CONTENTS 目录
What is ceramic 什么是陶瓷
Characteristics of ceramics for total joints 特征关节陶瓷总
Advantageds and risks Advantageds和风险
Alumina ceramic 氧化铝陶瓷
Zirconia ceramic 氧化锆陶瓷
Oxinium Oxinium TM 商标
Hydroxyapatite 羟基磷灰石
Ceramic for total knee 陶瓷全人工膝关节
osteoinductive substances 骨诱导物质
2 2
WHAT IS CERAMIC 什么是陶瓷
Ceramic materials used in total joints belong to a class of materials called oxide ceramics. 用陶瓷材料接头总共属于氧化物类陶瓷材料的调用。 These materials are formed by close packed crystals of oxides of aluminum or zirconium metals. 这些材料形成或接近铝锆金属的氧化物晶体的包装。 The arrangements of the crystals and the presence of impurities determine the characteristics of the resulting material. 晶体安排和杂质的存在对由此产生的物质的特性决定的。
The case of aluminum oxide provides a good example; the aluminum oxide appears in three forms: 铝的氧化物案件提供了一个很好的例子;铝氧化物的形式出现在3个：
Gems : 宝石 ：
A large, single, and perfect crystal of aluminum oxide with traces of other metals that give it its color forms the precious ruby and sapphire gems. 阿大，单一的，完善和铝氧化物晶体颜色的痕迹，它与其他金属的形式，让珍贵的红宝石和蓝宝石的宝石。
Surgical grade ceramic 手术高档陶瓷
Very small and very pure crystals of aluminum oxide compressed very close together form the basis of medical grade ceramics. 很小，很纯氧化物晶体铝压缩非常接近，形成了陶瓷的基础上，医用级。
Pottery 陶器
Coarse aluminum oxide crystals mixed together with the clay (silica oxide) and fired form the basis of commercial ceramic materials, such as the china cups on your table (very fragile) or electric insulators (very tough). 粗铝氧化物晶体与黏土混合在一起（氧化硅）和发射形式或）电绝缘体非常艰难（基础非常脆弱）商业陶瓷材料，如表（中国杯上的。
The name of the whole group of materials comes just from the Greek term "keramos" which means pottery. 这些材料名称组全体正值从希腊词“keramos”，这意味着陶器。
Hopefully you now also understand that the ceramic materials used in total hip prostheses have nothing to do with the pottery used on your dining table. 希望你现在也明白，陶瓷材料用于全髋关节假体无关，与你的餐桌上使用的陶器。 The commercial ceramic products are not only brittle; the body does not tolerate them! 商业陶瓷产品不仅脆，身体不容许他们！
3 3
MEDICAL GRADE CERAMIC 医药级陶瓷
Advantages and risks 优势与风险
Ceramics used for total hip joints surfaces (medical grade ceramics) are solid materials composed of pure crystals of aluminum or zirconium oxides. Such ceramics are the most chemically and biologically inert of all materials. 陶瓷用于全髋关节表面（医疗级陶瓷）的锆氧化物或铝固体纯晶体材料组成。这种陶瓷是最化学和生物惰性的所有材料。 They are not only inert, they are also stiff, strong, and hard. 他们不仅是惰性，他们也硬，强，硬。 For example, the only substance harder than aluminum oxide is diamond. 举例来说，唯一的困难比铝氧化物质是金刚石。
Thus ceramic are very resistant to scratches from the tiny particles that occasionally land between the artificial joint surfaces, be it particles of bone cement or metal. 因此，陶瓷是很耐划痕联合填平，从微小的颗粒，偶尔人工之间的土地，无论是金属颗粒骨水泥或。 The mechanical law states that the harder the surfaces coupled together are the less wear the coupling system produces. 力学定律指出，越是在一起表面磨损越少，加上是系统产生的耦合。 Thus total hip with ceramics surfaces produces very low rates of wear particles. 因此，陶瓷表面与生产的全髋关节磨损颗粒非常低的利率。 Ceramics also attract fluid on their surface so that couplings made of ceramic have low friction resistance. 陶瓷表面的液体也吸引他们，使陶瓷的接头作出有低摩擦性能。
