{"id":1951,"date":"2023-06-28T07:00:00","date_gmt":"2023-06-28T00:00:00","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=1951"},"modified":"2025-03-21T18:05:51","modified_gmt":"2025-03-21T11:05:51","slug":"vat-lieu-thay-khop-goi-khop-hang","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/vat-lieu-thay-khop-goi-khop-hang\/","title":{"rendered":"V\u1eadt li\u1ec7u thay kh\u1edbp g\u1ed1i kh\u1edbp h\u00e1ng"},"content":{"rendered":"<h2><strong>1. GI\u1edaI THI\u1ec6U<\/strong><\/h2>\n<h3><strong>L\u1ecbch s\u1eed<\/strong><\/h3>\n<p>Thu\u1eadt ng\u1eef \u201cv\u1eadt li\u1ec7u sinh h\u1ecdc\u201d xu\u1ea5t hi\u1ec7n t\u1eeb gi\u1eefa n\u0103m 1970, ngu\u1ed3n g\u1ed1c t\u1eeb ch\u1ec9nh h\u00ecnh h\u01a1n 4.000 n\u0103m tr\u01b0\u1edbc. N\u00f3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ea7u ti\u00ean trong c\u00e1c ph\u1eabu thu\u1eadt v\u00f4 tr\u00f9ng, l\u00fac \u0111\u00f3 vi\u1ec7c \u0111\u1eb7t v\u1eadt li\u1ec7u sinh h\u1ecdc c\u01a1 x\u01b0\u01a1ng kh\u1edbp v\u00e0o c\u01a1 th\u1ec3 th\u01b0\u1eddng c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong v\u1edbi t\u1ec9 l\u1ec7 g\u1ea7n 50%.<\/p>\n<p>C\u00f9ng v\u1edbi s\u1ef1 ti\u1ebfn b\u1ed9 c\u1ee7a v\u1eadt li\u1ec7u sinh h\u1ecdc v\u00e0 \u1ee9ng d\u1ee5ng v\u1eadt li\u1ec7u sinh h\u1ecdc trong ch\u1ec9nh h\u00ecnh, s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a k\u1ef9 thu\u1eadt v\u00f4 tr\u00f9ng c\u1ee7a Lister (nh\u1eefng n\u0103m 1860); c\u00e1c b\u00e1o c\u00e1o ban \u0111\u1ea7u v\u1ec1 v\u1eadt li\u1ec7u sinh h\u1ecdc ch\u1ec9nh h\u00ecnh bao g\u1ed3m vi\u1ec7c Hansman s\u1eed d\u1ee5ng th\u00e9p m\u1ea1 niken \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng g\u00e3y (1886), Gluck s\u1eed d\u1ee5ng m\u1ed9t ch\u1ecfm b\u1eb1ng ng\u00e0 \u0111\u1ec3 thay th\u1ebf ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i (1891), Lane s\u1eed d\u1ee5ng n\u1eb9p v\u00edt th\u00e9p \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng g\u00e3y (1893). Tuy nhi\u00ean, s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kim lo\u1ea1i ch\u1ed1ng \u0103n m\u00f2n (\u0111\u1ea7u nh\u1eefng n\u0103m 1900) \u0111\u00e3 gi\u00fap \u0111\u1eb7t m\u1ed9t v\u1eadt li\u1ec7u v\u00e0o c\u01a1 th\u1ec3 m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3, \u0111\u00f3ng v\u1ebft th\u01b0\u01a1ng xung quanh v\u1eadt li\u1ec7u v\u00e0 \u0111\u1ec3 n\u00f3 trong th\u1eddi gian d\u00e0i. C\u00e1c kim lo\u1ea1i ch\u1ed1ng \u0103n m\u00f2n \u0111\u1ea7u ti\u00ean l\u00e0 th\u00e9p kh\u00f4ng g\u1ec9, ti\u1ebfp theo l\u00e0 c\u00e1c h\u1ee3p kim coban.