Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model.
Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model.
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DOI：
10.1016/j.spinee.2018.02.018
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Puttlitz CM
中科院分区：
文献类型：
--
作者：
McGilvray KC;Easley J;Seim HB;Regan D;Berven SH;Hsu WK;Mroz TE;Puttlitz CM
脊柱外科中常用的椎间固定架材料有很大的差异。从理论上讲，使用多孔钛材料的三维（3D）打印体间笼可以提供更一致的骨长入和生物固定。本研究的目的是为脊柱融合椎间材料的决策提供循证方法。进行了动物对比研究。本研究使用了一个骨骼成熟的羊腰椎融合模型。采用三种不同的体间笼（聚醚醚酮[PEEK]、等离子喷涂多孔钛包覆PEEK [PSP]和3d打印多孔钛合金笼[PTA]）对27只成熟羊L2-L3和L4-L5进行体间融合。在三个主要运动方向上进行了无损运动学检测。采用微计算机断层扫描（μ-CT）对标本进行分析；进行骨融合的定量测量。通过椎间装置在矢状面也进行了组织形态学分析。结果参数在笼设计和时间点之间进行比较。与PEEK笼组相比，PTA组在16周时屈伸活动范围（ROM）有统计学意义上的降低（p值= 0.02）。在8周和16周牺牲时间点之间，只有PTA笼在所有三个加载方向上显示具有统计学意义的ROM减少和刚度增加（p值≤0.01）。Micro-CT数据显示，与PEEK笼相比，PTA笼在8周和16周的移植窗内的总骨体积均显著增加（p值< 0.01）。体间植入物的直接比较表明，在羊模型中，生物力学、μ-CT和组织学性能存在显著且可测量的差异。与PEEK和PSP相比，3d打印多孔钛体间笼在统计学上显著降低了ROM，增加了骨长入轮廓，以及平均结构刚度。
There is significant variability in the materials commonly used for interbody cages in spine surgery. It is theorized that three-dimensional (3D)-printed interbody cages using porous titanium material can provide more consistent bone ingrowth and biological fixation. The purpose of this study was to provide an evidence-based approach to decisionmaking regarding interbody materials for spinal fusion. A comparative animal study was performed. A skeletally mature ovine lumbar fusion model was used for this study. Interbody fusions were performed at L2-L3 and L4-L5 in 27 mature sheep using three different interbody cages (ie, polyetheretherketone [PEEK], plasma sprayed porous titanium-coated PEEK [PSP], and 3D-printed porous titanium alloy cage [PTA]). Non-destructive kinematic testing was performed in the three primary directions of motion. The specimens were then analyzed using micro-computed tomography (μ-CT); quantitative measures of the bony fusion were performed. Histomorphometric analyses were also performed in the sagittal plane through the interbody device. Outcome parameters were compared between cage designs and time points. Flexion-extension range of motion (ROM) was statistically reduced for the PTA group compared with the PEEK cages at 16 weeks (p-value=.02). Only the PTA cages demonstrated a statistically significant decrease in ROM and increase in stiffness across all three loading directions between the 8-week and 16-week sacrifice time points (p-value≤.01). Micro-CT data demonstrated significantly greater total bone volume within the graft window for the PTA cages at both 8 weeks and 16 weeks compared with the PEEK cages (p-value<.01). A direct comparison of interbody implants demonstrates significant and measurable differences in biomechanical, μ-CT, and histologic performance in an ovine model. The 3Dprinted porous titanium interbody cage resulted in statistically significant reductions in ROM, increases in the bone ingrowth profile, as well as average construct stiffness compared with PEEK and PSP.
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