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首页> 外文期刊>Journal of Biomechanics >Challenges to bone formation in spinal fusion.
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Challenges to bone formation in spinal fusion.

机译：脊柱融合术对骨形成的挑战。

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Spinal arthrodesis continues to expand in clinical indications and surgical practice. Despite a century of study, failure of bone formation or pseudarthrosis can occur in individual patients with debilitating clinical symptoms. Here we review biological and technical aspects of spinal fusion under active investigation, describe relevant biomechanics in health and disease, and identify the possibilities and limitations of translational animal models. The purpose of this article is to foster collaborative efforts with researchers who model bone hierarchy. The induction of heterotopic osteosynthesis requires a complex balance of biologic factors and operative technique to achieve successful fusion. Anatomical considerations of each spinal region including blood supply, osteology, and biomechanics predispose a fusion site to robust or insufficient bone formation. Careful preparation of the fusion site and appropriate selection of graft materials remains critical but is sometimes guided by conflicting evidence from the long-bone literature. Modern techniques of graft site preparation and instrumentation have evolved for every segment of the vertebral column. Despite validated biomechanical studies of modern instrumentation, a correlation with superior clinical outcomes is difficult to demonstrate. In many cases, adjuvant biologic therapies with allograft and synthetic cages have been used successfully to reproduce the enhancement of fusion rates observed with cancellous and tricortical autograft. Current areas of investigation comprise materials science, stem cell therapies, recombinant growth factors, scaffolds and biologic delivery systems, and minimally invasive surgical techniques to optimize the biologic response to intervention. Diverse animal models are required to approach the breadth of spinal pathology and novel therapeutics.
机译：脊柱关节固定术在临床适应症和手术实践中继续扩大。尽管进行了一个世纪的研究，但在具有令人衰弱的临床症状的个别患者中仍可能发生骨形成或假关节的失败。在这里，我们在积极研究下回顾了脊柱融合的生物学和技术方面，描述了健康和疾病中的相关生物力学，并确定了转化动物模型的可能性和局限性。本文的目的是促进与研究骨骼层次模型的研究人员的协作。异位骨合成的诱导需要生物学因素和手术技术的复杂平衡，以实现成功融合。每个脊柱区域的解剖学考虑因素（包括血液供应，骨科和生物力学）都使融合部位易于形成坚固或不足的骨质。仔细准备融合部位和适当选择移植材料仍然很关键，但有时会受到来自长骨文献的相互矛盾的证据的指导。椎骨柱的每个节段都已经发展了现代的移植部位准备和器械技术。尽管对现代仪器进行了有效的生物力学研究，但很难证明其与优异的临床结果之间的相关性。在许多情况下，具有同种异体移植物和合成笼的辅助生物疗法已成功用于重现松质和三皮质自体移植物观察到的融合率的提高。当前的研究领域包括材料科学，干细胞疗法，重组生长因子，支架和生物传递系统，以及微创外科手术技术，以优化对干预的生物反应。需要各种各样的动物模型来接近脊髓病理学和新疗法的广度。

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