<\/p>\n<p>G\u1ea7n 100 n\u0103m sau, <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Charnley\" target=\"_blank\" rel=\"noopener\">Charnley<\/a> l\u1ea7n \u0111\u1ea7u ti\u00ean s\u1eed d\u1ee5ng th\u00e9p kh\u00f4ng g\u1ec9 v\u00e0 polytetrafluoro- ethylen (PTFE) \u0111\u1ec3 thay kh\u1edbp \u00edt ma s\u00e1t. Do t\u1ed1c \u0111\u1ed9 m\u00e0i m\u00f2n cao v\u00e0 ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i c\u1ee7a m\u00f4 m\u1ec1m v\u1edbi c\u00e1c m\u1ea3nh v\u1ee5n, thi\u1ebft k\u1ebf c\u1ee7a Charnley nhanh ch\u00f3ng ph\u00e1t tri\u1ec3n \u0111\u1ec3 t\u00edch h\u1ee3p \u1ed5 c\u1ed1i ch\u1ecbu l\u1ef1c b\u1eb1ng polyethylen tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed si\u00eau cao (UHMWPE) v\u00e0o \u0111\u1ea7u nh\u1eefng n\u0103m 1960 v\u00e0 chu\u00f4i x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng h\u1ee3p kim coban-chrome-molypden (CoCrMo) d\u00f9ng trong c\u00f4ng nghi\u1ec7p v\u0169 tr\u1ee5. Do \u0111\u00f3, c\u00e1c v\u1eadt li\u1ec7u c\u1ee7a ch\u1ec9nh h\u00ecnh kh\u1edbp hi\u1ec7n \u0111\u1ea1i \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0 s\u1eed d\u1ee5ng cho \u0111\u1ebfn khi v\u1eadt li\u1ec7u sinh h\u1ecdc ra \u0111\u1eddi \u1edf Hoa K\u1ef3 v\u00e0 tr\u1ea3i qua s\u1ef1 ph\u00e1t tri\u1ec3n k\u1ec3 t\u1eeb \u0111\u00f3.<\/p>\n<h3><strong>V\u1eadt li\u1ec7u v\u00e0 thi\u1ebft k\u1ebf<\/strong><\/h3>\n<p>H\u1ec7 th\u1ed1ng kh\u1edbp nh\u00e2n t\u1ea1o ph\u1ea3i \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 ph\u00f9 h\u1ee3p:<\/p>\n<p><em>T\u1ea3i tr\u1ecdng cao truy\u1ec1n qua c\u00e1c khu v\u1ef1c nh\u1ecf: <\/em>khi \u0111i b\u1ed9, m\u1ed9t ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh trung b\u00ecnh c\u00f3 th\u1ec3 chuy\u1ec3n hai \u0111\u1ebfn ba l\u1ea7n tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 c\u1ee7a h\u1ecd qua c\u00e1c kh\u1edbp \u1edf chi d\u01b0\u1edbi. C\u00e1c ho\u1ea1t \u0111\u1ed9ng \u00edt th\u01b0\u1eddng xuy\u00ean h\u01a1n nh\u01b0 ch\u1ea1y, nh\u1ea3y, xu\u1ed1ng c\u1ea7u thang ho\u1eb7c v\u01b0\u1ee3t ch\u01b0\u1edbng ng\u1ea1i v\u1eadt c\u00f3 th\u1ec3 t\u1ea1o ra l\u1ef1c g\u1ea7n g\u1ea5p 10 l\u1ea7n tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3. Do \u0111\u00f3. v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p ph\u1ea3i \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 t\u00ednh \u0111\u1ebfn \u0111\u1ed9 d\u1ebbo dai khi ch\u00fang b\u1ecb \u0111\u1ee9t g\u00e3y.