Kafukufuku Watsopano Wapeza Kuti Ma Implants Achipatala a Titanium Akugwira Ntchito Kwambiri

3D kusindikiza titaniyamu ndondomeko

Poyerekeza ndi ndondomeko chikhalidwe, ubwino 3D luso kusindikiza kupanga payekha opangira opaleshoni implants ziwerengero makamaka zimaonekera mu: 3D kusindikiza ufulu kupanga makhalidwe akhoza mwamsanga ndi molondola makonda mkati implant, akhoza kugonjetsa chikhalidwe chilengedwe chonse implants chifaniziro mawonekedwe ndi zosemphana ndi thupi la munthu ndi katundu wake makina si mpaka mavuto muyezo; Popanga zinthu zovuta komanso zovuta kuzikonza, ma microstructures, makamaka porous kudzera m'mapangidwe, sangathe kukumana ndi zinthu zenizeni zakuthupi ndi zamankhwala, komanso amathandizira kuyanjana kwa biohistocompatibility.

Ubwino wotsatirawu utha kuthana ndi zovuta zomwe zimafala kwambiri pakuteteza kupsinjika komanso kuchepa kwachilengedwe kwa ma implants. Pakalipano, zogwiritsidwa ntchito kwambiri komanso zogwiritsidwa ntchito kwambiri za 3D zosindikizira titaniyamu ndi luso la SLM ndi luso la EBM.

Selective Laser Melting (SLM) imagwiritsa ntchito laser ngati gwero la kutentha kuti isungunuke mwadala zida za ufa zomwe zidayikidwa kale kuti zitheke kusungunuka mwachangu. Mfundo yaikulu yogwirira ntchito ndi yakuti pansi pa malo otetezera gasi a inert, chida ndi zida zimayang'anira mtengo wa laser molingana ndi njira yojambulira yodzaza yomwe imapangidwa ndi dongosolo la mapangidwe a dongosolo kuti asankhe ndi kusungunula wosanjikiza uliwonse wa ufa.

Ndiye nsanja imasunthidwa pansi, ufa umayikidwanso ndipo sintering imabwerezedwa mpaka mawonekedwe onse apangidwe. Kutetezedwa kwa mpweya wa inert kumalepheretsa chitsulo kuti zisagwirizane ndi mpweya wina pa kutentha kwakukulu. Tekinoloje ya SLM ndimitundu yambiri yopangira zinthu, kupulumutsa zinthu komanso kubwezerezedwanso, siziyenera kupanga ndikukonzekera dongosolo lothandizira, mndandanda waubwino uwu umapangitsa ukadaulo wa SLM kugwiritsidwa ntchito kwambiri.

Komabe, SLM imakhalanso ndi zovuta zina: chifukwa cha mphamvu yochepa ya laser ndi kusanthula galvanometer kupotoza Angle, kukula kwa magawo okonzedwa ndi SLM adzakhala ochepa; Ma lasers amphamvu kwambiri komanso zida zapamwamba zowoneka bwino ndizokwera mtengo kupanga, zomwe zimawonjezera zovuta zachuma kumlingo wina. Chifukwa cha kugwiritsa ntchito zipangizo za ufa mu teknoloji ya SLM, khalidwe lapamwamba la magawo opangidwa likhoza kukhala lovuta, lomwe limafuna kukonzanso kwachiwiri kwa mankhwala kuti agwiritsidwe ntchito pa ntchito yotsatira; Spheroidization ndi warping zolakwika zikhoza kuchitika pokonza ndondomeko, zomwe zimafuna sitepe ina kuti mosamalitsa kukhathamiritsa ndondomeko processing Electron mtengo kusungunuka, EBM ndi ndondomeko ntchito elekitironi mtengo monga gwero kutentha kusungunula zitsulo ufa wosanjikiza wosanjikiza mu zingalowe chilengedwe kupanga zowonjezera kupanga.

Mfundo yake yogwira ntchito ndi: ufa chisanadze TACHIMATA, mkulu-mphamvu elekitironi mtengo kupatuka pambuyo molunjika kutulutsa mphamvu mkulu m'dera ang'onoang'ono jambulani wosanjikiza ufa kupanga kutentha kwambiri ndipo ngakhale kusungunula, kudzera elekitironi mtengo mosalekeza kupanga sikani kupanga mphamvu pakati pa Sungunulani dziwe maphatikizidwe ndi kulimba, olumikizidwa mu liniya ndi planar wosanjikiza zitsulo.

