Research Progress on Application of Polyurethane and its Modified Materials forSpinal Implants
Xiao Ruxin1,2, Liao Liqiong1#*, Song Jian2#*
1(School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China) 2(School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, Guangdong, China)
Abstract：Polyurethane (PU) and its modified materials have been investigated for uses in clinical practice as emerging bone biomaterials due to their excellent physical and chemical properties and good biocompatibility. In clinical practice, the composition and processing methods of PU affect its mechanical properties, which in turn affects the stability of PU implants. By combing the effects of different synthesis and processing methods of PU materials, the biomechanical and clinical trial effects of their application in spinal implants were analyzed. Investigations of PU application in spinal implants were summarized, and the shortcomings of PU in the application were analyzed as well. In addition, development directions of PU in the application of spinal implants were discussed.
肖汝欣, 廖立琼, 宋剑. 面向脊柱内植物的聚氨酯及其改性材料的应用及研究进展[J]. 中国生物医学工程学报, 2025, 44(1): 112-123.
Xiao Ruxin, Liao Liqiong, Song Jian. Research Progress on Application of Polyurethane and its Modified Materials forSpinal Implants. Chinese Journal of Biomedical Engineering, 2025, 44(1): 112-123.
[1] Han Zhang, Zhonghan Wang, Yang Wang, et al. Biomaterials for interbody fusion in bone tissue engineering[J]. Frontiers in Bioengineering and Biotechnology, 2022, 10:900992. [2] Pahlevanzadeh F, Bakhsheshi-Rad HR, Kharaziha M, et.al. CNT and rGO reinforced PMMA based bone cement for fixation of load bearing implants: mechanical property and biological response[J]. Journal of the Mechanical Behavior of Biomedical Materials, 2021, 116:104320. [3] Cundy PJ, Venugopal K, Antoniou G, et al. Do children with spinal deformity who have metal implants and frequent exposure to X-rays increase their risk of cancer? [J]. Spine, 2020, 45(17):1200-1207. [4] Chengxin Chen, Qi Cheng, Yu Han, et al. A clean, rapid, and controllable approach for establishing bioactive surfaces on zirconia implants[J]. Advanced Materials Interfaces, 2023, 11(2):1-8. [5] Dewey MJ, Harley BAC. Biomaterial design strategies to address obstacles in craniomaxillofacial bone repair[J]. RSC Advance, 2021, 11(29):17809-17827. [6] Pisecky L, Luger M, Klasan A, et al. Bioabsorbable implants in forefoot surgery: a review of materials, possibilities and disadvantages[J]. EFORT Open Reviews, 2021, 6(12):1132-1139. [7] Wu YH, Wang CC, Chen CY. Effect of the cyclic structure content on aliphatic polycarbonate-based polyurethane[J]. Polymer Journal, 2021, 53:695-702. [8] Wang Qichao, Xin Xiulan, Liu Hongqin, et al. Influence of preparation method on adhesion and drying performances of polyurethane dispersion[J]. Journal of Applied Polymer Science, 2021, 138(21):50506. [9] 程国华,刘学鹏,徐瑞祥. 聚醚软段对HMDI基透明聚氨酯弹性体性能的影响[J]. 聚氨酯工业,2016,31(4):40-43. [10] Arjun S, Rajesh K, Pramod KS, et al. Investigation of the effect of diisocyanate on the thermal degradation behavior and degradation kinetics of polyether-based polyurethanes[J]. Journal of Macromolecular Science, Part B, 2020, 59(12):775-795. [11] 田春蓉,梁书恩,王建华. 聚氨酯弹性体性能的影响因素[J]. 合成橡胶工业,2008,31(6):441-445. [12] Stefan O, Daniel T, Veronica O. Design-properties relationships of polyurethanes elastomers depending on different chain extenders structures[J]. Journal of Polymer Research, 2019, 26:117. [13] Wang Xingyu, Yu Tianlai, Wu Yuxuan, et al. Study on mechanical properties of two-component polyurethane based on multi-scale molecular simulation[J]. Materials (Basel), 2023, 16(30):1006. [14] Ken K, Shuhei N, Atsushi T, et al. Control of mechanical properties of polyurethane elastomers synthesized with aliphatic diisocyanate bearing a symmetric structure[J]. Elastomers and Composites, 2019, 54(4):271-278. [15] Zhang Xiaojing, Cai Yuquan, Zhang Xianwei, et al. Synthesis and characterization of eugenol-based silicone modified waterborne polyurethane with excellent properties[J]. Journal of Applied Polymer Science, 2021, 138(22): 50515. [16] Wu CH, Chen CW, Chen PH, et al. Characteristics of polycarbonate soft segment-based thermoplastic polyurethane[J]. Applied Sciences, 2021, 11(12):5359. [17] Yang SJ, Jeongjae W, Eunsol L, et al. Synthesis and properties of bio-based thermoplastic poly (ether urethane) for soft actuators[J]. Journal of Polymer Research, 2022, 29:521. [18] Elsner JJ, McKeon BP. Orthopedic application of polycarbonate urethanes: a review[J]. Techniques in Orthopaedics, 2017, 32(3):132-140. [19] 宋雪晶, 罗运军. 