Department of Trauma Surgery, University Medical Centre, Regensburg, Germany.
Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany.
Injury. 2022 Nov;53 Suppl 3:S69-S73. doi: 10.1016/j.injury.2022.05.057. Epub 2022 Aug 4.
Since ancient times, reduction and internal fixation has been applied to restore skeletal integrity. Despite advances in the understanding of fracture healing, the risk of complication such as implant loosening or implant-related infection still depicts a challenging complication. Nowadays, a great deal of research is devoted to unreveal the impact of implant surface modifications on osteogenic processes to enhance bone consolidation and osseointegration. This narrative review is aimed to (1) show the evolution and already achieved milestones of implant optimization, and (2) to outline the key factors that contribute to an enhanced osseointegration. Different physical and chemical roughening techniques are currently applied in various studies. Surface patterning on the nanoscale has been found to be an essential factor for the biological response, achievable by e.g. anodisation or laser texturing. Besides surface roughening, also different coating methods are vastly investigated. Next to metal or inorganic compounds as coating material, a variety of biomolecules is currently studied for their osteosupportive capacities. Osseointegration can be improved by surface modification on the micro and nanoscale. Bioactive agents can further improve the osseointegration potential. Used agents at the moment are e.g. inorganic compounds, growth factors (BMPs and non-BMPs) and antiresorptive drugs. The advancement in research on new implant generations therefore aims at actively supporting osseointegration processing.
自古以来，人们一直采用复位和内固定来恢复骨骼的完整性。尽管人们对骨折愈合的机制有了更深入的了解，但诸如植入物松动或与植入物相关的感染等并发症的风险仍然是一个具有挑战性的难题。如今，大量的研究致力于揭示植入物表面改性对成骨过程的影响，以增强骨结合和骨整合。本文旨在（1）展示植入物优化的演变和已经取得的里程碑，以及（2）概述有助于增强骨整合的关键因素。目前，不同的物理和化学粗糙化技术在各种研究中得到了应用。在纳米尺度上进行表面图案化已被发现是生物响应的一个重要因素，这可以通过阳极氧化或激光纹理化等方法来实现。除了表面粗糙化，还有许多不同的涂层方法也在广泛研究中。除了金属或无机化合物作为涂层材料外，目前还研究了多种生物分子的成骨能力。通过微观和纳米尺度的表面改性可以提高骨整合能力。生物活性物质可以进一步提高骨整合的潜力。目前使用的药物有，例如无机化合物、生长因子（BMP 和非 BMP）和抗吸收药物。因此，新一代植入物的研究进展旨在积极支持骨整合过程。
