Остеопластические материалы нового поколения на основе биологических и синтетических матриксов

Цели. Цель литературного обзора – анализ остеопластических материалов и хирургических имплантатов нового поколения, изучение особенностей, характеристик и результатов их клинического применения.

Методы. Обзор суммирует объем научно-исследовательских материалов, представленных на порталах «PubMed» и «eLIBRARY». Проанализирован и обобщен материал 129 научных статей по следующим разделам: биологические, кальций-фосфатные, полимерные и биокомпозитные матриксы в качестве носителей целевых фармацевтических субстанций (рекомбинантных белковых остеоиндукторов, антибиотиков и биологически активных химических реагентов). Глубина поиска 10 лет.

Результаты. Среди всех видов остеопластических матриксов, применяемых в настоящее время в мировой хирургической остеологии, куда входит нейрохирургия, травматология и ортопедия, стоматология, челюстно-лицевая и детская хирургия, деминерализованный костный матрикс (ДКМ) занимает 26%. Полимерные и биокомпозитные матриксы сегодня представляются наиболее перспективными материалами в сравнении с ДКМ. Особое внимание в разработке новых видов матриксов уделяется возможности фиксации остеогенных факторов и целевых фармацевтических субстанций на материале-носителе с целью их контролируемого и пролонгированного выпуска на участке хирургической имплантации. Полимерные и биокомпозитные материалы способны замедлять время высвобождения фармсубстанций в месте имплантации, способствуя снижению токсичности и пролонгации терапевтического эффекта, являясь перспективной альтернативой аутогенной кости. Использование композитных носителей различного состава in vivo демонстрирует высокие показатели остеогенеза, способствует запуску биоминерализации и позволяет варьировать скорость деградации материала.

Выводы. Остеопластические материалы различного состава в сочетании с лекарственными средствами показали ускорение регенерации и минерализации костной ткани in vivo, исключая системные побочные реакции. И, хотя некоторые материалы уже зарегистрированы в качестве коммерческих препаратов, все еще сохраняется ряд нерешенных проблем. Из-за ограниченности клинических исследований материалов на людях остаются открытыми такие вопросы как недостаточное понимание токсичности материалов, времени их резорбции, скорости доставки лекарственного средства и его высвобождения, а также возможные неблагоприятные эффекты от использования имплантатов различного состава.

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