超支化聚酯-聚醚聚氨酯互穿网络的力学性能研究[J]. 化工新型材料, 2012, 40(8):100-102. [20] Shen Chen, Yan Shi, Sun Xiaole, et al. Oxidizability enhancement of hydroxyl terminated polyether polyurethane elastomers via fluoroalcohols grafting[J]. Propellants, Explosives, Pyrotechnics, 2022, 47:202200048. [21] Li Shiyu, Liu Zhiyong, Hou Lijie, et al. Effect of polyether/polyester polyol ratio on properties of waterborne two-component polyurethane coatings[J]. Progress in Organic Coatings, 2020, 141:105545. [22] Špírková M,Pavličević J, Strachota A, et al. Novel polycarbonate-based polyurethane elastomers: composition-property relationship[J]. European Polymer Journal, 2011, 47(5):959-972. [23] 汤显, 寿韬, 胡仕凯. 扩链剂结构对聚碳酸酯型聚氨酯性能的影响[J]. 化工新型, 2023, 51(5):113-117,122. [24] Chalissery D, Pretsch T, Staub S, et al. Additive manufacturing of information carriers based on shape memory polyester urethane[J]. Polymers, 2019, 11(6):1005. [25] Zhao Yuhua, Li Qifeng, Wang Junwei, et al. Preparation and properties of carbon fiber/polyether polyurethane composites[J]. Carbon, 2015, 85:446-447. [26] Li Tianqi, Zhang Ximing, Yang Wu, et al. Preparation and properties of block copolymerization thermoset polyurethane elastomers prepared in situ[J]. Polymer, 2024, 290:126586. [27] Guan Xiaoyu, Dong Yubing, Xia Hong, et al. Mechanical and shape memory performance of shape memory polyurethane-based aligned nanofibers[J]. Polymer Testing, 2020, 91:106778. [28] 华继军, 倪加旎, 高传花, 等. 水分散有机硅-聚氨酯嵌段共聚物的合成与性能[J]. 高分子材料科学与工程, 2009, 25(2):28-30. [29] Liu Zhanxu, Li Chenchen, Zhang Xiaofeng, et al. Synthesis of silicone blocked bio-polyurethane and its application in highly stretchable fiber-shaped strain sensor[J]. Nano Research, 2023, 16(5):7982-7990. [30] Illner S, Arbeiter D, Teske M, et al. Tissue biomimicry using cross-linked electrospun nonwoven fibre composites[J]. Current Directions in Biomedical Engineering, 2019, 5(1):119-122. [31] Solouki Bonab V, Zloczower IM. Revisiting thermoplastic polyurethane, from composition to morphology and properties[J]. Journal of Polymer Science, 2017, 55:1553-1564. [32] Rogulska M, Kultys A. Aliphatic polycarbonate-based thermoplastic polyurethane elastomers containing diphenyl sulfide units[J]. Journal of Thermal Analysis and Calorimetry, 2016, 126:225-243. [33] Verbelen L, Dadbakhsh S, Van den Eynde M, et al. Analysis of the material properties involved in laser sintering of thermoplastic polyurethane[J]. Additive Manufacturing, 2017, 15:12-19. [34] Ramirez D, Nanclares J, Spontón M, et al. Effect of cooling induced crystallization upon the properties of segmented thermoplastic polyurethanes[J]. Journal of Polymer Engineering, 2016, 37(5):0106. [35] Egorikhina MN, Bokov AE, Charykova IN, et al. Biological characteristics of polyurethane-based bone-replacement materials[J]. Polymers, 2023, 15(4):831. [36] Más Y, Gracia L, Ibarz E, et al. Finite element simulation and clinical followup of lumbar spine biomechanics with dynamic fixations[J]. PLoS ONE, 2017, 12(11):0188328. [37] John KRS. The use of polyurethane materials in the surgery of the spine: a review[J]. The Spine Journal, 2014, 14:3038-3047. [38] Lawless BM, Barnes SC, Espino DM, et al. Viscoelastic properties of a spinal posterior dynamic stabilization device[J]. Journal of the Mechanical Behavior of Biomedical Materials, 2016, 59:519-526. [39] Coe JD, Kitchel SH, Meisel HJ, et al. Nflex dynamic stabilization system: two-year clinical outcomes of multi-center study[J]. Journal of Korean Neurosurgical Society, 2012, 51(6):343-349. [40] Hsieh JY, Chen Chensheng, Chuang Shaoming, et al. Comparison of the optimal design of spinal hybrid elastic rod for dynamic stabilization: a finite element analysis[J]. Applied Sciences, 2022, 12(22):11759. [41] Haleem S, Ahmed A, Ganesan S, et al. Mean five years follow up results of a facet replacement device in the treatment of lumbar spinal stenosis and degenerative spondylolisthesis[J]. World Neurosurgery, 2021, 152:645-651. [42] Li Chuanhong, Yu Xing, Yang Xiong, et al. Mid-long-term follow-up of operated level kinematics after