Article(id=1211268932154037112, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.02.11, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1605283200000, receivedDateStr=2020-11-14, revisedDate=1608739200000, revisedDateStr=2020-12-24, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718617713, onlineDateStr=2025-12-26, pubDate=1614441600000, pubDateStr=2021-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718617713, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718617713, creator=13701087609, updateTime=1766718617713, updator=13701087609, issue=Issue{id=1211268928383348982, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='2', pageStart='107', pageEnd='211', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718616815, creator=13701087609, updateTime=1766718805938, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269721685627740, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269721685627741, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=175, endPage=180, ext={EN=ArticleExt(id=1211268933521380249, articleId=1211268932154037112, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress of mesoporous silica in the treatment of military bone trauma, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Bone injury is the most common type of war wound, and different from ordinary open bone injury. The war wound bone injury caused by high-energy weapons has the characteristics of deep bleeding site, coagulation dysfunction, multi bacteria infection and large bone defect area, so it is difficult to be treated in battlefield. Mesoporous silica is a new type of inorganic nano biomaterial, which is widely used in bleeding treatment and bone tissue engineering due to its high specific surface area, large porosity and easy modification. Compared with the traditional materials for the treatment of traumatic bone injury, mesoporous silica has the advantages of local sustained hemostasis, broad-spectrum, sustained-release and strong mechanical support. Its main research direction is the composite and multifunctional materials. The surface functionalized mesoporous silica has the functions of hemostasis and infectious bone defect repair. However, there are still some problems such as unclear biological distribution in vivo and hepatorenal toxicity in large doses of mesoporous silica materials; in terms of preparation technology, there are still some problems such as unclear selection of pore size and shape of materials for promoting bone formation. Based on the actual needs of the treatment of war-induced bone injuries, the multifunctional, easy-to-use and portable properties of new mesoporous silica materials are reviewed in this paper.

, correspAuthors=Xu-Sheng Li, authorNote=null, correspAuthorsNote=
*E-mail:
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骨创伤是最常见的战创伤类型,不同于普通开放性骨创伤,高能量武器导致的战伤性骨创伤具有出血部位深、伴凝血功能障碍、多菌种感染和骨缺损面积大等特点,战场救治较困难。介孔氧化硅(MSN)是一种新型无机纳米生物材料,因其超高的比表面积、较大的孔隙率和易修饰的特性,被广泛用于出血救治和骨组织工程学研究。相较传统的战伤性骨创伤救治材料,MSN具有局部持续止血,广谱、缓释抗感染和机械支撑力较强的优势,目前其主要研究方向为材料复合化和多功能化,经过表面官能化的MSN材料兼具止血和感染性骨缺损修复功能。但MSN材料尚存在体内生物分布不明确、大剂量使用具有肝肾毒性的问题;在制备工艺方面,也存在促骨生成的最佳材料孔径和形状选择不明确的问题。基于战伤性骨创伤的实际救治需求,该文对新型MSN材料的多功能性、易操作和便携性等军用材料特性进行总结。

, correspAuthors=李旭升, authorNote=null, correspAuthorsNote=
李旭升,E-mail:
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李鹏,硕士研究生,主要从事军事训练及战创骨伤方面的研究。E-mail:

