Gareb Barzi, Van Bakelen Nico B, Vissink Arjan, Bos Ruud R M, Van Minnen Baucke
Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Polymers (Basel). 2022 Jul 7;14(14):2782. doi: 10.3390/polym14142782.
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
骨固定系统用于颌面外科手术中固定骨段。钛骨固定系统是目前的金标准。然而，其缺点导致高达40%的病例需要进行有症状的取出。由可降解聚合物组成的可生物降解骨固定系统，可以减少骨固定系统取出的需求，同时避免钛骨固定系统的上述缺点。然而，可生物降解系统的缺点包括机械性能下降和可能的异物反应。在这篇综述中，讨论了聚焦于可生物降解和钛骨固定系统体外和体内性能的文献。重点是骨固定系统良好临床结果的潜在因素，包括可生物降解骨固定系统的降解特性以及它们引发的宿主反应。此外，还给出了临床应用和未来研究的建议。基于现有（临床）证据，当应用于治疗颌面创伤时，可生物降解共聚物骨固定系统是钛骨固定系统的可行替代方案，具有相似的疗效且有症状的骨固定取出率显著降低。对于正颌外科手术，可生物降解共聚物骨固定系统是钛骨固定系统的有效替代方案，但需要更长的手术时间。由无定形共聚物组成的骨固定系统，最好采用超声焊接，具有轮廓良好的形状和足够的机械性能，作为生物相容性可生物降解共聚物骨固定系统具有最大潜力。未来的研究应集中在表面改性（如纳米凝胶涂层）和新型可生物降解材料（如镁合金和丝绸）上，以解决当前骨固定系统的缺点。
