The Department of Materials Science and Engineering, The Ohio State University, Columbus, OH 43210, USA.
The Department of Materials Science and Engineering, The Ohio State University, Columbus, OH 43210, USA; Department of Plastic & Reconstructive Surgery, The Ohio State University, Columbus, OH 43212, USA.
Acta Biomater. 2024 Jan 1;173:51-65. doi: 10.1016/j.actbio.2023.11.011. Epub 2023 Nov 14.
It is well documented that overly stiff skeletal replacement and fixation devices may fail and require revision surgery. Recent attempts to better support healing and sustain healed bone have looked at stiffness-matching of these devices to the desired role of limiting the stress on fractured or engrafted bone to compressive loads and, after the reconstructed bone has healed, to ensure that reconstructive medical devices (implants) interrupt the normal loading pattern as little as possible. The mechanical performance of these devices can be optimized by adjusting their location, integration/fastening, material(s), geometry (external and internal), and surface properties. This review highlights recent research that focuses on the optimal design of skeletal reconstruction devices to perform during and after healing as the mechanical regime changes. Previous studies have considered auxetic materials, homogeneous or gradient (i.e., adaptive) porosity, surface modification to enhance device/bone integration, and choosing the device's attachment location to ensure good osseointegration and resilient load transduction. By combining some or all of these factors, device designers work hard to avoid problems brought about by unsustainable stress shielding or stress concentrations as a means of creating sustainable stress-strain relationships that best repair and sustain a surgically reconstructed skeletal site. STATEMENT OF SIGNIFICANCE: Although standard-of-care skeletal reconstruction devices will usually allow normal healing and improved comfort for the patient during normal activities, there may be significant disadvantages during long-term use. Stress shielding and stress concentration are amongst the most common causes of failure of a metallic device. This review highlights recent developments in devices for skeletal reconstruction that match the stiffness, while not interrupting the normal loading pattern of a healthy bone, and help to combat stress shielding and stress concentration. This review summarises various approaches to achieve stiffness-matching: application of materials with modulus close to that of the bone; adaptation of geometry with pre-defined mechanical properties; and/or surface modification that ensures good integration and proper load transfer to the bone.
有大量文献记载，过于僵硬的骨骼置换和固定装置可能会失效，需要进行翻修手术。最近，人们试图通过更好地支持愈合并维持愈合的骨骼，来研究这些装置的刚度与限制骨折或移植骨承受压缩载荷的期望作用相匹配，以及在重建的骨骼愈合后，确保重建医疗器械（植入物）尽可能少地打断正常的加载模式。通过调整其位置、整合/固定、材料、几何形状（外部和内部）以及表面特性，可以优化这些装置的机械性能。这篇综述强调了最近的研究，这些研究集中在优化骨骼重建装置的设计，以在愈合过程中和愈合后随着力学状态的变化而发挥作用。以前的研究已经考虑了超弹性材料、均匀或梯度（即自适应）孔隙率、增强设备/骨整合的表面改性以及选择设备的附着位置，以确保良好的骨整合和弹性负载传递。通过结合这些因素中的一些或全部，设备设计师努力避免由于不可持续的应力屏蔽或应力集中而导致的问题，从而创造出可持续的应力-应变关系，以最佳地修复和维持手术重建的骨骼部位。
尽管标准的骨骼重建装置通常可以允许患者在正常活动期间正常愈合并提高舒适度，但在长期使用过程中可能会存在重大缺点。应力屏蔽和应力集中是金属装置失效的最常见原因之一。这篇综述强调了最近用于骨骼重建的装置的发展，这些装置的刚度与正常骨骼的刚度相匹配，同时不会打断健康骨骼的正常加载模式，并有助于对抗应力屏蔽和应力集中。这篇综述总结了实现刚度匹配的各种方法：应用与骨骼模量相近的材料；通过预定义的机械性能来适应几何形状；以及确保良好的整合和适当的负载传递到骨骼的表面改性。