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介孔氧化硅在战伤性骨创伤救治中的应用研究进展
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李鹏 1, 2 , 卜琼 3 , 曹国定 1, 2 , 刘鹏 1, 2 , 方万顺 4 , 刘俊 1, 5 , 刘军 6 , 李旭升 2, *
解放军医学杂志 | 综述 2021,46(2): 175-180
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解放军医学杂志 | 综述 2021, 46(2): 175-180
介孔氧化硅在战伤性骨创伤救治中的应用研究进展
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李鹏1, 2, 卜琼3, 曹国定1, 2, 刘鹏1, 2, 方万顺4, 刘俊1, 5, 刘军6, 李旭升2, *
作者信息
  • 1甘肃中医药大学第一临床医学院,兰州 730030
  • 2解放军联勤保障部队第940医院全军骨科中心关节科,兰州 730050
  • 3哈尔滨医科大学附属第一医院呼吸内科,哈尔滨 150001
  • 4山东第一医科大学研究生部,济南 250000
  • 5解放军联勤保障部队第940医院泌尿外科,兰州 730050
  • 6西安交通大学第二附属医院骨科,西安 710000
  • 李鹏,硕士研究生,主要从事军事训练及战创骨伤方面的研究。E-mail:

通讯作者:

李旭升,E-mail:
Research progress of mesoporous silica in the treatment of military bone trauma
Peng Li1, 2, Qiong Bu3, Guo-Ding Cao1, 2, Peng Liu1, 2, Wan-Shun Fang4, Jun Liu1, 5, Jun Liu6, Xu-Sheng Li2, *
Affiliations
  • 1The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730030, China
  • 2Department of Joint Surgery, Institute of Orthopedics, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, China
  • 3Department of Respiratory Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • 4Graduate Department of Shandong First Medical University, Jinan 250000, China
  • 5Department of Urology, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, China
  • 6Department of Orthopedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710000, China
出版时间: 2021-02-28 doi: 10.11855/j.issn.0577-7402.2021.02.11
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骨创伤是最常见的战创伤类型,不同于普通开放性骨创伤,高能量武器导致的战伤性骨创伤具有出血部位深、伴凝血功能障碍、多菌种感染和骨缺损面积大等特点,战场救治较困难。介孔氧化硅(MSN)是一种新型无机纳米生物材料,因其超高的比表面积、较大的孔隙率和易修饰的特性,被广泛用于出血救治和骨组织工程学研究。相较传统的战伤性骨创伤救治材料,MSN具有局部持续止血,广谱、缓释抗感染和机械支撑力较强的优势,目前其主要研究方向为材料复合化和多功能化,经过表面官能化的MSN材料兼具止血和感染性骨缺损修复功能。但MSN材料尚存在体内生物分布不明确、大剂量使用具有肝肾毒性的问题;在制备工艺方面,也存在促骨生成的最佳材料孔径和形状选择不明确的问题。基于战伤性骨创伤的实际救治需求,该文对新型MSN材料的多功能性、易操作和便携性等军用材料特性进行总结。

介孔氧化硅  /  可修饰  /  骨创伤  /  战场救治

Bone injury is the most common type of war wound, and different from ordinary open bone injury. The war wound bone injury caused by high-energy weapons has the characteristics of deep bleeding site, coagulation dysfunction, multi bacteria infection and large bone defect area, so it is difficult to be treated in battlefield. Mesoporous silica is a new type of inorganic nano biomaterial, which is widely used in bleeding treatment and bone tissue engineering due to its high specific surface area, large porosity and easy modification. Compared with the traditional materials for the treatment of traumatic bone injury, mesoporous silica has the advantages of local sustained hemostasis, broad-spectrum, sustained-release and strong mechanical support. Its main research direction is the composite and multifunctional materials. The surface functionalized mesoporous silica has the functions of hemostasis and infectious bone defect repair. However, there are still some problems such as unclear biological distribution in vivo and hepatorenal toxicity in large doses of mesoporous silica materials; in terms of preparation technology, there are still some problems such as unclear selection of pore size and shape of materials for promoting bone formation. Based on the actual needs of the treatment of war-induced bone injuries, the multifunctional, easy-to-use and portable properties of new mesoporous silica materials are reviewed in this paper.