The main disadvantage of medical ceramic materials is their fragility. 陶瓷材料的主要缺点是其脆弱的医疗。 The ceramic materials cannot deform under the stress, as can do plastics and metals. 陶瓷材料变形不能下的压力，因为可以做塑料和金属。 When the stress acting on medical ceramic materials exceeds a certain limit, ceramic material bursts, formally explodes in many splinters. See Picture of burst ceramic ball of a failed ceramic total hip. 当应力作用于医疗陶瓷材料超过一定限度，陶瓷材料破裂，许多碎片正式爆炸英寸查看图片陶瓷球爆裂一个失败的陶瓷人工髋关节。
Such burst fractures of ceramic components of the total hips were observed in the past due to the poor quality of the ceramic material of that time. 这种爆裂骨折的观察总髋陶瓷元件过去由于质量差，当时的陶瓷材料。
However, even the modern third generation medical ceramic is still a fragile material, although it will not suffer the burst fracture. 然而，即使是现代医学的第三代陶瓷材料仍然是脆弱的，但不会遭受爆裂性骨折。 But the rim of the modern ceramic cup may still chip off during assembling with the metallic back up under surgery. 但美洲杯边缘的现代陶瓷芯片仍然可以在金属装配了与备份下手术。
Even modern ceramic materials are very sensitive to asymmetric loading and impingement by the femoral neck component. 即使是现代陶瓷材料是非常敏感的不对称冲击的装载和股骨颈的组成部分。 Thus, less accurate position of the ceramic cup may increase considerably the wear of the ceramic components in such a total hip joint. 因此，精确度较差的陶瓷杯的位置可能会增加相当的全髋关节戴上了陶瓷组件等。
Two kinds of ceramic materials are used in the modern ceramic total hip systems alumina ceramic and zirconia ceramic. 种陶瓷两种材料中使用了现代陶瓷人工髋关节系统的氧化铝陶瓷，氧化锆陶瓷。 Both materials have quite distinct positive sides and also some disadvantages. 这两种不同的材料有相当正面，也存在一些缺点。
2A 甲
Alumina ceramic 氧化铝陶瓷
Modern (third generation) alumina ceramic is composed of very small crystals of aluminum oxide, the impurities make less than 0,5% of the material's volume. 现代（第三代）氧化铝陶瓷是铝氧化物晶体组成的非常小，杂质使体积小于0.5％的材料的。 Modern ceramic is a tough and hard material. 现代陶瓷是一个艰难和硬物。 The smaller the crystals and the purer the material, the more fracture resistant is the final product. 较小的和纯洁的晶体材料，更耐断裂是最终产品。
Picture: 图片：
Old and modern medical grade alumina ceramic under microscope . 旧的和现代的医疗级氧化铝陶瓷显微镜下 。
Click on the icon for a full size image. 点击图标为一个完整的图像大小。
In the old ceramic materials the crystals of aluminum oxides were large, not assembled closely; there were many impurities and voids between them (actually impurities made about 5 % of the ceramic's volume). 在旧铝氧化物陶瓷材料的晶体较大，但未装配紧密，其中有许多杂质和他们之间的空隙（其实杂质数量进行约5％的陶瓷的）。
These impurities were the weak points for propagation of fracture cracks. 这些杂质被断裂裂纹传播薄弱点。 The coarse structure and impurities were the cause of the frequent fractures of the old ceramic components. 粗结构和杂质是导致旧陶瓷元件的频繁骨折。
In the modern ceramic the crystals of the aluminum oxide are very small, very closely packed together, and the impurities are making less than 0,5% of the material's volume. 在现代陶瓷氧化物晶体的铝是非常小，非常仔细地挤在一起，而且正在杂质小于0.5％的材料数量的。
The close packing of aluminum oxide crystals is achieved through the so-called HIPing procedure (Hot Isostatic Pressure). 紧密堆积的氧化物晶体铝是通过所谓的HIPing程序（热等静压压力）。 The ceramic component is reheated and then subjected to enormous symmetric pressures. 陶瓷元件加热，然后受到了巨大对称压力。 The HIPing process extrudes impurities out off the material and packs the crystals very close together. 该HIPing进程挤出出了杂质和包装材料的晶体非常接近。