<\/p>\n<ul>\n<li><em>M\u00f4i tr\u01b0\u1eddng \u0103n m\u00f2n: <\/em>n\u1ed3ng \u0111\u1ed9 natri clorua 0,9% trong m\u00e1u c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec7n h\u00f3a m\u1ea1nh m\u1ebd \u0111\u1ed1i v\u1edbi c\u00e1c thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p, \u0111\u1eb7c bi\u1ec7t l\u00e0 do ion clorua trong dung d\u1ecbch. Ngo\u00e0i ra c\u00f2n c\u00f3 c\u00e1c lo\u1ea1i ph\u1ea3n \u1ee9ng kh\u00e1c, bao g\u1ed3m peroxit v\u00e0 lipid b\u1ecb oxy h\u00f3a. M\u1eb7c d\u00f9 s\u1ef1 \u0103n m\u00f2n c\u00f3 th\u1ec3 t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc c\u1ee7a v\u1eadt li\u1ec7u, c\u00e1c s\u1ea3n ph\u1ea9m ph\u1ee5 c\u1ee7a s\u1ef1 \u0103n m\u00f2n c\u0169ng c\u00f3 nguy c\u01a1 g\u00e2y h\u1ea1i cho v\u1eadt ch\u1ee7. V\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p ph\u1ea3i t\u01b0\u01a1ng \u0111\u1ed1i tr\u01a1<\/li>\n<li><em>M\u00f4i tr\u01b0\u1eddng v\u1eadn \u0111\u1ed9ng cao:<\/em> c\u00e1c kh\u1edbp chi d\u01b0\u1edbi \u0111\u1ea3m nh\u1eadn h\u01a1n m\u1ed9t tri\u1ec7u b\u01b0\u1edbc m\u1ed7i n\u0103m; m\u1ed9t s\u1ed1 ng\u01b0\u1eddi \u0111i h\u01a1n 3,2 tri\u1ec7u b\u01b0\u1edbc m\u1ed7i n\u0103m. Do \u0111\u00f3, c\u00e1c b\u1ed9 ph\u1eadn gi\u1ea3 ph\u1ea3i \u0111\u1eb7c bi\u1ec7t ch\u1ed1ng m\u00e0i m\u00f2n. Nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t, bao g\u1ed3m chi ph\u00ed, m\u1eadt \u0111\u1ed9, kh\u1ea3 n\u0103ng gia c\u00f4ng v\u00e0 d\u1ec5 kh\u1eed tr\u00f9ng.<\/li>\n<\/ul>\n<p>C\u00e1c lo\u1ea1i v\u1eadt li\u1ec7u kh\u1edbp (m\u00f4 t\u1ea3 r\u00f5 h\u01a1n \u1edf c\u00e1c ph\u1ea7n sau theo t\u1eebng lo\u1ea1i kh\u1edbp):<\/p>\n<ul>\n<li><strong>V\u1eadt li\u1ec7u tr\u00f9ng h\u1ee3p: <\/strong><\/li>\n<\/ul>\n<p>+ PTFE<\/p>\n<p>+ UHMWPE<\/p>\n<p>+ PEEK.<\/p>\n<ul>\n<li><strong>Kim lo\u1ea1i:<\/strong><\/li>\n<\/ul>\n<p>+ Th\u00e9p kh\u00f4ng g\u1ec9<\/p>\n<p>+ Titan<\/p>\n<p>+ H\u1ee3p kim cobalt-chromium-molybdenum (CoCrMo) + C\u00e1c kim lo\u1ea1i kh\u00e1c.<\/p>\n<ul>\n<li><strong>Ceramic:<\/strong><\/li>\n<\/ul>\n<p>+ Alumina<\/p>\n<p>+ Zirconia<\/p>\n<p>+ Alumina c\u01b0\u1eddng l\u1ef1c zirconia.<\/p>\n<ul>\n<li><strong>Xi m\u0103ng x\u01b0\u01a1ng:<\/strong><\/li>\n<\/ul>\n<p>Xi m\u0103ng x\u01b0\u01a1ng l\u00e0 polymethylmethacrylate (PMMA), \u0111\u01b0\u1ee3c ph\u00e1t minh v\u00e0o \u0111\u1ea7u nh\u1eefng n\u0103m 1900 v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn nhi\u1ec1u h\u01a1n v\u1edbi t\u00ean g\u1ecdi Plexiglas. PMMA \u0111\u01b0\u1ee3c t\u1ea1o ra t\u1eeb metyl metacrylat (MMA) \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c tr\u00f9ng h\u1ee3p b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng benzoyl peroxit. Xi m\u0103ng