single-level artificial cervical disc replacement with Bryan disc[J]. Journal of Orthopaedic Surgery and Research, 2022, 17:149. [43] Lazennec JY, Aaron A, Ricart O, et al. The innovative viscoelastic CP ESP cervical disk prosthesis with six degrees of freedom: biomechanical concepts, development program and preliminary clinical experience[J]. European Journal of Orthopaedic Surgery & Traumatology, 2016, 26:9-19. [44] Jacobs CAM, Siepe CJ, Ito K. Viscoelastic cervical total disc replacement devices: design concepts[J]. The Spine Journal, 2020, 20(12):1911-1924. [45] Mahomed A, Moghadas PM, Shepherd DET, et al. Effect of axial load on the flexural properties of an elastomeric total disc replacement[J]. Spine, 2012, 37(15):908-912. [46] Anderson PA, Rouleau JP, Bryan VE, et al. Wear analysis of the Bryan cervical disc prosthesis[J]. Spine, 2003, 28(20):186-194. [47] Peck JH, Cade E, Palepu V, et al. Mechanical performance of thoracolumbosacral pedicle screw systems: an analysis of data submitted to the Food and Drug Administration[J]. Journal of Biomechanics, 2021, 125(26):110556. [48] 徐韬,盛伟斌. 正确认识动态稳定装置 Dynesys 系统治疗 AIS[J] . 中国脊柱脊髓杂志,2021, 10:874-875. [49] Chien CY, Kuo YJ, Lin SC, et al. Kinematic and mechanical comparisons of lumbar hybrid fixation using dynesys and cosmic systems[J]. Spine, 2014, 39(15):878-884. [50] Ianuzzi A, Kurtz SM, Kane W, et.al. In vivo deformation, surface damage, and biostability of retrieved Dynesys systems[J]. Spine, 2010, 35(23):1310-1316. [51] Xiao Xiao, Chen Gaoyang, Wang Song, et al. Efficacy of the Dynesys hybrid surgery for patients with multi-segmental lumbar spinal stenosis[J]. Frontiers in Surgery, 2022, 9:849679. [52] Zhou Luping, Zhang Renjie, Wang Jiaqi, et al. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases[J]. BMC Surgery, 2023, 23:46. [53] Bhattacharya S, Nayak A, Goel VK, et al. Gravimetric wear analysis and particulate characterization of bilateral facet-augmentation system -PercuDynTM[J]. Bio-Medical Materials and Engineering, 2010, 20(6):329-338. [54] Canero G, Carbone S. The results of a consecutive series of dynamic posterior stabilizations using the PercuDyn device[J]. European Spine Journal, 2015, 24(7):865-871. [55] Kareem H, Ulbricht C. A prospective long-term follow-up study of the posterior dynamic stabilizing system to treat back pain associated with degenerative disc disease[J]. Global Spine Journal, 2020, 10(1):30-38. [56] Lawless BM, Espino DM, Shepherd DET. In vitro oxidative degradation of a spinal posterior dynamic stabilization device[J]. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 2018, 106(3):1237-1244. [57] Serratricea N, Faddoul J, Tarabay B, et al. Radiological factors affecting functional outcome after the implantation of BDYNTM dynamic stabilization system for low-grade lumbar degenerative spondylolisthesis[J]. Neurochirurgie, 2023, 69(4):101456. [58] Choi HW, Kim YE, Chae AW. Effects of the level of mono-segmental dynamic stabilization on the whole lumbar spine[J]. International Journal of Precision Engineering and Manufacturing, 2016, 17(5):603-611. [59] Meyers K, Tauber M, Sudin Y, et al. Use of instrumented pedicle screws to evaluate load sharing in posterior dynamic stabilization systems[J]. The Spine Journal, 2008, 8(6):926-932. [60] Boukebous B, Serfaty L, Abdelhedi O, et al. The anteroposterior positioning of viscoelastic cervical disc prosthesis does not alter the outcomes[J]. International Journal of Spine Surgery, 2023, 17 (5): 690-697. [61] Schult M, Schultheiss M, Hartwig E, et al. Vertebral body replacement with a bioglass-polyurethane composite in spine metastases-clinical, radiological and biomechanical results[J]. European Spine Journal, 2000, 9:437-444. [62] Hongzhen Jiang, Sitoci-Ficici KH, Reinshagen C, et al. Adjustable polyurethane foam as filling material for a novel spondyloplasty: biomechanics and biocompatibility[J]. World Neurosurgery, 2018, 112:848-858. [63] Lv Nanning, Feng Xiaoxiao, Liu Haojun, et al. Study on the influence of balloon dilation mode on the intravertebral cleft of osteoporotic fracture[J]. BMC Surgery, 2022, 22:351. [64] Liao JC, Chen MJW, Lin TY, et al. Biomechanical comparison of vertebroplasty, kyphoplasty, vertebrae stent for osteoporotic vertebral compression fractures - a finite element analysis[J]. Applied Sciences, 2021, 11(13):5764.