Every one modern ceramic component is individually stress-tested before it is released on the market. 每一个组成部分，是现代陶瓷单独压力测试公布前，市场上。 The modern alumina ceramic ball is very tough structure, tougher than the metallic stem on which it is seated, and even more though then the natural thighbone. 现代氧化铝陶瓷球是非常艰难的结构，更严厉的比金属干它是坐着，甚至更多，但当时的自然大腿骨。
Alumina ceramic ball must sustain 60 times the average patient's weight Metallic femoral stem must sustain 15 times the average patient's weight 氧化铝陶瓷球必须保持60倍的平均病人的干体重金属股必须保持病人的平均15倍的重量
Thighbone 15 times the average patient's weight (The average patient's weight is 77 kg) 股骨病人平均15倍的体重（平均患者的体重为77公斤）
The ceramic components should also endure fatigue strain. The certification requires that the ceramic boll should endure repeated loadings of 18.5 times the average patient's weight, whereas the requirement for the metallic stem is three times less – it must endure "only" 6.5 times the average patient's weight. 陶瓷部分，也要忍受疲劳的压力。该认证要求的陶瓷铃要忍受重复金属的重量，而要求的干荷载病人18.5倍，平均少3倍-它必须忍受“只有”6.5倍，平均病人的体重。
The disadvantage of the modern alumina ceramic is lower toughness in spite of the impressive test figures. Thus the material engineers developed the 陶瓷的缺点现代氧化铝韧性低的数字尽管令人印象深刻的考验。因此，材料开发工程师
Zirconia Toughened Alumina (ZTA) ceramic. 氧化锆增韧氧化铝（ZTA陶瓷）陶瓷。
 |
Compared to pure Alumina ceramic, the ZTA has superior strength and resistance to wear. 相对于纯氧化铝陶瓷，ZTA陶瓷具有优异的强度和耐磨性。
The ZTA is commercially available under the name Biolox Delta. This ceramic contains about 75% of alumina and the rest are zirconium, Yttrium and chrome oxides. Several manufacturers use this ZTA ceramic in their total hips. 津巴布韦烟草协会提供的是商业的名义下Biolox三角洲。这种陶瓷材料包含大约75％的氧化铝，其余都是锆，钇和铬的氧化物。一些制造商使用这个ZTA陶瓷髋陶瓷在其总。
The pure Aluminum medical ceramic. produced by the same manufacturer (Ceram Tex) has the name Biolox Forte. As you see on this picture, there are many possible combinations of these two forms of Alumina ceramic. 纯铝医疗陶瓷。）由同一制造商生产的（策拉姆特克斯具有名称Biolox长处。正如你看到的图片，还有很多的氧化铝陶瓷这两种形式的可能组合。
|
| Possible combinations of Biolox ceramics Biolox陶瓷的可能组合
( Click on the icon for the full size picture ) （点击图片上的图标为全尺寸）
|
Overall the ZTA ceramic combinations in microseparation simulator studies consistently showed lower wear than the alumina used as historical control. This was in contradistinction to ytrria-stabilized zirconia balls that showed increased wear compared to the control. Thus the wear performance of ZTA implants in the laboratory was quite different to zirconia implants and appeared superior to the alumina as the historical control. The superior strength and wear resistance of ZTA ceramics may become advantageous in sub-optimal clinical cases that may have had the risk of implant fracture or abnormally high wear. (Clarke 2006) 总的来说，microseparation模拟器研究ZTA陶瓷陶瓷的组合，一直显示较低的磨损比历史控制的氧化铝使用。这就增加了在对比的ytrria稳定的氧化锆球，穿着显示与对照相比。因此，在实验室磨损性能ZTA陶瓷植入术相当不同的氧化锆植入物，似乎优于对照氧化铝的历史。优越的强度和耐磨损陶瓷ZTA陶瓷磨损可能成为有利分异常高的最佳临床病例，可能或已经有风险植入骨折 。（克拉克2006年）
References : 参考文献 ：
Clarke et al: 11th Biolox R Symposium, Rome 2006) 克拉克等人：第11 Biolox?研讨会，罗马2006年）
Kay J : Engineering Materials 2005;Vols 284-6: 979 -82 凯记：工程材料2005年卷集284-6：979 -82
3A 第3A
Zirconia ceramic 氧化锆陶瓷
 |