Mukamaliza wosanjikiza panopa, kubwereza ufa atagona ntchito kupanga. Popanga, EBM imatenga malo enieni osungunuka mpweya kuti zitsimikizire kulimba kwazinthuzo ndikupewa makutidwe ndi okosijeni wa alloy. Poyerekeza ndi SLM, ubwino waukulu wa EBM ndi: kutulutsa bwino kwa mphamvu ya electron beam kumawononga mphamvu zochepa, liwiro la kupanga ndilokwera, kotero kuti mphamvu yeniyeni ya makina onse ndi apamwamba; Kupatuka kwa mtengo wa ma elekitironi sikuyenera kusuntha gawo la zida, zomwe zimawonjezera liwiro la sikani. Malo abwino otentha amatsimikizira kukhazikika kwa mawonekedwe a magawo osindikizidwa a 3D, amaonetsetsa kuti makina ake osasunthika, amakwaniritsa zofunikira zamoyo, ndipo ufa wachitsulo ukhoza kubwezeretsedwanso.

Mkhalidwe ndi kupita patsogolo kwa ma implants osindikizidwa a 3D

Ma implants opangira opaleshoni ndi ma orthotics okhala ndi kusindikiza kwa 3D ali ndi chiyembekezo chogwiritsa ntchito bwino pankhani ya mafupa. Tsopano pali ochulukirapoZida za implant zosindikizidwa za 3Dmonga kumva Edzi, ziwalo zobisika, maupangiri opangira maopaleshoni amunthu payekha, malo opangira mafupa, makutu ochita kupanga, ma implants a mano ndi zina zomwe zimagwiritsidwa ntchito pochiza munthu payekha. Malinga ndi malipoti, mu 2014, ofufuza pa yunivesite ya Peking bwinobwino anaikapo 12 wazaka mnyamata ndi payekha 3D kusindikizidwa yokumba msana ndi yaying'ono-mabowo, umene unali mlandu woyamba mu dziko. M’chaka chomwecho, madokotala ndi asayansi anaika msungwana wazaka 5 ku Scotland kachidindo ka 3D ka prosthetic.

Stomatology Specialty Center ya 411th Hospital of the People's Liberation Army idagwiritsa bwino ntchito ukadaulo wa EBM kupanga makonda ndikuyika mandibular titanium alloy implant yokhala ndi kayeseleledwe kake ka thupi kwa wodwala hemimaxillary resection. Pa opaleshoni, resection wa matenda mandible ndi munthu payekha ntchito kukonza anamalizidwa nthawi imodzi, ndi chilema mandible anakonzedwa payekha ndi kumangidwanso. Zotsatira za postoperative zinali zokhutiritsa. Lethaus B ndi ofufuza ena adagwiritsa ntchito ukadaulo wosindikiza wa 3D kuti amangenso mafupa ndi ma microvascular flaps mwa odwala 20 okhala ndi mandibular resection, omwe adafupikitsa nthawi ya opaleshoni ndikuwongolera magwiridwe antchito, ndipo zotsatira za postoperative zinali zabwino. M'zaka zaposachedwa, nkhani zofananira ndi kafukufuku zakhala zikutuluka mosalekeza, zomwe zikuwonetsa bwino chiyembekezo chakugwiritsa ntchito kusindikiza kwa 3D m'chipatala.

Kumbali ya mankhwala a mafupa, zida za 3D zosindikizidwa zopangira opaleshoni zikuyendanso pang'onopang'ono kumalonda ndi malonda. Mu 2007, makapu a 3D osindikizidwa a acetabulum okhala ndi scaffolders olimba opangidwa ndi kampani yaku Italy Adler Ortho ndi LIma-LTO adapereka chiphaso cha CE. Zogulitsa za Exactech zidavomerezedwa ndi FDA mu 2010. Mu 2009, chipangizo chophatikizira chamagulu onse a titaniyamu chopangidwa ndi kampani yaku America ya AMT pogwiritsa ntchito kusindikiza kwa 3D chidapambananso chiphaso cha EU CE. Mu 2013, choyikapo choyamba cha chigaza cha bioprinted ku United States chinavomerezedwa ndi FDA, chomwe chilinso chojambula choyamba cha 3D chosindikizidwa cha PEEK cha chigaza cha 3D.

