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頁籤選單縮合
題名 | 全人工關節置換術的生醫材料 |
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作 者 | 蔡清霖; | 書刊名 | 醫學工程 |
卷期 | 6:4 1994.08[民83.08] |
頁次 | 頁110-117 |
專輯 | 生醫材料在臨床上的問題 |
分類號 | 416.61 |
關鍵詞 | 生醫材料; 全人工關節置換術; 附著; 磨損; Biomaterial; Total joint replacement; Attachment; Wear; |
語文 | 中文(Chinese) |
中文摘要 | 金屬和合金、聚合物、陶瓷、碳、其結合物(combination)、以及混合物(composite)都被用來作為全人工關節置換術(TJR)所用的生醫材料,目前的設計仍未臻完美。在年輕人和活動力較強的病人,植入物在體內的壽命是一個顧慮的問題,因此人工關節的長期功能仍受到限制。人工關節生醫材料的性質和功能的交互作用,有關的強度和可能的極限,均值得探討。人工關節曾經發生組織支撐鬆脫、移動、疼痛,以及有些植入物需要重置換;而磨損碎屑可能是引起骨蝕(osteolysis)的主要原因。骨科植入物沒有所謂是最好的材料,每一種材料有其特殊的性質,而每一類性質在植入物的設計上都有優點和局限性。目前,只要能減少不良的生醫材料後遺症,就能維持功能設計上的效果;但若要延長壽命二到四倍,則可能需要新一代的生醫材料,設計,以及治療模式。在生醫材料科學中,應該發展出新一代的混合物,其化學和機械性質是非等向的(anisotropic),較像欲置換的組織,是三向性的(three-dimensional),能穩定地結合在活組織上,並減少生物分解(biodegradation)和磨損碎屑。利用表面處理和併用高抗磨損的材料來製作人工關節,也可能使磨損碎屑減到最少。另外,從評估組織和植入物的生物機械性質,分析元素和力量在植入物上以及透過組織接觸面的作用,研究其相關的生物相容性,可能進一步找出可以改善的地方,甚或發明新系統的全人工關節。 |
英文摘要 | The use of orthopaedic implants is growing rapidly in both number and sophistication. Metals and alloys, ceramics, carbons, polymers, combinations and composites are all being used as biomaterials for total joint replacement (TJR) devices. Limitations associated with long-term function in younger and more active patients have resulted in concern about existing longevities. In this regard, properties and functional interactions have been reviewed to assess some of the relative magnitudes and possible limitations. Wear, which has been implicated as the major cause of osteolysis, is emerging as the principal limit on successful long-term fixation of total joint components, whereas aseptic loosening has resulted in loss of tissue support loss of motion, pain, and device revisions. Up to now, there exists no material in the world whose properties are considered optimal for the production of orthopaedic implants. As it stands, each material, with its specific property determined by its composition and processing technique, carries with it an inherent set of disadvantages as well as advantages in implant design. Current theories suggest that three-dimensional composites with anisotropic property similar to the tissues being replaced are still under investigation, whereas biochemical bonding to tissues could help to optimize conditions of force transfer, tissue maintenance, and function. Surface modifications and combinations of highly wear-resistant biomaterials for articulation could also result in minimal magnitudes of wear-based debris. Through the continuation of clinical observation and selection of devices most suitable for the individual needs of each patient, progress in biomaterials and technological developments will continue to successful contribute to orthopaedic surgery. |
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