是创伤骨科医师面临的实际问题,值得讨论和推敲。目的：通过对自体骨、同种异体骨和人工骨材料在应用中的相关文献分析,评价3种骨修复替代材料的生物性能,有利于骨科医师更好的理解几种骨修复替代材料的理化、生物性能,进一步提高诊断和治疗水平。方法：人工骨材料在骨缺损修复中起到不可取代的作用,并且也获得良好的临床效果,但近期临床效果并非是与传统材料的最终比较结果。人工骨材料安全性和稳定性的验证尚缺乏足够的实验依据,确切疗效尚须长期的临床观察。寻找具有良好生物特性的人工骨材料抑制是骨科的研究热点。分别对自体骨、同种异体骨、人工骨材料3种骨修复替代材料治疗骨缺损的理化、生物性能,安全性综合比较进行实验数据分析。结果与结论：①在骨缺损修复过程中,从修复质量、免疫排斥和疾病传播等多方面来衡量,自体骨都是最佳的选择,成为骨移植的金标准。但来源有限且取骨区可能产生并发症,取骨又造成第二术区的创伤,因而它的临床应用受到了很大的限制。②同种异体骨的来源比自体骨多,但与宿主间的免疫排斥反应,并有感染疾病如肝炎病毒的可能。③人工骨材料成型迅速,在计算机辅助设计和辅助制作的帮助下,能更好的合成与缺损骨形态接近的骨修复替代材料,人工骨材料的骨诱导性和仿生物性骨结构方面还不能令人满意。④现有的骨修复替代材料均存在各自不同某些缺陷,不能完全满足临床质量的需要。未来能代替天然骨骼,解决骨缺损修复的材料应当是优势的组合,是骨修复替代材料的发展趋势。

Selection and application of bone substitute materials for repair of bone defects

BACKGROUND： In the treatment of bone defects, there has been a series of major scientific breakthroughs in the field of bone repair substitute materials in recent years, and a lot of bone repair substitute materials have been made. At present, there are many kinds of bone repair substitute materials in clinic, and each kind of material has its advantages and disadvantages. Proper selection and application are the practical problems faced to the trauma orthopedic surgeons, and that is worthy for discussion and scrutiny. OBJECTIVE： To evaluate the biological properties of three kinds of bone repair substitute materials through relative analysis on the application of autologous bone, allograft bone and bone substitute materials which is conductive for the orthopedic surgeons a better understanding of physicochemical and biological properties of several bone repair substitute materials and further improve the diagnosis and treatment. METHODS： Artificial bone materials play an irreplaceable role in the repairing of bone defects and have achieved a great clinical effect, but, the recent clinical effect was not the final result of the comparison with traditional materials. There still lacked of experimental evidence on the verification of the security and stability of the artificial bone material, and yet long-term clinical observation was needed to identify the exact effect. Looking for the artificial bone material suppression with good biological characteristics was the orthopedic research hot spot. The experimental data of thecomprehensive comparison of physicochemical and biological properties and security of three kinds of bone repair substitute materials, including the autologous bone, allograft bone and artificial bone material were analyzed. RESULTS AND CONCLUSION： ①In the bone defects repairing, we measured from the repair quality, immune rejection and the spread of the disease, and finding the autologous bone is the best choice and has become the gold standard of bone graft. However, the disadvantages of limited sources, complications on the harvesting area and the trauma of second surgery area caused by bone harvesting have limit its clinical application. ②The source of allograft bone is larger than autologous bone, but it has the disadvantage of the immune rejection between the host, and it may cause the infectious diseases such as hepatitis virus. ③ The artificial bone vanis formed rapidly, and with the help of computer-aided design and auxiliary production, it can better synthesis the bone repair substitute materials which are close to the morphology of the defected bone. But the osteoinductive and of the artificial bone materials are not satisfied. ④ There are some shortages of the existing bone substitute materials whichare unable to fully meet the needs of clinical quality. The substitute materials which can replace the natural bone and repair the bone defects in the future should be the preponderant combination and be the development trend of bone repair substitute materials.