Pettersen Emily, Anderson Jenna, Ortiz-Catalan Max
Center for Bionics and Pain Research, Mölndal, Sweden.
Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
J Neuroeng Rehabil. 2022 Mar 21;19(1):31. doi: 10.1186/s12984-022-01005-7.
Electrical stimulation has shown to be a promising approach for promoting osseointegration in bone anchoring implants, where osseointegration defines the biological bonding between the implant surface and bone tissue. Bone-anchored implants are used in the rehabilitation of hearing and limb loss, and extensively in edentulous patients. Inadequate osseointegration is one of the major factors of implant failure that could be prevented by accelerating or enhancing the osseointegration process by artificial means. In this article, we reviewed the efforts to enhance the biofunctionality at the bone-implant interface with electrical stimulation using the implant as an electrode. We reviewed articles describing different electrode configurations, power sources, and waveform-dependent stimulation parameters tested in various in vitro and in vivo models. In total 55 English-language and peer-reviewed publications were identified until April 2020 using PubMed, Google Scholar, and the Chalmers University of Technology Library discovery system using the keywords: osseointegration, electrical stimulation, direct current and titanium implant. Thirteen of those publications were within the scope of this review. We reviewed and compared studies from the last 45 years and found nonuniform protocols with disparities in cell type and animal model, implant location, experimental timeline, implant material, evaluation assays, and type of electrical stimulation. The reporting of stimulation parameters was also found to be inconsistent and incomplete throughout the literature. Studies using in vitro models showed that osteoblasts were sensitive to the magnitude of the electric field and duration of exposure, and such variables similarly affected bone quantity around implants in in vivo investigations. Most studies showed benefits of electrical stimulation in the underlying processes leading to osseointegration, and therefore we found the idea of promoting osseointegration by using electric fields to be supported by the available evidence. However, such an effect has not been demonstrated conclusively nor optimally in humans. We found that optimal stimulation parameters have not been thoroughly investigated and this remains an important step towards the clinical translation of this concept. In addition, there is a need for reporting standards to enable meta-analysis for evidence-based treatments.
电刺激已被证明是促进骨锚式植入物骨整合的一种有前景的方法，其中骨整合定义了植入物表面与骨组织之间的生物结合。骨锚式植入物用于听力和肢体缺失的康复，并且广泛应用于无牙患者。骨整合不足是植入失败的主要因素之一，可通过人工手段加速或增强骨整合过程来预防。在本文中，我们回顾了以植入物作为电极，通过电刺激增强骨-植入物界面生物功能的相关研究。我们回顾了描述在各种体外和体内模型中测试的不同电极配置、电源和波形相关刺激参数的文章。截至2020年4月，使用PubMed、谷歌学术搜索和查尔姆斯理工大学图书馆发现系统，通过关键词“骨整合”“电刺激”“直流电”和“钛植入物”共识别出55篇英文同行评审出版物。其中13篇出版物在本综述范围内。我们回顾并比较了过去45年的研究，发现实验方案不一致，在细胞类型和动物模型、植入位置、实验时间线、植入材料、评估分析方法以及电刺激类型等方面存在差异。在整个文献中，刺激参数的报告也不一致且不完整。使用体外模型的研究表明，成骨细胞对电场强度和暴露持续时间敏感，这些变量在体内研究中同样影响植入物周围的骨量。大多数研究表明电刺激在导致骨整合的潜在过程中具有益处，因此我们发现现有证据支持利用电场促进骨整合的观点。然而，这种效果在人体中尚未得到确凿或最佳的证明。我们发现尚未对最佳刺激参数进行深入研究，而这仍然是该概念临床转化的重要一步。此外，需要报告标准以实现基于证据的治疗的荟萃分析。