Zirconia ceramic is one of the highest-strength ceramics suitable for medical use. 氧化锆陶瓷是用一个最高强度的医疗陶瓷适合。 It is two to three times stronger material than alumina ceramic. Thus one can make the femoral balls out of this material that are smaller (22 mm diameter) than the balls made out of alumina ceramic (28 - 32 mm). 这是2至3倍的氧化铝陶瓷材料比强。因此，可以使股骨球出这种材料的体积更小（22毫米直径）比球开出的氧化铝陶瓷（28 - 32毫米）。 The surface of the zirconia ball can be made smoother than the surface of the ball made out of the alumina ceramic; the wear produced by the zirconia ball coupled with polyethylene cup is only half as large as the wear produced by alumina ceramic ball in identical coupling. 球表面的氧化锆可较平滑的陶瓷表面的氧化铝球开出;杯聚乙烯氧化锆耐磨球再加上所产生的只有一半大，相同的耦合产生的磨损由氧化铝陶瓷球。 These characteristics apply, however, only to ceramics made from the tetragonal crystals of zirconia. 这些特点适用，但是，只有氧化锆陶瓷的四方晶体制成的。 |
Whereas the high strength and low wear made the zirconia ceramic is so attractive for constructers of total hips, the instability of zirconia is a big and not well-understood problem. 而高强度，低磨损的氧化锆陶瓷是那么有吸引力的臀部共建设者的，氧化锆的不稳定是一项庞大而没有得到很好理解的问题。 Ceramic made out of the strong tetragonal crystals may spontaneously transform in other crystalloid forms. 陶瓷做成的强烈四方晶体可以自发地变换在其他晶体形式。 The ceramic consisting of these other crystalloid form is weak, rough, and fragile. 陶瓷的晶体形式组成的这些其他薄弱，粗糙，脆弱。
Thus, zirconia ceramic must be "stabilized" by addition of oxide of another metal, yttrium. 因此，氧化锆陶瓷必须是“稳定”由加入金属氧化物另一个，钇。 The whole process is not well understood and this may be the cause of the many fractures of zirconia ceramic balls reported in the literature. 整个过程不是很清楚，这可能是导致许多骨折氧化锆陶瓷球的文献报道的。
 |
Recent studies demonstrate that zirconia ceramic ages in the body's temperature and the surface of the zirconia ball's surface roughens. On the left there is a picture (scanning electrone microscope) of the surface of a Zirconia ball retrieved after few years in the body . You can see several craters on the surface of the zirconia ball instead of a plain even surface. 最近的研究表明，氧化锆陶瓷年龄在身体的温度和roughens表面的氧化锆球的表面。在左边有一个图片（扫描electrone显微镜）的回收表面的一球氧化锆后身体数年。您可以表面看甚至几个坑平原上的一个表面的氧化锆球代替。 |
| Rough surface of Zirconia ball ( From Clarke: Current status of Zirconia, J Bone Joint Surg- Am 2003, 85-A Supplement 4: 73 - 84.) 粗糙表面 氧化锆 氧化锆球 （ 从当前状态克拉克：，强骨关节外科，2003年时，85补充4：73 - 84。） |
This is also the reason why in the current total hip systems the zirconia balls are always coupled with a polyethylene cup and not with a ceramic cup. 这也是为什么在目前的全髋关节杯系统的氧化锆陶瓷球总是加上一个聚乙烯一个杯子，而不是用。 Laboratory experiments demonstrated namely that the wear of this zirconia on zirconia system might be very high with aging of ceramic (Clarke 2003). 实验室的实验表明，该系统即穿氧化锆氧化锆这很可能是对高，老龄化陶瓷（克拉克2003年）。
3B 3B的
Oxinium materials for total hips. 总臀部Oxinium材料。
Through a special technology one can create a thin layer of zirconium oxide on the surface of the solid zirconium metal. 通过特殊的技术可以制造出锆金属表面的固体薄的锆氧化物层。
Zirconium is a strong and biocompatible metal similar to titanium. 锆是一种强有力的生物相容性类似金属钛。
One manufacturer exploited this technology and produced total hip and total knee components made out of this material composite. 一个制造商利用此技术和生产的全髋全膝关节复合材料制成的元件出这一点。
