腰椎椎间融合材料的发展现状

The Current Development Status of Lumbar Interbody Fusion Materials

摘要: 腰椎椎间融合术常用于治疗退行性腰椎疾病、腰椎滑脱、脊柱畸形，以及在某些感染或肿瘤切除后的重建脊柱。所谓“融合材料”主要包括两部分：第一为椎间支架，它帮助恢复椎间盘高度，用于恢复椎间高度并提供即时力学支撑，承担终板载荷传递；第二为椎间植骨材料与骨生物制剂(Bone Graft & Osteobiologics)，它们为骨组织生长提供框架，传递信号刺激骨生长，并提供成骨细胞。在过去二十年里，腰椎融合材料沿着两条主要方向发展。对于支架，我们从单纯使用“惰性结构件”，发展到能够与骨整合、满足力学需求，甚至可以个性化设计的类型，比如PEEK、钛合金、钛涂层PEEK以及3D打印多孔钛对于骨移植，重点则从主要使用自体骨转向来源多样且具有可控生物活性的组合，如异体骨、脱矿骨基质(DBM)、陶瓷(HA, β-TCP, BCP)、生物活性玻璃、细胞骨基质以及rhBMP-2等生长因子。同时，我们对下沉、假关节形成以及与骨生物制剂相关的问题有了更多认识，材料改进和风险管理也在不断推进。这篇综述回顾了目前腰椎椎间融合材料的现状，涵盖支架、骨移植/生物制剂以及并发症管理，旨在为临床实践中选材和风险控制提供参考。

Abstract: Lumbar interbody fusion is commonly used to treat degenerative lumbar disease, lumbar spondylolisthesis, spinal deformities, and to reconstruct the spine after certain infections or tumor resection. The so-called “fusion material” mainly includes two parts: the first is the intervertebral scaffold, which helps to restore the height of the intervertebral disc, restores the height of the intervertebral disc, provides immediate mechanical support, and bears the load transfer of the endplate; The second is bone graft & osteobiologics, which provide a framework for bone tissue growth, transmit signals to stimulate bone growth, and provide osteoblasts. Over the past two decades, lumbar fusion materials have evolved along two main directions. For scaffolds, we have moved from simply using “inert structural parts” to types that can be integrated with bone, meet mechanical requirements, and even individualized design, such as PEEK, titanium alloys, titanium-coated PEEK, and 3D-printed porous titanium. For bone grafts, the emphasis has shifted from mainly using autologous bone to combinations of diverse sources and controllable biological activity. Such as allogeneic bone, demineralized bone matrix (DBM), ceramics (HA, β-TCP, BCP), bioactive glass, cellular bone matrix and growth factors such as rhBMP-2. At the same time, more has been learned about subsidence, pseudarthrosis formation, and issues associated with bone biologics, and advances have been made in material improvements and risk management. This review reviews the current status of materials for lumbar interbody fusion, covering stents, bone grafts/biologics, and complication management, aiming to provide a reference for material selection and risk control in clinical practice.