HydroxylapatiteHydroxylapatite nanoparticlesnanoparticles gel as a bone gel as a bone substitutesubstitute糊状纳米级羟基糊状纳米级羟基磷灰石骨填充物磷灰石骨填充物C SCHWARTZ, R BORDEI, S MALINCENCOR BORDEI, S MALINCENCO 创伤骨科创伤骨科创伤骨科创伤骨科 巴斯德医院巴斯德医院巴斯德医院巴斯德医院, , 科尔玛科尔玛科尔玛科尔玛( ( 法国法国法国法国) )E DINGELDEIN E DINGELDEIN aap, aap, 柏林柏林柏林柏林( (德国德国德国德国) )INTRODUCTION介绍BiphasicBiphasicceramicsareeffectivebutnoteasytouseincertaincircumstancesceramicsareeffectivebutnoteasytouseincertaincircumstances双相陶瓷效果可以，但有时使用不方便。Phospho-calciccementsaremorePhospho-calciccementsaremorepracticalpracticalbutlessbioactivebutlessbioactive含磷钙的产品比较实用，但不具有生物活性。ItremainstofindainjectableandbioactivesubstituteItremainstofindainjectableandbioactivesubstituteevenosteo-inductive.evenosteo-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 方法方法 50 proximal tibial open-wedge osteotomies50 proximal tibial open-wedge osteotomies50例胫骨近端开放楔形截骨术例胫骨近端开放楔形截骨术 Oct. 02 to Feb. 04 Oct. 02 to Feb. 04 2002年10月-2004年2月 Etiology : Etiology : 病因病因 EspeciallyEspecially Arthritis Arthritis 48 cases48 cases 主要为主要为关节炎关节炎48例例 Post trauma. 2 cases Post trauma. 2 cases 创伤创伤 2例例 23 F - 24 M (47 cases with 3 bilateral)23 F - 24 M (47 cases with 3 bilateral) 47例双侧例双侧 Age: 39 to 68 Age: 39 to 68 ( (average average 51 51 yearsyears) ) 年龄：年龄：年龄：年龄：39-6839-68（平均（平均（平均（平均5151） Follow-up 1 yearFollow-up 1 year (12 to 38 months) (12 to 38 months) 跟踪跟踪1年年( 12-38月）月）Pre-operativeaxis:varus3to14术前轴线：内翻3-14Thegoalisavalgusabout3:目标：外翻约3(averagecorrection=8,7)平均矫正=8.7Controls:6w,3m,6mand1year.对比时间：6周，3月，6月和1年Surgical Procedure 手术步骤手术步骤Wedge楔形开口Surgical Procedure 手术步骤手术步骤HAnanoparticlessuspensioninwater(35%)HA纳米微粒悬浮液（35%HA,65%水）Whiteinjectablepaste白色糊状，可直接注射Gammasterilization伽马射线消毒METHODS 方法方法CHARACTERISATION 特点特点 PrecipitationwithoutfrettingPrecipitationwithoutfretting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 surfaceSpecific surface 有效表面积有效表面积: 106 m2/g，比硫酸钙大比硫酸钙大30-50倍倍 CrystallitessizeCrystallitessize微晶大小:18nm(2 Theta = 25)(2 Theta = 25)pH值:7,5(7,2-7,8)CLINICAL RESULTS 临床结果临床结果(superposable with those of the other addition techniques )Pain 疼痛疼痛:-None or light无或轻微无或轻微= 88 % Moderated中中= 9 % ; Severe严重严重 = 3 %Walk行走行走: -unlimited不受限不受限 = 31例例 1-5Km=141-5Km=14例例 ;1Km=2; powder: milling under liquid azote and lyophilisation 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 apatiteThe 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 PASTEOSTIM PASTE使用奥速特使用奥速特使用奥速特使用奥速特1 1年后活检年后活检年后活检年后活检XRD奥速特奥速特自然骨骼自然骨骼CONCLUSIONS 结论结论The clinical and radiological results are The clinical and radiological results are The clinical and radiological results are comparable with the series with autograft or biphasiccomparable with the series with autograft or biphasiccomparable with the series with autograft or biphasic临床与临床与临床与临床与X X线结果表明奥速特线结果表明奥速特线结果表明奥速特线结果表明奥速特骨愈合速度与自体骨移植文献相当骨愈合速度与自体骨移植文献相当骨愈合速度与自体骨移植文献相当骨愈合速度与自体骨移植文献相当The application of the substitute is easier and faster that The application of the substitute is easier and faster that The application of the substitute is easier and faster that those of granules of ceramicsthose of granules of ceramicsthose of granules of ceramics奥速特使用比颗粒状陶瓷更加简单快捷奥速特使用比颗粒状陶瓷更加简单快捷奥速特使用比颗粒状陶瓷更加简单快捷奥速特使用比颗粒状陶瓷更加简单快捷Thankyou!谢谢！