Total hip system (Oxinium total hip system) has the femoral head made out of Oxinium that articulates with a polyethylene cup. See the chapter Ceramic total hips. 全髋系统（Oxinium全髋关节系统）有股骨头作出Oxinium阐述了这一杯用聚乙烯。见本章陶瓷总臀部。
The femoral ball is first made from zirconium metal (actually from zirconium alloy with other metals such as Niobium). 股骨球是首次提出，如铌）由其他金属锆（实际上来自锆合金金属。 The surface of this metallic component is then oxidized: the metallic components surface is heated and then subjected to oxygen gas that diffuses into the surface of the metal. 在这个金属部件的表面，然后氧化：金属部件表面被加热，然后受到氧气的气体，扩散到金属表面的。 This process creates a thin and durable layer of zirconium oxide on the surface of the metal. 此过程将创建锆表面的金属氧化物对薄的和持久层。 The finished product thus combines the benefits of metals and ceramics. 因此，结合成品和金属陶瓷的好处。 It offers superior wear resistance on its surface whereas the zirconium metal itself, with characteristics close to titanium, is a material without the risk of brittle fracture. Note that oxidized zirconium is black. 它提供锆金属本身优良的耐磨损，而在其表面，具有特色的接近钛，是一种无脆性材料断裂的危险。注意，氧化锆为黑色。
 |
OXINIUM TM femoral ball OXINIUM 商标股骨球
On this picture you see 你看到在这个图片
A - the finished, highly polished Oxinium femoral ball. A little rectangle shows the area of cross section in B. 阿-成品，高度抛光Oxinium股骨球。阿B的小矩形截面显示在该地区
B - cross section through the surface of the cup: 乙-杯截面通过表面：
It shows from at the top a thin layer of black zirconium oxide (Oxinium TM) 这表明来自于高层的一Oxinium商标薄薄的一层黑色的氧化锆（）
successively changing into 先后改为
a compact zirconium alloy material of the femoral ball (yellow) bellow. 紧凑型锆黄色）合金材料的股骨球（波纹管。
C - an artist's view of diffusion of oxygen molecules into the surface of the zirconium ball. You see from the top : the oxygen atmosphere with oxygen molecules (blue) diffusing into the surface of the zirconium ball - middle layer: a layer of gray molecules of oxidized zirconium ( zirconium oxide) on the surface of the ball - lowermost: zirconium alloy molecules (yellow) with occasional oxygen molecules. ? -一个艺术家的分子认为氧扩散到球表面的锆。你看从顶部：灰色分子氧的气氛与氧分子（蓝色）的扩散到表面锆球-中间层：1层氧化锆（氧化锆）在球表面的-最下面：锆合金分子偶尔氧分子（黄色）的研究。
|
| Production of Oxinium (TM) femoral ball 生产Oxinium（商标）股骨球 |
This is a new technology, see also the manufacturer's website( www.strongasanox.com ). The manufacturer maintained in 2001 that the zirconium oxide is not an externally applied coating but rather a transformation of the original metal surface into zirconium -oxide ceramic...Previous testing has demonstrated that this oxide has excellent cohesion and adhesion..." (Spector 2001) 这是一种新技术，也看到制造商的网站（ www.strongasanox.com ）。制造商2001年将保持在该氧化锆不是外加涂层而是一氧化氮转化成锆金属表面陶瓷原.. 。以前的测试表明，此氧化具有良好的凝聚力和粘附...“（斯佩克特2001年）
This statement is in recent years (2006-7) called in question by some surgeons. There are appearing reports about failure of the oxinium femoral balls. The problem is namely that the Zirconium metal used for production of Oxinium femoral balls is about twice as soft as the metal backing sleeve (made from Cobalt Chrome alloy) that encloses the polyethylene cup. 这项声明是在最近几年（2006-2007年）的问题在一些所谓的外科医生。oxinium有出现故障的报告，关于股骨球。问题是即使用的锆金属球的生产Oxinium股约两倍软为支持金属套筒（钴铬合金制成）所环绕的聚乙烯杯。
