Short-term and long-term effects of orthopedic biodegradable implants.
Short-term and long-term effects of orthopedic biodegradable implants.
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DOI：
10.1615/jlongtermeffmedimplants.v21.i2.10
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发表时间：
2011
影响因子：
--
通讯作者：
Nukavarapu SP
中科院分区：
文献类型：
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作者：
Amini AR;Wallace JS;Nukavarapu SP
目前，整形外科和口腔/颌面植入物的市场总额为28亿美元，预计这一数字将大幅持续增长。虽然传统的永久性植入物已被证明是临床有效的，但它们也有一些缺点，包括二次翻修和取出手术。非永久性、可生物降解的植入物为患者提供了一种有前途的替代方案，因为它们提供了临时支撑，并以与组织形成相匹配的速度降解，从而消除了对二次手术的需求。这些种植体已经在临床上使用了近25年，与永久性种植体的性能直接竞争，甚至可能超过永久性种植体的性能。与永久性材料一样，生物可降解材料的初始植入会引起急性宿主炎症反应。随着时间的推移，植入物降解特征和可能的降解产物毒性介导长期可生物降解的植入物诱导的炎症。然而，与永久性植入物不同，一旦材料消失，这种炎症可能会停止。种植体介导的炎症是种植体成功的关键决定因素。因此，为了开发具有促进最佳骨再生和最小有害炎症的能力的主动生物可降解植入物，需要对短期和长期炎症事件进行全面了解。在这里，我们讨论了一系列可生物降解的骨科植入物，其相关的短期和长期炎症反应，以及调解这些炎症事件的方法。
Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events.