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生物调节植入物以增强骨-植入物固位。

Biomodulation of an implant for enhanced bone-implant anchorage.

机构信息

Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund 22185, Sweden.

Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund 22185, Sweden; Umeå University, Faculty of Medicine, Umeå 90187, Sweden.

出版信息

Acta Biomater. 2019 Sep 15;96:619-630. doi: 10.1016/j.actbio.2019.07.009. Epub 2019 Jul 10.

Abstract

Aseptic loosening of implants is the major cause for revision surgery. By modulating the bone-implant interface, early bone-implant anchorage could be improved. Implant surface manipulation by the addition of osteopromotive molecules locally and systemically to promote implant integration has been described with limited success. This study describes a novel approach by making the implant capable of biologically modulating its surroundings. It was hypothesized that the early implant fixation would improve by filling the interior of the implant with a carrier providing spatio-temporal release of bone active drugs with known osteogenic effect. The implant consisted of a threaded polyether ether ketone (PEEK) hollow chamber with holes at the bottom. The implant was filled with a calcium sulphate (CaS)/hydroxyapatite (HA) carrier, delivering two bone active molecules; zoledronic acid (ZA) and bone morphogenic protein-2 (BMP-2). At first, a rat abdominal muscle pouch model indicated a sustained in-vivo release of both I-rhBMP-2 (57%) and C-ZA (22%) from the CaS/HA carrier over a period of 4-weeks. The biomodulated implant was then inserted in the proximal tibia in rats with the following experimental groups: G1) Empty implant, G2) Implant + CaS/HA, G3) Implant + CaS/HA + ZA and G4) Implant + CaS/HA + ZA + rhBMP-2. Significantly higher bone volume (BV) was seen around the implant in groups G3 (3.3 ± 0.7 mm) and G4 (3.1 ± 0.7 mm) compared to the control (1.3 ± 0.4 mm) using micro-computed tomography and qualitative histology. Group G3, also exhibited significantly higher pull-out force and absorbed energy when compared to the control group G1. These findings indicate that a low dose of ZA alone, released in a controlled manner from within a fenestrated implant is enough to improve implant anchorage without the need of adding rhBMP-2. This simple method of using a fenestrated implant containing a ceramic carrier releasing bone active molecules improved bone anchorage and could clinically reduce prosthetic failure. STATEMENT OF SIGNIFICANCE: Aseptic loosening remains as a major cause for implant revisions and early reaction of surrounding bone to the prosthesis is important for longevity. A novel approach to enhance early bone-implant anchorage is presented. The implant is filled with a carrier providing controlled release of bone active molecules. In an animal model, a calcium sulphate (CaS)/hydroxyapatite (HA) carrier was used to provide a spatio-temporal release of bone morphogenic protein-2 (BMP-2) and zoledronic acid (ZA). Significantly better bone-implant integration was achieved using ZA alone, thereby eliminating the need for adding BMP-2. The developed method of implant biomodulation holds potential to prevent implant loosening and is an alternative to prosthetic coatings or systemic drug treatment. Importantly, all constituents are approved for clinical use.

摘要

种植体的无菌性松动是翻修手术的主要原因。通过调节骨-种植体界面,可以改善早期的骨-种植体锚定。已经描述了通过添加局部和全身的成骨促进分子来操纵种植体表面以促进种植体整合的方法,但效果有限。本研究描述了一种通过使植入物能够生物调节其周围环境的新方法。研究假设通过用提供具有已知成骨作用的骨活性药物时空释放的载体填充植入物内部,早期植入物固定将得到改善。植入物由带有底部孔的聚醚醚酮(PEEK)空心腔组成。植入物填充有硫酸钙(CaS)/羟基磷灰石(HA)载体,可输送两种骨活性分子;唑来膦酸(ZA)和骨形态发生蛋白-2(BMP-2)。首先,大鼠腹部肌肉囊模型表明,在 4 周的时间内,CaS/HA 载体中 I-rhBMP-2(57%)和 C-ZA(22%)的体内释放持续。然后将生物调节的植入物插入大鼠的胫骨近端,实验分组如下:G1)空植入物,G2)植入物+CaS/HA,G3)植入物+CaS/HA+ZA 和 G4)植入物+CaS/HA+ZA+rhBMP-2。使用微计算机断层扫描和定性组织学,与对照组(1.3±0.4mm)相比,G3(3.3±0.7mm)和 G4(3.1±0.7mm)组的植入物周围的骨体积(BV)明显更高。与对照组 G1 相比,G3 组的拔出力和吸收能量也显著更高。这些发现表明,单独使用低剂量的 ZA 以受控方式从带孔植入物中释放足以改善植入物锚固,而无需添加 rhBMP-2。这种使用含有骨活性分子的多孔植入物的简单方法改善了骨锚固,并且可以在临床上减少假体失效。意义声明:无菌性松动仍然是植入物翻修的主要原因,周围骨骼对假体的早期反应对于假体的长期使用非常重要。提出了一种增强早期骨-植入物锚固的新方法。植入物用提供骨活性分子控释的载体填充。在动物模型中,使用硫酸钙(CaS)/羟基磷灰石(HA)载体提供骨形态发生蛋白-2(BMP-2)和唑来膦酸(ZA)的时空释放。单独使用 ZA 可实现更好的骨-植入物整合,从而无需添加 BMP-2。植入物生物调节的开发方法有可能防止植入物松动,是假体涂层或全身药物治疗的替代方法。重要的是,所有成分均获准临床使用。

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