Diabetes as a Risk Factor for Orthopedic Implant Surface Performance: A Retrieval and In Vitro Study.
Diabetes as a Risk Factor for Orthopedic Implant Surface Performance: A Retrieval and In Vitro Study.
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DOI：
10.1007/s40735-021-00486-8
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发表时间：
2021-06-01
影响因子：
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通讯作者：
Rodrigues, Danieli C
中科院分区：
文献类型：
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作者：
Arteaga, Alexandra;Qu, Jiayi;Rodrigues, Danieli C
由于伤口愈合能力受损，骨科器械通常与糖尿病患者的风险增加有关。免疫功能低下患者在种植体-组织界面处的不良生物反应可导致显著的骨吸收，从而增加失败率。本研究的目的是表征从糖尿病患者身上取出的植入物的表面，以确定糖尿病诱导的骨整合受损的潜在机制。从糖尿病和非糖尿病患者中获得39个钛和不锈钢矫形装置，并与未植入的对照组进行比较。光学显微镜、扫描电镜、能量色散x射线能谱和x射线光电子能谱分别显示了回收样品的形貌、化学成分、氧化态和氧化物厚度的变化。此外，钛盘在模拟糖尿病体外条件下浸泡28天，然后采用电感耦合等离子体发射光谱法定量金属溶解。对回收的样品和体外研究的样品进行电化学测试。除了生物沉积外，与未植入对照相比，检索结果显示表面变色，坑状地层和氧化物变薄，表明暴露于不利的酸性条件下。骨折固定螺钉和钢板上的循环承载区域描述了开裂和分层。浸没盘或种植体的腐蚀行为在糖尿病和非糖尿病情况下无显著差异。然而，模拟糖尿病条件下铝的释放升高。这阐明了骨科植入失败的潜在原因是糖尿病环境在植入物-组织界面。设计新的种植体表面应考虑特定的策略，以诱导免疫功能低下患者的建设性愈合反应，同时减轻酸性糖尿病环境中的腐蚀。
Orthopedic devices are often associated with increased risk for diabetic patients due to impaired wound healing capabilities. Adverse biological responses for immunocompromised patients at the implant-tissue interface can lead to significant bone resorption that may increase failure rates. The goal of this study was to characterize the surface of implants removed from diabetic patients to determine underlying mechanisms of diabetes-induced impaired osseointegration. Thirty-nine retrieved titanium and stainless-steel orthopedic devices were obtained from diabetic and non-diabetic patients, and compared to non-implanted controls. Optical Microscopy, Scanning Electron Microscopy, Energy Dispersive X-ray Spectroscopy, and X-ray Photoelectron Spectroscopy revealed changes in morphology, chemical composition, oxidation state, and oxide thickness of the retrieval specimens, respectively. Additionally, titanium disks were immersed for 28 days in simulated in vitro diabetic conditions followed by Inductively Coupled Plasma-Optical Emission Spectroscopy to quantify metal dissolution. Electrochemical testing was performed on specimens from retrievals and in vitro study. Aside from biological deposits, retrievals demonstrated surface discoloration, pit-like formations and oxide thinning when compared to non-implanted controls, suggesting exposure to unfavorable acidic conditions. Cyclic load bearing areas on fracture-fixation screws and plates depicted cracking and delamination. The corrosion behavior was not significantly different between diabetic and non-diabetic conditions of immersed disks or implant type. However, simulated diabetic conditions elevated aluminum release. This elucidates orthopedic implant failures that potentially arise from diabetic environments at the implant-tissue interface. Design of new implant surfaces should consider specific strategies to induce constructive healing responses in immunocompromised patients while also mitigating corrosion in acidic diabetic environments.