mesoporous silica  /  modifiable  /  bone injury  /  battlefield care
李鹏, 卜琼, 曹国定, 刘鹏, 方万顺, 刘俊, 刘军, 李旭升. 介孔氧化硅在战伤性骨创伤救治中的应用研究进展. 解放军医学杂志, 2021 , 46 (2) : 175 -180 . DOI: 10.11855/j.issn.0577-7402.2021.02.11
Peng Li, Qiong Bu, Guo-Ding Cao, Peng Liu, Wan-Shun Fang, Jun Liu, Jun Liu, Xu-Sheng Li. Research progress of mesoporous silica in the treatment of military bone trauma[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (2) : 175 -180 . DOI: 10.11855/j.issn.0577-7402.2021.02.11
随着现代军事硬件的迅速发展,新型战伤导致的参战人员死亡率和伤残率迅速升高[1],高能量武器导致的战创伤中,约70%存在四肢开放性骨折[2],战伤性骨创伤早期可因严重出血导致大量作战人员死亡[3],同时,火器伤导致的开放性骨折多伴骨感染,易发生创伤性骨髓炎(post-traumatic osteo-myelitis,PTO)[4],造成感染性骨缺损。面对现代战争场景下复杂的战伤性骨创伤,传统救治手段已无法满足战场急救的需要。纳米材料介孔氧化硅(mesoporous silica nanoparticle,MSN)已被广泛研究并应用于化工、医疗和环境保护等众多领域,近期国内外有学者发现复合MSN材料兼具止血、抗感染和骨组织修复等功能[5-7]。各新型MSN复合材料的出现,为战伤性骨创伤的战场救治提供了新的可能。
根据国际纯粹与应用化学联合会规定,MSN是一种孔径介于2~50 nm的多孔无机高分子材料[8],具有超高的比表面积(约1000 m2/g)、规则有序的孔道结构、较高的热稳定性(约900 ℃)、较高的机械强度和良好的生物相容性,同时具有作为无机生物多孔材料最重要的特质——均一可控的孔隙率[9],因此是一种良好的止血和骨组织工程原材料。
目前,关于MSN本身的基础研究已较为透彻,其更多扮演的是一种基础原材料的角色。基于MSN孔径大小的易调节性和表面官能团的易修饰性,研究者将MSN与传统的止血、抗感染和骨组织工程材料相结合,使止血和感染性骨缺损修复功能一体化,是MSN应用于战伤性骨创伤救治的研究趋势。
在医疗条件缺乏的战场环境下,院前大出血是造成战创伤死亡或严重后遗症的重要因素。据统计,15%~20%的战斗死亡人员死于严重战创性出血[10]。战伤性骨创伤具有出血量大、部位深的特点,尤其是严重失血造成凝血因子丢失和稀释继而并发凝血功能障碍时,止血变得更加困难。因此,战场上的大出血目前依然是各国战创伤救治的首位考虑因素[11-12]
传统战伤性骨创伤止血手段有止血带压迫止血、静脉输注凝血成分、局部止血材料止血。止血带是目前公认的最为有效的止血手段,但连续使用时间不能超过2~3 h[13],难以实现多发骨创伤局部持续止血。有机局部止血材料对于严重动脉出血创面止血效果不稳定。无机局部止血材料,如美军主要的止血装备沸石材料Quick Clot,在使用时放热反应会产生超过100 ℃的高温,造成创面组织灼伤[14],而蒙脱石矿粉类止血材料最近被证实会对伤口愈合产生负性作用[15]
