人工关节材料性能与运动性关节软骨损伤

doi:10.3969/j.issn.2095-4344.2015.52.023

摘要/Abstract

摘要：

背景：人工关节从开始设计到临床应用已经经历了近一个世纪的历史，人工关节的先导为人工髋关节，随着在临床上的技术应用不断娴熟，推动了腕关节、肩关节、膝关节等人工关节的设计、应用及改进。

目的：总结运动性关节损伤中人工关节材料的应用进展及性能特征。

方法：由第一作者检索1980至2015年PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)、万方数据库(http://wanfangdata.com.cn/)及CNKI中国期刊全文数据库(http://www.cnki.net/)，以“sports；cartilage injury； Artificial Joint”为英文检索词，“运动，关节软骨损伤，人工关节”为中文检索词，对目前国内外人工关节的研究资料进行了分析和归纳，逐一介绍并分析了国内外常用的人工关节材料，并从材料科学的角度分析了各种材料在应用时的优劣，对目前常用人工关节的表面处理方法作了阐述，并从发展的角度指出了人工关节的研究方向。

结果与结论：钛合金的表面改性可获得结合性能良好的表面陶瓷层，可有效提高钛合金的耐磨损性能。超高分子量聚乙烯的填充改性，可获得耐磨损性能良好的关节复合材料，有效减少超高分子量聚乙烯磨损颗粒的产生并降低其磨损颗粒引起的生物学反应。陶瓷人工关节的进一步研究与完善将是未来人工关节的发展方向。

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 生物材料, 软骨生物材料, 人工关节材料, 金属, 高分子, 陶瓷, 表面改性, 综述文献

Abstract:

BACKGROUND: The artificial joint has gone through nearly a century of history from the beginning of design to the clinical application. The forerunner of artificial joints is artificial hip joint. With the skilled technological application in clinic, the design, application and improvement of wrist, shoulder, knee and other artificial joints have been promoted.

OBJECTIVE: To summarize the application progress and performance characteristics of artificial joint materials in exercise-induced articular cartilage injury.

METHODS: PubMed (http://www.ncbi.nlm.nih.gov/PubMed), Wanfang database (http://wanfangdata.com.cn/) and China National Knowledge Infrastructure (http://www.cnki.net/) during 1980 to 2015 were retrieved by the first author. “Sports; Cartilage Injury; Artificial Joint” were taken as the key words in English and Chinese, respectively. Retrieved data were analyzed and summarized. The artificial joint materials commonly used at home and abroad were introduced and analyzed one by one. The clinical advantages and disadvantages of various materials were analyzed from the view of materials science. The surface treatment methods commonly used for artificial joints were described. The direction of the artificial joint research was pointed out from a development perspective.

RESULTS AND CONCLUSION: The surface modification of titanium alloys can obtain surface ceramic layer with good performance, and can effectively improve the anti-wear properties of titanium alloys. The filling and modification of ultra-high molecular weight polyethylene can obtain joint composites with good anti-wear properties that can effectively reduce the production of ultra-high molecular weight polyethylene wear particles and the biological response induced by ultra-high molecular weight polyethylene wear particles. Further research and improvement of ceramic artificial joints will be the future direction of development of artificial joints.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

中图分类号:

R318

王大鹏，迟猛，裴艳明. 人工关节材料性能与运动性关节软骨损伤[J]. 中国组织工程研究, 2015, 19(52): 8492-8497.

Wang Da-peng, Chi Meng, Pei Yan-ming . Properties of artificial joint materials and exercise-induced articular cartilage injury [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(52): 8492-8497.

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引言

关节软骨损伤的原因是多方面的，关节软骨一旦损伤，关节运动功能将受到影响。随着比赛对抗程度的明显增强，导致运动性关节损伤有上升趋势。运动性关节软骨损伤必要时需要接受人工关节置换。随着医学的发展，人工关节的需求量会越来越大，人工关节要替代关节的功能，所以对材料要求非常高。虽然人工关节材料种类很多，但目前使用的人工关节，其质量并没有达到临床理想效果，这些材料的运用都存在一定的限制性^[1-2]。主要原因为人工关节材料间出现的磨损，因为在磨损的过程中能够产生磨屑，置换部位因为磨屑的存在诱发无菌性炎症，进而影响了人工关节的使用效果^[3]。因此，高可靠性、耐磨人工关节材料的研究开发对人工关节的临床应用极为重要。降低人工关节面之间的摩擦，减少磨屑的产生，提高人工关节的抗磨损性能将是今后人工关节研究急需解决的问题^[4]。相关研究表明，通过表面改性技术可以提高不同人工关节材料的抗磨损性能和生物相容性，这种方法有望成为设计理想人工关节材料的候选者之一^[5]。研究者需要对目前的人工关节材料进一步改进，使其具备更加优异的耐磨性能、更好的生物相容性，进而能够提高人工关节的使用寿命^[6]。

金属、高分子有机材料及生物陶瓷是目前用于人工关节假体的材料，3类材料各有优缺点。以对机械性能要求较高的人工髋关节的股骨头、膝关节的股骨髁的表面，一般采用钴铬钼、钛合金等金属材料组成；针对构成关节面的材料，要求有很好的表面光洁度和耐磨性的人工髋关节的髋臼部分、人工膝关节的胫骨平台部分，多选用陶瓷、超高分子聚乙烯材料组成^[7]；还有一种固定材料叫聚甲基丙烯酸甲酯，俗称骨水泥，用于人工关节假体与骨组织的固定^[8]。近年来，新材料还在不断开发并应用于临床，如新的耐磨聚乙烯材料、全陶瓷人工关节等，但其长期效果还有待进一步观察^[9]。文章阐述了几种人工关节材料的性能要求，列举了这些人工关节材料在人工关节上的典型应用，比较了各自的性能特点；综述了为提高材料综合性能而进行的各种改性处理技术，分析了这些技术的特点，对人工关节材料研究的现状和未来做了总结和展望，从而促进了人工关节材料的进一步推广应用。

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程