x\u01b0\u01a1ng \u0111\u01b0\u1ee3c ph\u00e2n ph\u1ed1i g\u1ed3m hai ph\u1ea7n: bao b\u1ed9t v\u00e0 ch\u1ea5t l\u1ecfng. B\u1ed9t g\u1ed3m PMMA, MMA v\u00e0 benzoyl peroxit. L\u00fd do c\u00f3 m\u1ed9t s\u1ed1 MMA \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00f9ng h\u1ee3p l\u00e0 \u0111\u1ec3 h\u1ea1n ch\u1ebf s\u1ef1 co r\u00fat x\u1ea3y ra khi tr\u00f9ng h\u1ee3p c\u00e1c monomer c\u0169ng nh\u01b0 gi\u1ea3m b\u1edbt n\u0103ng l\u01b0\u1ee3ng t\u1ecfa nhi\u1ec7t do qu\u00e1 tr\u00ecnh n\u00e0y gi\u1ea3i ph\u00f3ng. Ch\u1ea5t l\u1ecfng l\u00e0 MMA. Khi ph\u1ea3n \u1ee9ng tr\u00f9ng h\u1ee3p \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u, MMA n\u1edf ra khi ch\u00fang chuy\u1ec3n th\u00e0nh PMMA, \u0111\u1ed9 nh\u1edbt c\u1ee7a PMMA c\u0169ng t\u0103ng l\u00ean v\u00e0 s\u1ebd c\u1ee9ng l\u1ea1i khi k\u1ebft th\u00fac ph\u1ea3n \u1ee9ng. Ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a xi m\u0103ng x\u01b0\u01a1ng ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o \u0111\u1ed9 \u0111\u1ed3ng nh\u1ea5t \u0111\u1ea1t \u0111\u01b0\u1ee3c khi tr\u1ed9n b\u1ed9t v\u00e0 ch\u1ea5t l\u1ecfng. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng nh\u1ea5t, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i c\u00f3 m\u1ed9t h\u1ec7 th\u1ed1ng tr\u1ed9n nhanh \u0111\u1ec3 tr\u1ed9n b\u1ed9t v\u00e0 ch\u1ea5t l\u1ecfng m\u1ed9t c\u00e1ch nhanh ch\u00f3ng v\u00e0 \u0111\u1ed3ng \u0111\u1ec1u. Tr\u1ed9n c\u00e1c th\u00e0nh ph\u1ea7n trong m\u00f4i tr\u01b0\u1eddng ch\u00e2n kh\u00f4ng gi\u00fap lo\u1ea1i b\u1ecf kh\u00f4ng kh\u00ed b\u1ecb m\u1eafc k\u1eb9t trong xi m\u0103ng. B\u1ecdt kh\u00ed l\u00e0m t\u0103ng \u0111\u1ed9 x\u1ed1p v\u00e0 l\u00e0m gi\u1ea3m \u0111\u1eb7c t\u00ednh \u0111\u1ed9 b\u1ec1n c\u01a1 h\u1ecdc c\u1ee7a v\u1eadt li\u1ec7u.<\/p>\n<p>Ch\u1ee9c n\u0103ng c\u1ee7a xi m\u0103ng l\u00e0 c\u1ed1 \u0111\u1ecbnh c\u00e1c b\u1ed9 ph\u1eadn gi\u1ea3 v\u00e0 truy\u1ec1n t\u1ea3i tr\u1ecdng t\u1eeb b\u1ed9 ph\u1eadn gi\u1ea3 sang x\u01b0\u01a1ng v\u00ec n\u00f3 \u0111\u00f3ng vai tr\u00f2 l\u00e0 c\u1ea7u n\u1ed1i gi\u1eefa hai m\u00f4-\u0111un n\u00e0y. M\u1eb7t ph\u00e2n c\u00e1ch gi\u1eefa PMMA v\u00e0 b\u1ed9 ph\u1eadn gi\u1ea3 kim lo\u1ea1i \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn nhi\u1ec1u. Khi b\u1ed9 ph\u1eadn gi\u1ea3 \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o, m\u1ed9t li\u00ean k\u1ebft c\u01a1 h\u1ecdc ph\u00e1t sinh gi\u1eefa kim lo\u1ea1i v\u00e0 PMMA. Tuy nhi\u00ean, m\u1ed1i li\u00ean k\u1ebft n\u00e0y cu\u1ed1i c\u00f9ng s\u1ebd ch\u1ea5m d\u1ee9t v\u00e0 do \u0111\u00f3 t\u1ea5t c\u1ea3 c\u00e1c chu\u00f4i nh\u00e2n t\u1ea1o \u0111\u1eb7t v\u00e0o s\u1ebd bi\u1ec3u hi\u1ec7n s\u1ef1 di tr\u00fa. Hi\u1ec7u qu\u1ea3 c\u1ee7a m\u1eb7t ph\u00e2n c\u00e1ch c\u1ee7a PMMA v\u1edbi chu\u00f4i ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o thi\u1ebft k\u1ebf c\u1ee7a chu\u00f4i v\u00e0 \u1ea3nh h\u01b0\u1edfng c\u1ee7a n\u00f3 khi di tr\u00fa. Charnley \u0111\u1ea1t k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n v\u1edbi chu\u00f4i \u0111\u01b0\u1ee3c l\u00e0m b\u00f3ng l\u00e1ng so v\u1edbi chu\u00f4i phun c\u00e1t.<\/p>\n<p>M\u1eb7t ph\u00e2n c\u00e1ch t\u1ed1t gi\u1eefa x\u01b0\u01a1ng v\u00e0 xi m\u0103ng ph\u1ee5 thu\u1ed9c ph\u1ea7n l\u1edbn v\u00e0o s\u1ef1 t\u00e1i tu\u1ea7n ho\u00e0n c\u1ee7a x\u01b0\u01a1ng. Vi\u1ec7c tr\u1ed9n xi m\u0103ng b\u1eb1ng \u00e1p su\u1ea5t v\u00e0 ch\u00e2n kh\u00f4ng cho ph\u00e9p t\u1ec9 l\u1ec7 co r\u00fat l\u1edbn h\u01a1n, tr\u00e1i ng\u01b0\u1ee3c v\u1edbi xi m\u0103ng tr\u1ed9n b\u1eb1ng tay. S\u1ef1 co r\u00fat cho ph\u00e9p t\u00e1i tu\u1ea7n ho\u00e0n di\u1ec5n ra nhanh h\u01a1n v\u00e0 ng\u0103n ng\u1eeba <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hoai-tu-vo-mach-chom-xuong-dui\/\">caseation<\/a> x\u01b0\u01a1ng.<\/p>\n<h2><strong>2. KH\u1edaP H\u00c1NG<\/strong><\/h2>\n<h3><strong>2.1 \u0110\u1eb7c \u0111i\u1ec3m c\u00e1c lo\u1ea1i v\u1eadt li\u1ec7u<\/strong><\/h3>\n<p>V\u1eadt li\u1ec7u tr\u00f9ng h\u1ee3p: v\u1eadt li\u1ec7u polyme l\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u \u0111\u1ec3 thay <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/trat-khop-vai-khuyu-hang\/\">hip joint<\/a> v\u1edbi \u0111\u1ed9 ma s\u00e1t th\u1ea5p, nh\u01b0 Charnely \u0111\u00e3 ch\u1ee9ng minh. C\u00e1c h\u1ec7 th\u1ed1ng polyme cao ph\u00e2n t\u1eed c\u00f3 \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh cao nh\u01b0 polytetrafluoroethylen (PTFE), ultra-high molecular weight polyethylen (UHMWPE) ho\u1eb7c polyetheretherketon (PEEK) \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u do c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc tuy\u1ec7t v\u1eddi v\u00e0 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao c\u1ee7a ch\u00fang. Tuy nhi\u00ean, khi \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p, \u1ed5 c\u1ed1i b\u1eb1ng polyethylen t\u1ea1o ra c\u00e1c m\u1ea3nh v\u1ee5n b\u1ecb h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 t\u1ea5n c\u00f4ng. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn m\u1ea5t x\u01b0\u01a1ng, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ti\u00eau x\u01b0\u01a1ng. H\u01a1n n\u1eefa, c\u00e1c m\u1ea3nh v\u1ee5n t\u00edch t\u1ee5 \u1edf khu v\u1ef1c g\u1ea7n v\u1edbi kh\u1edbp nh\u00e2n t\u1ea1o, ti\u00eau x\u01b0\u01a1ng d\u1eabn \u0111\u1ebfn l\u1ecfng chu\u00f4i, khi \u0111\u00f3 ph\u1ea3i ph\u1eabu thu\u1eadt thay l\u1ea1i kh\u1edbp. Vi\u1ec7c thay l\u1ea1i kh\u1edbp do l\u1ecfng l\u1ebbo cao h\u01a1n b\u1ed1n l\u1ea7n so v\u1edbi l\u00fd do h\u00e0ng \u0111\u1ea7u ti\u1ebfp theo (tr\u1eadt kh\u1edbp \u1edf m\u1ee9c 13,6%) v\u00e0 nghi\u00eam tr\u1ecdng h\u01a1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i.<\/p>\n<ul>\n<li><strong>PTFE: <\/strong>c\u00f3 \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh nhi\u1ec7t cao; k\u1ef5 n\u01b0\u1edbc, \u1ed5n \u0111\u1ecbnh trong h\u1ea7u h\u1ebft c\u00e1c lo\u1ea1i m\u00f4i tr\u01b0\u1eddng h\u00f3a h\u1ecdc, \u0111\u01b0\u1ee3c coi l\u00e0 tr\u01a1 trong c\u01a1 th\u1ec3. N\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c Charnley s\u1eed d\u1ee5ng trong l\u1ea7n thay kh\u1edbp h\u00e1ng \u0111\u1ea7u ti\u00ean c\u1ee7a m\u00ecnh, nh\u01b0ng c\u00f3 hai nh\u01b0\u1ee3c \u0111i\u1ec3m ch\u00ednh, \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y sau khi thay kh\u1edbp h\u00e1ng cho 300 b\u1ec7nh nh\u00e2n. V\u1eadt li\u1ec7u n\u00e0y c\u00f3 t\u1ed1c \u0111\u1ed9 m\u00e0i m\u00f2n r\u1ea5t cao, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 0,5 mm m\u1ed7i th\u00e1ng. PTFE t\u1ea1o ra kh\u1ed1i l\u01b0\u1ee3ng l\u1edbn v\u1eadt li\u1ec7u v\u00f4 \u0111\u1ecbnh h\u00ecnh do c\u00f3 r\u1ea5t nhi\u1ec1u t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 c\u1ee7a d\u1ecb v\u1eadt, h\u01a1n n\u1eefa, m\u1ea3nh v\u1ee1 n\u00e0y g\u00e2y ra m\u1ed9t ph\u1ea3n \u1ee9ng d\u1ecb v\u1eadt d\u1eef d\u1ed9i m\u00e0 Charnley \u0111\u00e3 x\u00e1c minh b\u1eb1ng c\u00e1ch ti\u00eam hai m\u1eabu PTFE \u0111\u00e3 \u0111\u01b0\u1ee3c chia nh\u1ecf v\u00e0o \u0111\u00f9i c\u1ee7a ch\u00ednh m\u00ecnh.<\/li>\n<\/ul>\n<p>Charnley \u0111\u00e3 c\u1ed1 g\u1eafng s\u1eed d\u1ee5ng v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p d\u1ef1a tr\u00ean PTFE \u0111\u01b0\u1ee3c gia c\u1ed1 b\u1eb1ng s\u1ee3i th\u1ee7y tinh (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 Fluorosint), c\u00f3 \u0111\u1eb7c t\u00ednh k\u00e9m trong c\u01a1 th\u1ec3 s\u1ed1ng, m\u1eb7c d\u00f9 n\u00f3 ho\u1ea1t \u0111\u1ed9ng t\u1ed1t trong \u1ed1ng nghi\u1ec7m. V\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p sau m\u1ed9t n\u0103m \u0111\u1eb7t v\u00e0o, ph\u00e1t tri\u1ec3n b\u1ec1 m\u1eb7t nh\u00e3o v\u00e0 c\u00f3 th\u1ec3 d\u1ec5 b\u1ecb