With a hip dislocation, the Oxinium cup comes into contact with the hard rim of the metallic sleeve: the result is deep scratch on the ball surface. Dislocation of a total hip is usually managed by reposition on the emergency room - a nuisance not needing operation. For patients with Oxinium total hip the surgeon must open the total hip, remove and replace the scratched ball with all risks and problems that follow such a revision operation. (Evangelista 2007) 随着髋关节脱位，在Oxinium杯生效套筒接触的金属硬边缘的：结果是深表面划伤的球。髋关节脱位手术通常是一个总管理的重新定位在急诊室-一滋扰不需要。对于Oxinium例全髋关节外科医生必须打开全髋关节，删除和替换的修订工作抓球的所有风险和问题，按照这样的。（杰利斯塔2007）
Some surgeons now say that they will not use the Oxinium total hip until this problem is solved. 现在有些医生说，他们将不会使用Oxinium全髋关节，直到这一问题得到解决。
Hardening of the total joint surfaces by diffusion of gases is nothing new in the history of total joints. 气体通过扩散硬化表面关节全关节是什么新的总的历史。 Nitrogen diffusion was once used for hardening of titanium made ball components; the laboratory results were splendid, the clinical results were a fiasco. 钛氮扩散曾经使用过的球硬化了的组成部分;灿烂的化验结果，临床结果是惨败。
Reference: Evangelista GT et al.: Surface damage to an Oxinium femoral head... J Bone Joint Surg-Br 2007; 89-B: 535 - 7. 参考：万杰利斯塔燃气轮机等。：表面损坏，Oxinium股骨头骨关节外科... J -溴2007; 89 -乙：535 - 7。
Spector M et al:: J Bone Joint Surg-Am 2001, 83-A Supplem 2 Part 2: 80 - 6. 斯佩克特M等人：：J骨关节外科，2001年时，83甲Supplem 2第2部分：80 - 6。
3C 3c中
Hydroxyapatite coating 羟基磷灰石涂层
See also the chapter Cemented and cementless TH / Hydroxyapatite 另见章水泥及水泥钍 /羟基磷灰石
This is another ceramic substance used in the total joint prostheses. 这是另一种陶瓷物质假肢使用的人工关节。
In normal bone tissue, the collagen fibers are interspersed with crystals of hydroxyapatite. 在正常骨组织中，胶原纤维与羟基磷灰石晶体的点缀。 Synthetically produced hydroxyapatite is used as thin coating on the porous surfaces of the cementless total hip prostheses. 综合生产的羟基磷灰石被用作水泥髋关节假体薄涂层的多孔总表面的。 The purpose is to enhance the ingrowth of the bone tissue into the surface of the hip prosthesis. 其目的是要提高人工髋关节表面的长入成骨组织。
Chemically. hydroxyapatite (HA) used for coating purposes is a calcium phosphate. 化学。 羟基磷灰石 （HA）用途用于涂装是一种磷酸钙。 Its composition and crystallographic structure are similar to those of the bone mineral phase. 其组成和晶体结构相类似的骨矿物。 The chemical formula of this material is Ca 10 (PO4) 6 (OH ) 2 这种材料的化学公式为Ca 10（磷酸盐）6（OH）2的 . 。
|
|
A The picture shows the complex spatial organization of the hydroxyapatite crystal. 阿图为 羟基磷灰石晶体的复杂的空间组织。 This crystal has biological properties for which it is described as “living crystal”. 这晶体结晶的“生物属性的生活也被描述为”。 It attracts the bone forming cells, osteoblasts , to its surface. 它吸引了骨形成细胞， 成骨细胞 ，它的表面。
B Microscopic studies demonstrated that bone forming cells ( osteoblasts ) adhere to the HA crystals coating the surface of the total joints already few weeks after implantation. 乙微观研究表明，骨形成细胞（ 成骨细胞 ）坚持表面总关节植入已经几个星期后向房委会晶体的涂层。 This process fixes firmly the total joint to its bone bed. 这一过程的总修复关节牢固的骨床。 This picture shows an osteoblast cell (pink color) adhering to the hydroxyapatite coating (green color). 这张照片显示了成骨细胞（粉红色）坚持羟基磷灰石涂层（绿色）。
|
In this way the total joint device is soon enveloped by a newly formed bone tissue and fixed to the bone bed. 这样，总联合装置很快包围了新成立的骨组织和骨固定在床上。
|
|