MSN是新式止血材料的研究热点,其良好的止血效果主要依赖于其特有的结构和理化性质:(1)球形结构、极高的比表面积和孔隙率,可在骨伤出血处迅速吸收血液中的大量水分,凝结凝血因子和血小板,产生大量凝血块,实现局部快速止血[16];(2)表面携带大量负电荷,可激活凝血级联的接触激活途径[17];(3)孔径大小可控,表面易修饰,可搭载各类凝血因子;(4)MSN材料呈粉末或颗粒状,使用灵活,可用于爆炸碎片导致的多发骨伤止血。结合MSN和传统止血材料的止血优势进行复合止血材料的研发,是目前主要的研究方向。Dai等[17]发现,将MSN与传统有机止血材料壳聚糖相结合制备出的复合材料——大孔壳聚糖包覆MSN干凝胶小球,兼具壳聚糖的止血作用和MSN的密集介孔网络系统的体液吸收止血作用。加入了金属离子的MSN材料,如钙离子(凝血因子Ⅳ),可与其他凝血因子一起发挥辅助凝血因子的作用,同时参与内源和外源两条凝血途径的激活。Li等[18]发现,通过静电纺丝技术将负载姜黄素的MSN颗粒引入聚乙烯吡咯烷酮纳米纤维垫中,可以明显改善杂化纳米纤维的止血和抗菌效果。由此可见,复合MSN止血材料的出现,弥补了现代战伤性骨创伤传统止血材料局部持续止血效果差、功能单一的缺陷,改良后的MSN材料兼具止血和抗感染的双重功效,符合感染高发的战伤性骨创伤止血救治需求。
火器伤导致的开放性骨折,受伤部位组织遭到大量破坏,感染菌种复杂[19],血供残缺,并可伴有死骨产生,导致口服和静脉输入的抗生素几乎不可能达到并在患处局部维持稳定的药物浓度。局部骨抗生素递送系统(local bone antibiotic delivery systems,LBADS)是目前全身应用抗生素治疗骨感染的主要替代方法之一,可以直接在受感染的骨骼部位以受控和持续的方式释放多种抗生素,符合战伤性骨创伤局部持续抗感染的救治要求。
战伤性骨创伤创面往往伴有金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌等多菌种感染[20],战场救治时抗感染用药通常为外科医师的经验性选择。单一抗生素无法同时杀灭耐甲氧西林金黄色葡萄球菌、耐万古霉素金黄色葡萄球菌类耐药菌,而全身大剂量使用多种抗生素又会产生严重的肝肾毒性。因此采用传统手段对战伤性骨创伤行局部广谱抗感染治疗非常困难。
有研究发现,局部多种抗生素联用可以产生协同作用,能明显增强对顽固性细菌的杀灭作用[21]。经过表面官能化修饰的复合MSN药物载体可同时搭载多种抗菌药物,复合MSN材料在伤口部位逐渐溶解时,其搭载的抗生素在同一部位按比例同时释放,可消除多种抗菌药物联用时药代动力学的差异,使游离状态下各抗生素的药物浓度比例实现可控,进而使得局部广谱抗菌成为可能,且因MSN具有止血作用,亦可降低感染随血液向周围及全身扩散的风险。Gounani等[22]制备的羧基改性MSN可携带足量的黏菌素B和万古霉素,在局部释放后,能够同时杀灭革兰阴性菌和革兰阳性菌,且二者高浓度联用时细胞毒性较低。在军事应用上,MSN应根据具体作战环境常见的感染菌种搭载对应的抗生素,如目前英国的军事创伤治疗标准为每8 h联合静脉注射1.2 g阿莫西林克拉维酸钾进行经验性抗感染治疗,但Penn-Barwell等[23]认为,在水生环境中受伤的患者在接受阿莫西林克拉维酸治疗的同时,还应接受环丙沙星抗感染治疗。这为MSN类LBADS搭载抗菌药物种类的选择提供了新思路,即依据海陆空等不同军种作战环境中常见的致病菌种,有针对性地载入各类抗感染药物,以实现更精准的抗菌治疗。而对各军种作战环境中常见菌种进行总结,也可为MSN载入相应的广谱抗生素提供理论依据。
战伤性骨创伤早期抗感染治疗效果不佳,继而可发生慢性PTO。在自体免疫力低下、患处局部血供差、存在超级耐药菌和细菌生物膜形成等因素的共同作用下[24],可使战创伤性慢性PTO反复感染、迁延不愈。慢性PTO的治疗目前尚无统一标准,普遍认可的治疗方案是积极的外科清创和术后长期口服或者肠外抗生素治疗[25]。万古霉素作为骨髓炎全身治疗的首选药物,骨组织渗透性极差,仅能提供10%的骨/血清药物浓度比[26]。因此,MSN类LBADS更适合战伤性骨创伤的长期局部抗感染治疗。
