1、Hydroxylapatite nanoparticles gel as a bone substitute 糊狀納米級羥基 磷灰石骨填充物,C SCHWARTZ, R BORDEI, S MALINCENCO 創(chuàng)傷骨科 巴斯德醫(yī)院, 科爾瑪( 法國) E DINGELDEIN aap, 柏林(德國),INTRODUCTION 介紹,Biphasic ceramics are effective but not easy to use in certain circumstances 雙相陶瓷效果可以，但有時使用不方便。 Phospho-calcic cements are more prac

2、tical but less bioactive 含磷鈣的產(chǎn)品比較實用， 但不具有生物活性。 It remains to find a injectable and bioactive substitute even osteo-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,50 proximal tibial open-wedge osteotomies 50例脛骨近端開放楔形截骨術(shù) Oct. 02 to Feb. 04 2002年10月-2004年2月 Etiology : 病因 Especially Arthritis 48

3、 cases 主要為關(guān)節(jié)炎48例 Post trauma. 2 cases 創(chuàng)傷 2例 23 F - 24 M (47 cases with 3 bilateral) 47例雙側(cè) Age: 39 to 68 (average 51 years) 年齡：39-68（平均51） Follow-up 1 year (12 to 38 months) 跟蹤1年( 12-38月）,Pre-operative axis : varus 3 to 14 術(shù)前軸線：內(nèi)翻 3-14 The goal is a valgus about 3: 目標(biāo)：外翻約3 (average correction = 8,7)

4、平均矯正= 8.7,Controls : 6 w, 3 m, 6 m and 1 year . 對比時間：6周，3月，6月和1年,Surgical Procedure 手術(shù)步驟,Wedge 楔形開口,Surgical Procedure 手術(shù)步驟,HA nanoparticles suspensionin water ( 35 % ) HA納米微粒懸浮液 （35%HA,65%水） White injectable paste 白色糊狀，可直接注射 Gamma sterilization 伽馬射線消毒,METHODS 方法,CHARACTERISATION 特點,Precipitation wi

5、thout fretting沉淀法制取，無高溫?zé)Y(jié) 分子式: Ca10(PO4)6(OH)2=HA羥基磷灰石 Ca/P 鈣/磷原子比：(1,62-1,73) 1,675 Specific surface 有效表面積: 106 m2/g，比硫酸鈣大30-50倍 Crystallites size微晶大小:18 nm (2 Theta = 25) pH值: 7,5 ( 7,2 - 7,8),CLINICAL RESULTS 臨床結(jié)果(superposable with those of the other addition techniques ),Pain 疼痛: - None or light

6、無或輕微 = 88 % Moderated中= 9 % ; Severe嚴(yán)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無 = 45 ; one一支 = 2,RADIOLOGICAL RESULTS X線結(jié)果,ALL CONSOLIDATED 全部愈合 in 6 to 10 weeks 6-10周時間 except 2 delayed, 只有2例延遲 treated by immobilization during 2 months 制動2個月,Vaxe PO,延遲愈合病例

7、,Standard evolution標(biāo)準(zhǔn)進(jìn)展,3 Y,Other example 其它病例,6 M,9 M,Other example其它病例,5 M,COMPLICATIONS并發(fā)癥,No pseudarthrosis, 2 consolidation delayed 無假關(guān)節(jié)，2例愈合延遲 No infection but 無感染 4 x asymptomatic light seepage 4例無癥狀體液輕微滲出 which dries itself up in 15 to 20 days without any treatment. 無須治療15-20天自行干燥,BIOPSY活檢,C

8、 Schwartz, 科爾瑪 E Dingeldein, aap,BIOPSY 活檢, 6 months 6個月 osteoblasts line成骨細(xì)胞 89% osteoblasts alive 89%成骨細(xì)胞存活,HES, x 100,HES, x 200,C Schwartz, 科爾瑪 C Sattonnet, 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,The resorption is done by macrophages which invade the site. 巨噬細(xì)胞侵入，實現(xiàn)降解,x7797,X 29

9、371,C Schwartz, 科爾瑪 E Dingeldein, aap,奧速特,Details macrophage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-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。,O,New vessels新生血管,x 11362,C Schwa

10、rtz, 科爾瑪 E Dingeldein, aap,new bone formation 新骨生成,At the proximity one finds collagen having been synthesized by osteoblasts.臨近處可見膠原質(zhì)已被成骨細(xì)胞合成。,C Schwartz, 科爾瑪 E Dingeldein, aap,O,C,C,X 7797,osteoid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: milling under liquid azote and lyo

11、philisation to eliminate water and alcohol. 活檢粉末：在液氮下研磨，使用凍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,使用奧速特1年后活檢,XRD,奧速特,自然骨骼,CONCLUSIONS 結(jié)論,The clinical and radiological results are comparable with the serie