This picture shows a cross section through a thighbone which had the shaft component of a total hip placed into the marrow cavity (animal experiment). 这张照片显示了动物实验）一截面通过大腿骨腔（即进入骨髓轴组件放置有一个全髋关节。 After some months there formed sufficient new bone tissue that filled entirely the previous bone marrow cavity (black arrows). 数月后有足够的新骨组织形成，填补了以往完全骨髓腔（黑色箭头）。 The shaft component (B) in the marrow cavity is now embedded by the newly formed bone (A). 轴组件的骨髓腔（B）在目前新成立的嵌入骨（甲）。 The thin layer of hydroxyapatite coating is still visible on the surface of the shaft as a thin white line (C). 羟基磷灰石涂层薄层仍然）可见C的表面（轴作为一个薄白线。
|
The picture shows the apparatus used for plasma spraying of HA. 图为医管局等离子喷涂用的器具。
|
|
The application of the hydroxyapatite coating onto the surface of the total joint is done by a plasma spray technique. 联合应用羟基磷灰石涂层表面上总的是通过等离子喷涂技术。 In principle the hydroxyapatite particles ( B) - white powder - are injected into a chemically inert gas stream raised to high temperature and speed. 原则上， 羟基磷灰石微粒（ 乙） -白色粉末-注入到一个惰性气体流的速度提高到高温。
In this hot gas stream ( A ) the HA particles melt and are then projected onto a previously treated metal surface of the total joint where they adhere and form a continuous surface thick some tenth of millimeter. 在这种高温气体流（ 一 ）医管局颗粒熔化，然后再投射到毫米厚一些以前的十分金属表面处理的，他们坚持全关节表面，形成一个连续的。 . 。
( Bioland 1988, old facts still valid 2010 – and perfect pictures!) （ 爱奥乐 1988年，2010年仍然有效的旧事实-和完善的照片！）
|
Many HA coatings contain only about 70% of HA crystals and the rest is calcium phosphate, whereas other manufacturers ( Howmedica ) claim that they use pure (100%) hydroxyapatite substance. 许多HA涂层晶体只包含房委会约70％，其余为磷酸钙，而好医 ）其他制造商（声称，他们使用纯（100％）， 羟基磷灰石的实质内容。 It is difficult to tell whether this change in chemical composition of the coating may influence the long term stability of the total hip device. 这是很难说这是否改变涂层的化学成分会影响设备的长期稳定的全髋关节。
In the 1980's, when the HA coating was introduced on the market, there appeared many short term observations, made on small patient groups that claimed excellent results with the HA coated total hips. 在20世纪80年代，当HA涂层是市场上推出，短期内似乎有很多意见，臀部关于小病人群体涂层索赔总额的优异成绩与房委会。 In later years, when a long term observation became available, many authors are claiming that HA coating is not an advantage but a risk factor for loosening of the total hip devices ( Lazarinis S et al: Acta Orthopaedica 2009, 80 (6), xx) 在随后几年中，当一个长期的观察可得，许多作者都声称HA涂层是不是优势，但在2009年，风险因素矫形全髋关节松动的装置（Lazarinis S等人：兽类80（6），第xx ）
4 4
Ceramic for total knees: 陶瓷总膝盖：
Use of ceramic for total knee joints is hampered by two facts: 膝盖关节使用的陶瓷共受到了两个事实：
First: The total knee joints have not congruent joint surfaces. 第一：总膝关节没有共同一致的表面。 Thus, in a total knee joint with both joint surfaces made from ceramic materials, there would appear large localized stresses that would destroy components made from the contemporary ceramics. 因此，在联合全膝关节材料制成的陶瓷表面，既有合资，便出现大的本地化强调，会破坏当代陶瓷元件制成的。
Second: It is as yet difficult to fabricate such a large yet thin ceramic component as is the form of the femoral component that would sustain the stresses that occur during walking in the knee. 第二：它是迄今难以制造如此大而薄的陶瓷元件是膝关节股骨元件的形式，将维持强调，在行走过程中发生。