LBADS主要包括不可降解[如聚甲基丙烯酸甲酯(polymethyl methacrylic,PMMA),即抗生素骨水泥]与可降解(如胶原蛋白海绵和硫酸钙等)两类。PMMA存在抗生素暴释现象,且需要二次手术取出;硫酸钙等药物释放过程相对稳定,吸收性好,但机械支撑力相对较差,不利于维持骨折处的结构稳定。
自2001年Manzano等[27]提出在MSN微孔中载入药物的建议后,MSN作为一种LBADS的研究成为热点,且相较其他药物缓释系统具有以下优点:(1)含大量Si-OH官能团,保证了多种抗感染药物的搭载;(2)孔径大小均一,保证了药物持续稳定释放;(3)表面结构易修饰,便于材料与其他离子结合进行缓释改性;(4)表面携带负电荷,可提供数量可观的阳离子抗生素(如多黏菌素B)吸附位点[28];(5)无大量热能释放过程,可用来包埋各类不耐高温的抗生素;(6)材料刚性强,对大量骨组织缺失的战伤性骨创伤可起到一定的支撑固定作用。MSN的理化特性可使患处局部保持较高的抗生素药物浓度,避免了长期静脉滴注大量抗生素引起的全身不良反应,又可减轻采用PMMA材料抗感染治疗后行二次手术取出的痛苦。在MSN缓释载体性能改良方面,Skwira等[29]研究发现,搭载了银离子的MSN材料,随着材料在体内的溶解,银离子不断被释放入体内,可形成持续杀菌效果。传统模板法获得的MSN材料以粉末形式存在,众所周知,粉末状材料因为快速溶解易产生搭载药物暴释现象,对于此问题,Prokopowicz等[30]利用颗粒制备技术将粉末状MSN制备成孔径均一的微球,通过制备工艺的改良进一步优化了MSN的缓释可控性。Kéri等[31]研究发现,MSN-明胶混合气凝胶可实现药物快速释放及延迟释放,而药物释放的动力学取决于载体中明胶的含量。考虑到战地医疗资源的紧张性,MSN药物缓释系统应具备局部长期稳定抗感染的特点,Skwira等[29]将制备的MSN-聚合物复合材料搭载冻干环丙沙星,体外实验证实可维持局部稳定药物浓度30 d,对金黄色葡萄球菌和铜绿假单胞菌均具有持续的杀灭作用。
稳定的药物释放曲线,较低的药物释放摇摆率,以及极低的成骨细胞毒性,保证了MSN缓释系统在骨组织内长期置入的稳定性和安全性。
高能量武器导致的开放性粉碎骨折直接产生大量骨缺损,多伴有慢性PTO的发生,而慢性PTO患者在手术彻底清除坏死骨后产生的死腔又加重了骨缺损程度,严重者甚至需要截肢处理,致残率极高。因此,在彻底手术清创的基础上进行骨缺损修复是目前治疗感染骨缺损的基本原则。
传统的骨缺损修复材料有自体骨、同种异体骨和骨移植替代物等。自体骨取材有限,同种异体骨存在免疫排斥反应,且需要低温保存和定期进行消毒处理[32],仅骨移植替代物符合战伤性骨创伤的救治要求。骨移植替代物分为不可降解型和可降解型两类。不可降解型的代表为PMMA,即抗生素骨水泥,其抗生素的兼容性较差(仅能搭载耐高温类抗生素),在治疗感染性骨缺损时抗生素释放不稳定,后期持续低剂量抗生素的刺激作用甚至是细菌耐药性产生的危险因素。可降解的骨移植替代物如硫酸钙、β-磷酸钙等也存在机械支撑力不足、诱导成骨细胞活性不佳[32]等限制。
相较其他骨移植替代物,MSN在骨组织工程学上具有明显优势:(1)材料本身可刺激诱导骨髓间充质细胞的增殖和成骨分化,具有促进成骨细胞黏附、生长和分化的效果[6];(2)多孔径的结构有利于羟基磷灰石的沉积,可促进新生骨矿化;(3)相较其他孔径材料,MSN结晶度低,具有最佳的生物降解性和生物相容性;(4)可局部控释抗生素,适合战创性感染性骨缺损的填补;(5)机械支撑力较强,一定程度上可避免骨折移位和二次骨折的发生。有研究发现,在药物和生长因子双重因素的干预下,骨缺损修复材料能够显示出最好的促骨生成效果[6]。骨形态发生蛋白-2(bone morphogenetic protein 2,BMP-2)和地塞米松等促骨生成因子释放不当会导致异位成骨现象,BMP-2释放速率过高还会导致骨溶解和骨形成抑制,而通过MSN负载可实现此类骨生成因子的控释[6]。Zhou等[33]制备的氨化-MSN纳米材料,其表面的氨基可以与BMP-2相互结合,而介孔内可搭载地塞米松,解决了两种促骨生成因子同时搭载的技术问题。Prokopowicz等[30]将羟基磷灰石与MSN结合制备成MSN复合骨修复材料,进一步增强了MSN复合材料的促进骨再生的作用。另外,MSN孔径大小易调节,经过调控的MSN在体内降解的时间约为3个月,与机体新生骨的生成速度相适应,可以在新骨生成之时自行降解[34]。经过3D打印等技术生产的MSN复合材料还具备分子筛的功能,可以将成纤维细胞等其他组织隔绝,减少骨不连的发生。
