The failure of polypropylene surgical mesh in vivo.
The failure of polypropylene surgical mesh in vivo.
复制标题
聚丙烯手术网片在体内的失效。
DOI：
10.1016/j.jmbbm.2018.08.041
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发表时间：
2018
影响因子：
3.9
通讯作者：
D. Taylor
中科院分区：
文献类型：
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作者：
D. Taylor
由聚丙烯 (PP) 纤维制成的手术网材料已广泛使用五十多年。然而，近年来，这些材料在某些外科手术（称为“盆腔器官”或“经阴道”手术）中的使用受到了质疑。本文回顾了当前的知识状况，并使用一些简单的生物力学分析，以便为未来的工作提出建议。我的结论是，PP 网片在盆腔器官产品中的失败率高得令人无法接受，而在用于疝气修复时则要低得多。精确的机械环境很难量化，但初步结论是纯机械机制（疲劳和蠕变）不太可能发生故障。有一些证据表明环境退化（即应力腐蚀），但这在文献中存在很大争议。总而言之，我的结论是，应力腐蚀失效是最可能的解释，但目前没有实验结果可以最终证明这种失效机制发生在体内。需要进一步的工作，特别是外植材料的分析，来解决这个紧迫的问题。
Surgical mesh materials made from fibres of polypropylene (PP) have been widely used for over fifty years. However in recent times the use of these materials has been called into question for certain surgical operations, known as “pelvic organ” or “transvaginal” procedures. This article reviews the current state of knowledge and uses some simple biomechanics analysis in order to make recommendations for future work. My conclusion is that the failure rate of PP mesh in pelvic organ products is unacceptably high whilst being much lower when it is used for hernia repair. The precise mechanical environment is difficult to quantify but a tentative conclusion is that failure by purely mechanical mechanisms (fatigue and creep) is unlikely. There is some evidence for environmental degradation (i.e. stress-corrosion) but this is highly contested in the literature. On balance my conclusion is that stress-corrosion failure is the most likely explanation but currently no experimental results exist to prove conclusively that this failure mechanism occurs in vivo. Further work is needed, especially the analysis of explanted material, to resolve this urgent problem.