One solution that appeared recently is the Oxinium total knee prosthesis: The femoral component of this total knee is made from the metal Zirconium, which is highly biocompatible and will sustain the localized stresses that occur in the knee. 最近出现的一种解决方案是全膝假体Oxinium：总膝关节股骨组成部分，这是局部的金属锆制成，这是高度的生物相容性，并强调维持膝盖出现在。
 |
The surface of this component is then oxidized: the metallic components surface is heated and then subjected to oxygen gas that diffuses into the surface of the metal. 该组件的表面氧化，这是当时：金属部件表面被加热，然后受到氧气的气体，扩散到金属表面的。 This process creates a thin and durable layer of zirconium oxide on the surface of the metal. 此过程将创建锆表面的金属氧化物对薄的和持久层。 The finished product thus combines the benefits of metals and ceramics. 因此，结合成品和金属陶瓷的好处。 It offers superior wear resistance on its surface whereas the metal itself, with characteristics close to titanium, is a material without the risk of brittle fracture. 它提供了金属本身优良耐磨损，而在其表面，具有特色的接近钛，是一种无脆性材料断裂的风险。
Note that the oxidized zirconium is black 请注意，氧化锆为黑色
|
| Oxinium made femoral component of a total knee Oxinium全人工膝关节股骨元件的一 |
The first results with the cemented Oxinium total knees were positive (Laskin 2003) whereas the cementless Oxinium total knees ended in a catastrophe well contained by the manufacturer. Oxinium总膝盖的第一个成果是积极的，而水泥水泥Oxinium（拉斯金2003年）的制造商以总得到很好的控制，而在一个膝盖灾难。
Japanese surgeons use, however, components made from alumina ceramic in some of their total knee systems (Akagi 2000). The details of these materials are unknown to me. 日本外科医生使用，但是，零部件）从2000年作出了氧化铝陶瓷赤城在他们的一些全膝关节系统（。这些材料的详细情况不明，我要。 The results show that these components do not sustain fractures. 结果表明，这些组件不支持骨折。 The authors, however, point out that these characteristics are applicable to the (small) Japanese population only. 作者，但是，指出这些特点是适用于（小）日本的人口只。
References: 参考文献：
Akagi et al : J Bone Joint Surg-Am, 2000; 82-A:1626-33 赤城等人 ：J骨关节外科，上午，2000年82甲:1626 - 33
Clarke IC et a l.: J Bone Joint Surg-Am 2003; 85-A Suppl 4: 73 – 84 克拉克集成电路等一湖：J骨关节外科，上午2003年85甲增刊4：73 - 84
Good V et al .: J Bone Joint Surg-Am 2003; 85-A Suppl 4: 105 – 110 良好V等 。：J骨关节外科，上午2003年85甲增刊4：105 - 110
Heisel Ch et al.: J Bone Joint Surg-Am 2003; 85-A: 1366 - 79 海泽尔总等人。：J骨关节外科，上午2003年85答：1366年至1379年
Laskin RS . 拉斯金遥感 。 : An oxidized Zr ceramic surfaced femoral component for total knee arthroplasty. ：一种氧化锆陶瓷出现膝关节置换术股骨假体总。 Clin Orthop. 万方数据骨科。 2003 Nov; (416): 191-6 2003年11月（416）：191-6
www.oxidizedzirconium.com www.oxidizedzirconium.com
www.strongasanox.com www.strongasanox.com
OTHER CERAMIC MATERIALS 其它陶瓷材料
6 6
Other osteoinductive substances 其他骨诱导物质
They are not ceramic but I believe that they should be mentioned here. 他们不是陶瓷，但我相信他们应该提到这里。
In laboratories, the scientists have been experimenting with other osteoinductive substances, such as growth hormones, and Bone Morphogenetic Proteins, applied on the porous surfaces of artificial joints. 在实验室中，科学家们一直在试验与其他骨诱导物质，激素，如增长，骨形态发生蛋白，表面采用人工关节上的漏洞。 These substances too should increase the ingrowth of the bone tissue in the porous surface of artificial joints. 这些物质也应该增加多孔表面人工关节的组织长入的骨头。 Although some experiments produced promising results, the use of these substances is still in the experimental state. 虽然一些实验产生令人鼓舞的结果，使用这些物质仍处于实验状态。
|