依据不同需求制备出多层、中空、管状或有机-无机结合等杂化MSN复合骨缺损修复材料,使其兼具骨缺损修复和局部缓释抗感染治疗的功能,可降低作战人员因战创感染性骨缺损而导致的残疾率,在一定程度上减轻战地医疗资源负担。
虽然MSN被广泛用于食品添加剂和化妆品中,但截至目前,美国食品和药物管理局尚未批准任何一款MSN产品用于医药领域,首要原因为该材料在体内的生物分布、代谢机制尚不明确[35],且缺少足量有效的临床试验。其次,MSN的孔径虽然可调控,但目前几乎没有任何的粒子制造技术能够做到对其一次性独立改变一个变量,并监控每个变量的效果。作为一种军用材料,MSN的生物安全性与制备技术均需进一步提升。
MSN在实验动物体内的降解时间从几小时到几周不等,目前已知通过调节其孔径及比表面积可影响MSN材料的溶解速率,但尚不能依据孔径大小和比表面积来精确计算进而控制其降解速率,另外,是否有其他影响代谢速率的因素尚待明确。有研究发现,MSN材料的药物代谢速率具有pH依赖性[36],战伤性骨创伤部位pH与MSN释放速率的相互关系有待进一步探索。
MSN在生物体内主要以硅酸或低聚硅石的形式被自身吸收或经尿液排出[37],MSN颗粒皮下注射无毒性,生物相容性良好,但是静脉内、腹膜内注射则会导致实验动物因肺栓塞而死亡[38]。Cheng等[39]发现,MSN材料所携带的表面电荷对肝脏胆汁排泄率会产生一定的影响,带正电荷的MSN复合材料颗粒在肝脏中累积,经粪便排泄;而带负电荷的MSN复合材料颗粒则会被库普弗细胞吸收,并导致肝毒性。掺入银、钙和铜离子等金属离子的MSN复合材料虽然可以明显抑制金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌等细菌的活性,但在战场上大剂量使用后,高剂量的金属离子释放入体则会产生细胞毒性,因此,在抗菌活性和生物安全性之间需要权衡。
成骨细胞大小为10~50 μm,研究显示,成骨细胞在100~200 μm的孔径材料上更容易产生矿化骨,此孔径范围允许巨噬细胞浸润,可诱导与血管形成有关的细胞定植、迁移和浸润,同时可消除细菌和其他体外微生物的定植[40-41]。经过调控和修饰的MSN具备六角形、立方形、同心形、泡沫状、放射状或蠕虫状等多种孔型[27,42],但其与战伤性骨创伤救治相匹配的孔径和材料形状尚不明确。Huang等[43]研究发现,与其他形状相比,球形MSN颗粒可使细胞迁移速度更快,更能促进细胞黏附,似乎更适合用作骨组织工程材料,但仍需进一步考证。因此,无论是将MSN制备成微球、薄膜还是纳米管状等任何形式的复合材料,产品的孔径和形状均应纳入考虑。
MSN作为一种新型战伤性骨创伤救治材料,具有许多传统战伤性骨创伤救治材料不具备的优点,但包括MSN在内的任何一种单一材料都无法同时应对战伤性骨创伤导致的严重出血和感染性骨缺损等复杂状况。对MSN进行研究不应仅局限于其本身性能的开发,而且应基于其易修饰的特性,结合传统或者其他新型骨伤救治材料的优势,开发出多功能复合材料。在制备工艺上,MSN材料应针对可压缩、轻便易携带的军需品特征进行改良,使其像传统军用止血粉一样简单易操作,可单兵装备自我急救。尽早地将MSN复合材料应用于战场上,以降低现代战争中作战人员因战伤性骨创伤救治不良导致的死亡率和残疾率,是军用MSN复合材料研究和探索的最终目的。