Pamaziko awa, mu 2014, United States Oxford Company inalandira chilolezo cha FDA cha 3D printing maxillofacial bone products (5IOK mode). Kuphatikiza apo, akuti mu Seputembala 2015, cholumikizira cha 3D chosindikizidwa cha 3D - cholumikizira mchiuno chopanga chopangidwa ndi Chipatala Chachitatu cha Beijing Medicine ndi Beijing Aikang Yicheng Medical Equipment Co., LTD., Adalembetsedwa ndi State Food and Drug Administration. Cholumikizira cha 3D chosindikizidwa cha m'chiuno chalowa "gawo lopanga anthu ambiri", zomwe zikutanthauza kuti ma implants osindikizira aku China a 3D nawonso alowa gawo lopanga.

Ukadaulo wosindikizira wa 3D wawonetsa gawo lofunikira kwambiri pazasayansi yazachipatala ndi luso laukadaulo, ndipo kafukufuku ndikugwiritsa ntchito ma prostheses osiyanasiyana amunthu payekhapayekha, miyendo yolumikizira, implants zamano ndi zina ndizokulirapo. Chifukwa chake, kuwunika kwa biosafety kwa ma implants okonzedwa ndi njira yatsopanoyi kumafunikira chidwi chochulukirapo.

Kafukufuku pa biosafety ya 3D yosindikiza titaniyamu

Chitetezo cha zinthu zachilengedwe chimawonetsedwa makamaka pakulumikizana pakati pa minofu ndi zida. Kuti zida zachitsulo zokhala ndi biomedical zigwirizane ndi miyezo ya zida zoyikidwa, ziyenera kufunidwa kuti zomwe zimachitika chifukwa cha kuyikidwa m'thupi la munthu zikhale pamlingo wovomerezeka, ndipo nthawi yomweyo, sizingapangitse kusintha kwamakhalidwe ndi mawonekedwe azinthuzo. Kuyanjana pakati pa thupi la munthu ndi thupi la munthu kumawonekera makamaka mu biocompatibility ndi ntchito yake yachilengedwe.

Chifukwa chake, pambuyo pa kuikidwa m'thupi la munthu, implants sayenera kuyambitsa zoyipa monga ziwengo, kutupa ndi chemistry m'maselo amunthu, magazi ndi ziwalo, kapena kukana matupi akunja amunthu. Panthawi imodzimodziyo, pamafunikanso kuti ma implants omwe amayenera kuikidwa kwa nthawi yayitali ayenera kukhala ndi zinthu zabwino zokhazikika, ndiko kuti, mphamvu zokwanira, zotanuka modulus yoyenera, kukhazikika kwakukulu, kukana kwa dzimbiri komanso kukhazikika kolimba. Tsopano kuyika kwa opaleshoni ya aloyi ya titaniyamu kumagwiritsidwa ntchito kwambiri pazachipatala, ndipo kafukufuku wa biocompatibility nawonso wakhwima. Chifukwa chake, chitetezo cha zigawo za titaniyamu zokhudzana ndi kusindikiza kwa 3D zimayang'ana kwambiri chitetezo cha ntchito yake ya biomechanical.

Kafukufuku woona ngati 3D yosindikizidwa zitsulo implantat ndi wofanana ndi mankhwala ambiri implants wa ndondomeko ya chikhalidwe malingana ndi katundu makina, kukana dzimbiri ndi biocompatibility, ndi ngati ena mwa malo amodzi mawotchi katundu wa aloyi implantation angathe kukwaniritsa ntchito zachipatala ndi mfundo dziko akadali ikuchitika. Zapezeka kuti mawonekedwe osasunthika a 3D osindikizidwa a titaniyamu amplants amatha kukwaniritsa zosowa zachipatala. Zitsanzo za Ti6A14V zokonzedwa ndi njira ya EBM zidayesedwa ndi kuyesa kwamphamvu kwachindunji ndi kuyesa kwapang'onopang'ono kwa isostatic. Zotsatira zake zidawonetsa kuti mphamvu za zitsanzo za TI6A14V zidapitilira muyeso wazopanga.

