Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm 89081, Germany.
J R Soc Interface. 2012 Aug 7;9(73):1869-79. doi: 10.1098/rsif.2012.0016. Epub 2012 Feb 15.
Currently, numerous hydrogels are under examination as potential nucleus replacements. The clinical success, however, depends on how well the mechanical function of the host structure is restored. This study aimed to evaluate the extent to and mechanisms by which surgery for nucleus replacements influence the mechanical behaviour of the disc. The effects of an annulus defect with and without nucleus replacement on disc height and nucleus pressure were measured using 24 ovine motion segments. The following cases were considered: intact; annulus incision repaired by suture and glue; annulus incision with removal and re-implantation of nucleus tissue repaired by suture and glue or plug. To identify the likely mechanisms observed in vitro, a finite-element model of a human disc (L4-L5) was employed. Both studies were subjected to physiological cycles of compression and recovery. A repaired annulus defect did not influence the disc behaviour in vitro, whereas additional nucleus removal and replacement substantially decreased disc stiffness and nucleus pressure. Model predictions demonstrated the substantial effects of reductions in replaced nucleus water content, bulk modulus and osmotic potential on disc height loss and pressure, similar to measurements. In these events, the compression load transfer in the disc markedly altered by substantially increasing the load on the annulus when compared with the nucleus. The success of hydrogels for nucleus replacements is not only dependent on the implant material itself but also on the restoration of the environment perturbed during surgery. The substantial effects on the disc response of disruptions owing to nucleus replacements can be simulated by reduced nucleus water content, elastic modulus and osmotic potential.
目前,许多水凝胶正被作为潜在的核替代物进行研究。然而,临床成功取决于宿主结构的机械功能恢复的程度。本研究旨在评估核替代手术对椎间盘机械性能的影响程度和机制。使用 24 个绵羊运动节段测量了有和没有核置换的环层切开术对椎间盘高度和核压力的影响。考虑了以下情况:完整;通过缝合和胶水修复的环层切开术;通过缝合和胶水或塞子修复的环层切开术伴有核组织切除和再植入。为了确定体外观察到的可能机制,采用了人椎间盘(L4-L5)的有限元模型。这两项研究都经历了生理压缩和恢复循环。修复的环层切开术不会影响体外椎间盘的行为,而额外的核切除和置换会显著降低椎间盘的刚度和核压力。模型预测表明,与测量结果相似,替代核含水量、体积模量和渗透压的降低对椎间盘高度损失和压力有显著影响。在这些情况下,与核相比,椎间盘的压缩负荷传递明显改变,大大增加了环的负荷。水凝胶作为核替代物的成功不仅取决于植入材料本身,还取决于手术过程中受扰环境的恢复。由于核置换引起的椎间盘反应的显著影响可以通过降低核的含水量、弹性模量和渗透压来模拟。