  • 国家自然科学基金(81371983)
  • 全军后勤科研计划面上项目(CWH17J009)
  • 兰州市人才创新创业项目(2019-RC-65)
  • 中央高校基本科研业务费专项资金(31920200018)
  • 全军医学科技青年培育计划(19QNP047)
  • 甘肃省青年科技基金(18JR3RA410)
  • 甘肃省卫生行业科研计划项目(GSWSKY2018-21)
  • 甘肃省卫生行业科研计划项目(GSWSKY2019-94)
  • 陕西省自然科学基金(2020JM-339)
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2021年第46卷第2期
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doi: 10.11855/j.issn.0577-7402.2021.02.11
  • 接收时间:2020-11-14
  • 首发时间:2025-12-26
  • 出版时间:2021-02-28
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  • 收稿日期:2020-11-14
  • 修回日期:2020-12-24
基金
National Natural Science Foundation of China(81371983)
国家自然科学基金(81371983)
Military Logistics Research Project(CWH17J009)
全军后勤科研计划面上项目(CWH17J009)
Lanzhou Talent Innovation and Entrepreneurship Project(2019-RC-65)
兰州市人才创新创业项目(2019-RC-65)
Fundamental Research Funds for the Central Universities(31920200018)
中央高校基本科研业务费专项资金(31920200018)
Military Medical Science and Technology Youth Development Program(19QNP047)
全军医学科技青年培育计划(19QNP047)
Youth Science and Technology Foundation of Gansu Province(18JR3RA410)
甘肃省青年科技基金(18JR3RA410)
Health Industry Research Plan Project of Gansu Province(GSWSKY2018-21)
甘肃省卫生行业科研计划项目(GSWSKY2018-21)
Health Industry Research Plan Project of Gansu Province(GSWSKY2019-94)
甘肃省卫生行业科研计划项目(GSWSKY2019-94)
Natural Science Foundation of Shaanxi Province(2020JM-339)
陕西省自然科学基金(2020JM-339)
作者信息
    1甘肃中医药大学第一临床医学院,兰州 730030
    2解放军联勤保障部队第940医院全军骨科中心关节科,兰州 730050
    3哈尔滨医科大学附属第一医院呼吸内科,哈尔滨 150001
    4山东第一医科大学研究生部,济南 250000
    5解放军联勤保障部队第940医院泌尿外科,兰州 730050
    6西安交通大学第二附属医院骨科,西安 710000

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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