糊狀納米級(jí)羥基課件

Hydroxylapatite

nanoparticlesgelasabonesubstitute糊狀納米級(jí)羥基磷灰石骨填充物CSCHWARTZ,

RBORDEI,SMALINCENCO

創(chuàng)傷骨科巴斯德醫(yī)院,科爾瑪(法國(guó))EDINGELDEINaap,柏林(德國(guó))INTRODUCTION介紹Biphasicceramicsareeffectivebutnoteasytouseincertaincircumstances雙相陶瓷效果可以，但有時(shí)使用不方便。Phospho-calciccementsaremorepracticalbutlessbioactive含磷鈣的產(chǎn)品比較實(shí)用，但不具有生物活性。Itremainstofindainjectableandbioactivesubstituteevenosteo-inductive.臨床上需要一種可注射的具有生物活性，甚至是骨誘導(dǎo)性的骨填充物。METHODS方法50proximaltibialopen-wedgeosteotomies50例脛骨近端開(kāi)放楔形截骨術(shù)Oct.02toFeb.042002年10月-2004年2月Etiology:病因EspeciallyArthritis

48cases

主要為關(guān)節(jié)炎48例Posttrauma.2cases創(chuàng)傷2例23F-24M(47caseswith3bilateral)

47例雙側(cè)Age:39to68(average51years)年齡：39-68（平均51）Follow-up>1year(12to38months)

跟蹤>1年(

12-38月）Pre-operativeaxis:varus3°to14°術(shù)前軸線：內(nèi)翻3°-14°Thegoalisavalgusabout3°:目標(biāo)：外翻約3°

(averagecorrection=

8

,7°)平均矯正=8.7°Controls

:6w,3m,6mand1year

.對(duì)比時(shí)間：6周，3月，6月和1年SurgicalProcedure

手術(shù)步驟Wedge楔形開(kāi)口SurgicalProcedure

手術(shù)步驟CLINICALRESULTS臨床結(jié)果

(superposablewiththoseoftheotheradditiontechniques)Pain疼痛:-Noneorlight無(wú)或輕微

=88%

Moderated中=9%;Severe嚴(yán)重=3%Walk行走

:

-unlimited不受限=31例

1-5Km=14例;<1Km=2例

Useofsticks拄拐

:

none無(wú)=45;one一支

=2

RADIOLOGICALRESULTS

X線結(jié)果ALLCONSOLIDATED全部愈合

in6to10weeks

6-10周時(shí)間

except2delayed,

只有2例延遲

treatedby

immobilizationduring2months制動(dòng)2個(gè)月VaxePO延遲愈合病例

Standardevolution標(biāo)準(zhǔn)進(jìn)展3YOtherexample

其它病例6M9MOtherexample其它病例5MCOMPLICATIONS并發(fā)癥Nopseudarthrosis,2consolidationdelayed無(wú)假關(guān)節(jié)，2例愈合延遲Noinfectionbut無(wú)感染

4xasymptomaticlightseepage

4例無(wú)癥狀體液輕微滲出

whichdriesitselfupin15to20dayswithoutanytreatment.無(wú)須治療15-20天自行干燥

BIOPSY活檢

CSchwartz,科爾瑪EDingeldein,aap奧速特奧速特奧速特類骨質(zhì)成骨細(xì)胞新生骨新生骨奧速特奧速特類骨質(zhì)成骨細(xì)胞

BIOPSY活檢,6months6個(gè)月

osteoblasts

line成骨細(xì)胞

89%osteoblastsalive89%成骨細(xì)胞存活HES,x100HES,x200CSchwartz,科爾瑪CSattonnet,Cagnes奧速特新生骨新生骨奧速特成骨細(xì)胞成骨細(xì)胞OSTIM?resorption奧速特?的吸收Theresorptionisdonebymacrophageswhichinvadethesite.巨噬細(xì)胞侵入，實(shí)現(xiàn)降解x7797X29371CSchwartz,科爾瑪EDingeldein,aap奧速特Detailsmacrophage

巨噬細(xì)胞放大圖奧速特吸附了蛋白質(zhì)，

所以顏色較深New

bone

formation

新骨生成

micro-vascularinvasionandfastcolonizationbyproosteoblaststhendifferentiationofthosewithcollagenfiberdeposit.

微血管迅速入侵，骨形成細(xì)胞快速增殖，分化為成骨細(xì)胞，進(jìn)而產(chǎn)生膠原纖維。

ONewvessels

新生血管x11362CSchwartz,科爾瑪EDingeldein,aapnew

boneformation

新骨生成Attheproximityonefindscollagenhavingbeensynthesizedbyosteoblasts.

臨近處可見(jiàn)膠原質(zhì)已被成骨細(xì)胞合成。CSchwartz,科爾瑪EDingeldein,aapOCCX7797osteoid類骨質(zhì)osteoid類骨質(zhì)膠原質(zhì)膠原質(zhì)DENSIFICATION:密度增加：

Why?為什么？Biopsy>>>powder:millingunderliquidazoteandlyophilisationtoeliminatewaterandalcohol.

活檢>>>粉末：在液氮下研磨，使用凍干法去除水分和乙醇。Thediagramisthatofawellcrystallizedapatite

(toogoodcomparedto

diagram

ofatraditionalbone

wherepeaks

located

intheneighbourhoodsof

40°in2tétaareingeneral

withdifficulty

dissociable)OSTIMPASTE使用奧速特1年后活檢XRD奧速特自然骨骼CONCLUSIONS結(jié)論Theclinicalandradiologicalresultsare

comparablewiththeseries