Li Jun, Cui Xiaolin, Hooper Gary J, Lim Khoon S, Woodfield Tim B F
Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand.
Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand; Medical Technologies Centre of Research Excellence (MedTech CoRE), New Zealand.
J Mech Behav Biomed Mater. 2020 May;105:103671. doi: 10.1016/j.jmbbm.2020.103671. Epub 2020 Feb 6.
Evolution of metallurgy and biomaterials has progressively shifted the focus of metallic bone-interfacing implant design from adequate mechanical strength and biocompatibility to rapid osseointegration and infection inhibition. The now relatively well-established technology - powder bed additive manufacturing (AM), offers the ability to fabricate porous implants with precise mechanical properties, topological pore architectures and patient-specific design functions, has revolutionized the production of customized multifunctional metallic implants for the individual patient with anatomic-specific requirement. Even though AM titanium and its alloy Ti-6Al-4V have been investigated and adopted for clinical application for decades, the development of porous AM titanium implants is far from complete and further research is required to achieve excellent long-term clinical performance. In this review, we summarize the current status of AM in bone-interfacing implant fabrication, with particular focus on the experimental outcomes of various factors that influence osseointegration, bone and vascular ingrowth as well as hybrid strategies to combat infection, including: pore size, porosity, pore structure, surface modification techniques and incorporation of biological factors. In addition, we also discuss the osteogenic capacity of constructs fabricated through different manufacturing methods and titanium alloys. To this end, we highlight the exciting prospect of AM for bone-interfacing implant manufacture through optimization via material development, implant design, bio-functionalization to clinical evaluation to provide enhanced patient specificity and long-term function.
冶金学和生物材料的发展已逐渐将金属骨植入物设计的重点从足够的机械强度和生物相容性转移到快速骨整合和抗感染方面。如今相对成熟的技术——粉末床增材制造（AM），能够制造出具有精确机械性能、拓扑孔隙结构和患者特定设计功能的多孔植入物，彻底改变了为有解剖学特定需求的个体患者定制多功能金属植入物的生产方式。尽管增材制造的钛及其合金Ti-6Al-4V已被研究并应用于临床数十年，但多孔增材制造钛植入物的发展仍远未完善，需要进一步研究以实现优异的长期临床性能。在本综述中，我们总结了增材制造在骨植入物制造中的现状，特别关注影响骨整合、骨和血管长入以及抗感染混合策略的各种因素的实验结果，包括：孔径、孔隙率、孔隙结构、表面改性技术以及生物因子的掺入。此外，我们还讨论了通过不同制造方法和钛合金制造的结构的成骨能力。为此，我们强调了通过材料开发、植入物设计、生物功能化到临床评估的优化，增材制造在骨植入物制造方面令人兴奋的前景，以提供更高的患者特异性和长期功能。
