糊状纳米级羟基.ppt

1、Hydroxylapatite nanoparticles gel as a bone substitute 糊状纳米级羟基 磷灰石骨填充物,C SCHWARTZ, R BORDEI, S MALINCENCO 创伤骨科 巴斯德医院, 科尔玛( 法国) E DINGELDEIN aap, 柏林(德国),INTRODUCTION 介绍,Biphasic ceramics are effective but not easy to use in certain circumstances 双相陶瓷效果可以，但有时使用不方便。 Phospho-calcic cements are more prac

2、tical but less bioactive 含磷钙的产品比较实用， 但不具有生物活性。 It remains to find a injectable and bioactive substitute even osteo-inductive. 临床上需要一种可注射的具有生物活性， 甚至是骨诱导性的骨填充物。,METHODS 方法,50 proximal tibial open-wedge osteotomies 50例胫骨近端开放楔形截骨术 Oct. 02 to Feb. 04 2002年10月-2004年2月 Etiology : 病因 Especially Arthritis 48

3、 cases 主要为关节炎48例 Post trauma. 2 cases 创伤 2例 23 F - 24 M (47 cases with 3 bilateral) 47例双侧 Age: 39 to 68 (average 51 years) 年龄：39-68（平均51） Follow-up 1 year (12 to 38 months) 跟踪1年( 12-38月）,Pre-operative axis : varus 3 to 14 术前轴线：内翻 3-14 The goal is a valgus about 3: 目标：外翻约3 (average correction = 8,7)

4、平均矫正= 8.7,Controls : 6 w, 3 m, 6 m and 1 year . 对比时间：6周，3月，6月和1年,Surgical Procedure 手术步骤,Wedge 楔形开口,Surgical Procedure 手术步骤,HA nanoparticles suspensionin water ( 35 % ) HA纳米微粒悬浮液 （35%HA,65%水） White injectable paste 白色糊状，可直接注射 Gamma sterilization 伽马射线消毒,METHODS 方法,CHARACTERISATION 特点,Precipitation wi

5、thout fretting沉淀法制取，无高温烧结 分子式: Ca10(PO4)6(OH)2=HA羟基磷灰石 Ca/P 钙/磷原子比：(1,62-1,73) 1,675 Specific surface 有效表面积: 106 m2/g，比硫酸钙大30-50倍 Crystallites size微晶大小:18 nm (2 Theta = 25) pH值: 7,5 ( 7,2 - 7,8),CLINICAL RESULTS 临床结果(superposable with those of the other addition techniques ),Pain 疼痛: - None or light

6、无或轻微 = 88 % Moderated中= 9 % ; Severe严重 = 3 % Walk行走 : - unlimited不受限 = 31例 1-5 Km = 14例 ; 1Km = 2例 Use of sticks拄拐 : none无 = 45 ; one一支 = 2,RADIOLOGICAL RESULTS X线结果,ALL CONSOLIDATED 全部愈合 in 6 to 10 weeks 6-10周时间 except 2 delayed, 只有2例延迟 treated by immobilization during 2 months 制动2个月,Vaxe PO,延迟愈合病例

7、,Standard evolution标准进展,3 Y,Other example 其它病例,6 M,9 M,Other example其它病例,5 M,COMPLICATIONS并发症,No pseudarthrosis, 2 consolidation delayed 无假关节，2例愈合延迟 No infection but 无感染 4 x asymptomatic light seepage 4例无症状体液轻微渗出 which dries itself up in 15 to 20 days without any treatment. 无须治疗15-20天自行干燥,BIOPSY活检,C

8、 Schwartz, 科尔玛 E Dingeldein, aap,BIOPSY 活检, 6 months 6个月 osteoblasts line成骨细胞 89% osteoblasts alive 89%成骨细胞存活,HES, x 100,HES, x 200,C Schwartz, 科尔玛 C Sattonnet, Cagnes,奥速特,新生骨,新生骨,奥速特,成骨细胞,成骨细胞,OSTIM resorption奥速特的吸收,The resorption is done by macrophages which invade the site. 巨噬细胞侵入，实现降解,x7797,X 29

9、371,C Schwartz, 科尔玛 E Dingeldein, aap,奥速特,Details macrophage巨噬细胞放大图,奥速特吸附了蛋白质，所以颜色较深,New bone formation 新骨生成micro-vascular invasion and fast colonization by pro osteoblasts then differentiation of those with collagen fiber deposit.微血管迅速入侵，骨形成细胞快速增殖，分化为成骨细胞，进而产生胶原纤维。,O,New vessels新生血管,x 11362,C Schwa

10、rtz, 科尔玛 E Dingeldein, aap,new bone formation 新骨生成,At the proximity one finds collagen having been synthesized by osteoblasts.临近处可见胶原质已被成骨细胞合成。,C Schwartz, 科尔玛 E Dingeldein, aap,O,C,C,X 7797,osteoid类骨质,osteoid 类骨质,胶原质,胶原质,DENSIFICATION:密度增加： Why?为什么？,Biopsy powder: milling under liquid azote and lyo

11、philisation to eliminate water and alcohol. 活检粉末：在液氮下研磨，使用冻干法去除水分和乙醇。 The diagram is that of a well crystallized apatite (too good compared to diagram of a traditional bone where peaks located in the neighbourhoods of 40 in 2 tta are in general with difficulty dissociable),OSTIM PASTE,使用奥速特1年后活检,XRD,奥速特,自然骨骼,CONCLUSIONS 结论,The clinical and radiological results are comparable with the serie