Kukana kwa dzimbiri kwa aloyi a Co-Cr-Mo okonzedwa ndi ukadaulo wa SLM ndi wofanana ndi aloyi yokonzedwa ndi njira yachikhalidwe, ndipo kuchuluka kwa kusungunuka kwa ion m'malo ofananirako amalovu ndikocheperako kusindikiza kwa 3D kuposa komwe kumapangidwira. Chogulitsa cha Ti6A14V chokonzedwa ndi ukadaulo wa DMLS chidapezeka ndi kampani ya EOS kuti ili ndi mawonekedwe osasunthika komanso kukana kutopa monga momwe amapangira kale pokonza pambuyo pake. Chida chophatikizira cha titanium alloy vertebrae fusion chokonzedwa ndi EBM chidayikidwa m'thupi la mbuzi ndipo chidapeza zotsatira zabwino munjira yophatikizira khomo la khomo la nkhosa. Mawonekedwe a mafupa anali abwinoko kuposa chipangizo cha PEEK fusion.

Clinically, zotanuka modulus ndi zina mawotchi katundu titaniyamu aloyi sizikugwirizana zimatha fupa la munthu, zomwe zidzachititsa kuti chodabwitsa cha "kutchinjiriza nkhawa" mu zotumphukira fupa minofu ya implants ndi chifukwa kufooka kwa mafupa, chifukwa mu mayamwidwe fupa, kumasulira ndi imfa ya implantation ndi kulephera. Pofuna kuchepetsa vutoli ndi ma implants a titaniyamu, ma implants a porous structure alowa m'maso mwa ofufuza. Tsopano, kafukufuku wasonyeza kuti 3D kusindikiza akhoza kusintha microstructure wa implants mwatsatanetsatane kwambiri kusintha modulus awo zotanuka ndi makina makina, kuti zigwirizane ndi fupa fupa la munthu ndi kupititsa patsogolo biomechanical ntchito pamaziko a kuonetsetsa kuti thupi loyenera katundu.

Mapangidwe oyendetsedwa ndi thupi la Ti6AI4V adapangidwa ndiukadaulo wopanga EBM, ndipo mawonekedwe amkati osowa adapezeka kuti akugwirizana ndi kapangidwe kake pansi pa scanning electron microscopy, yomwe idakwaniritsa kuwongolera kolondola kwa EBM pamapangidwe azinthu zosindikizidwa za 3D. Kupyolera mu kuyesa kwamakina, mphamvu yolumikizirana ndi 163MPa ndipo zotanuka modulus ndi 14MPa pa 60.1% pore porosity, yomwe ili pafupi ndi fupa la munthu. Chikhalidwe cha ma cell mu vitro chidawonetsanso kuyanjana kwa ma cell.

Ma scaffolds a porous adakonzedwa ndi ukadaulo wa EBM kudzera pakukhathamiritsa kwa magawo apangidwe, ndipo mawonekedwe awo amawunikiridwa adawunikidwa. Zinapezeka kuti ma biomechanics a zida zopangira porous anali ndi digiri yapamwamba yapamwamba pakuyerekeza kuyanjana kwa gawo ndi kufananiza kwa implantation. Mitundu itatu ya titaniyamu ya porous yokhala ndi 300gm, 600gm ndi 900 ~ tm yokonzedwa ndi SLM idayikidwa mu tibia ya kalulu kuti ifufuze momwe chiŵerengero cha pore chimakhudzira kukula kwa mafupa. Zotsatira zake zidawonetsa kuti minyewa ya fupa yokhala ndi 600 ~ m porous mapangidwe anali ndi kutalika kwabwinoko komanso biocompatibility.

Pankhani ya kukula kwa fupa, scaffold yokhala ndi porosity chosinthika ndi kabowo idzakhala yabwino kwambiri kufala ndi kufala kwa zakudya m'thupi la munthu, komanso kulimbikitsa luso la kukula kwa fupa, kuwonjezera kuphatikiza kwa ma implants ndi mabedi a mafupa, ndikukulitsa moyo wautumiki wa prosthesis, kuti mupeze zotsatira zabwino zachipatala kuposa mawonekedwe olimba a titaniyamu. M'zaka zaposachedwapa, Mipikisano dzenje titaniyamu aloyi sitepe ndi sitepe amaonedwa kuti abwino kwambiri chipatala latsopano minofu yolimba kukonza ndi zipangizo m'malo, ndi ntchito 3D kusindikizidwa titaniyamu aloyi amadzala ndi nyumba zosiyanasiyana ting'onoting'ono kapena nyumba watsegulanso munda watsopano.