m\u00f2n. Th\u00eam v\u00e0o \u0111\u00f3, ch\u1ea5t nh\u00e3o t\u00e1c \u0111\u1ed9ng m\u00e0i m\u00f2n v\u00e0 m\u00e0i v\u00e0o kim lo\u1ea1i \u1edf m\u1eb7t \u0111\u1ed1i di\u1ec7n. H\u01a1n n\u1eefa, v\u1eadt li\u1ec7u n\u00e0y cho th\u1ea5y t\u1ec9 l\u1ec7 nhi\u1ec5m tr\u00f9ng (20%) v\u00e0 l\u1ecfng l\u1ebbo (57%) cao h\u01a1n so v\u1edbi c\u00e1c v\u1eadt li\u1ec7u kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n<ul>\n<li><strong>UHMWPE:<\/strong> Charnley gi\u1edbi thi\u1ec7u UHMWPE v\u00e0o n\u0103m 1962, \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi s\u1ef1 th\u1ea5t b\u1ea1i c\u1ee7a PTFE nh\u01b0 m\u1ed9t v\u1eadt li\u1ec7u ch\u1ecbu l\u1ef1c v\u00e0 \u0111\u01b0\u1ee3c duy tr\u00ec b\u1edfi tr\u1ea1ng th\u00e1i \u0111\u1ea7y h\u1ee9a h\u1eb9n trong c\u00e1c th\u1eed nghi\u1ec7m trong ph\u00f2ng th\u00ed nghi\u1ec7m. Polyme \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao, \u0111\u1ed9 ma s\u00e1t th\u1ea5p v\u00e0 \u0111\u1ed9 b\u1ec1n va \u0111\u1eadp cao. N\u00f3 \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1eb1ng c\u00e1ch tr\u00f9ng h\u1ee3p ethylen v\u00e0 n\u00f3 l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i polyme \u0111\u01a1n gi\u1ea3n nh\u1ea5t. C\u00f4ng th\u1ee9c h\u00f3a h\u1ecdc c\u1ee7a n\u00f3 l\u00e0 (\u2013C2H4\u2013)n, trong \u0111\u00f3 n l\u00e0 m\u1ee9c \u0111\u1ed9 tr\u00f9ng h\u1ee3p, l\u00e0 s\u1ed1 \u0111\u01a1n v\u1ecb l\u1eb7p l\u1ea1i d\u1ecdc theo chu\u1ed7i. M\u1ee9c \u0111\u1ed9 trung b\u00ecnh c\u1ee7a n t\u1ed1i thi\u1ec3u l\u00e0 36.000, c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed \u00edt nh\u1ea5t l\u00e0 1 tri\u1ec7u g\/mol theo \u0111\u1ecbnh ngh\u0129a ti\u00eau chu\u1ea9n.<\/li>\n<\/ul>\n<p>Trong nh\u1eefng n\u0103m 1980 v\u00e0 \u0111\u1ea7u nh\u1eefng n\u0103m 1990, l\u1ecfng v\u00f4 tr\u00f9ng v\u00e0 ti\u00eau x\u01b0\u01a1ng n\u1ed5i l\u00ean nh\u01b0 nh\u1eefng v\u1ea5n \u0111\u1ec1 l\u1edbn trong l\u0129nh v\u1ef1c ch\u1ec9nh h\u00ecnh v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 n\u00e0y \u0111\u01b0\u1ee3c coi l\u00e0 h\u1ea1n ch\u1ebf tu\u1ed5i th\u1ecd c\u1ee7a thay kh\u1edbp. \u0110\u1ec3 h\u1ea1n ch\u1ebf n\u1ed3ng \u0111\u1ed9 h\u1ea1t m\u00e0i m\u00f2n v\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc t\u1ed5ng th\u1ec3, ng\u01b0\u1eddi ta \u0111\u00e3 n\u1ed7 l\u1ef1c c\u1ea3i thi\u1ec7n c\u00e1c \u0111\u1eb7c t\u00ednh chung c\u1ee7a UHMWPE cho kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o. Trong nh\u1eefng n\u0103m 90, c\u00e1c nh\u00e0 khoa h\u1ecdc \u0111\u00e3 c\u00f3 th\u1ec3 t\u01b0\u01a1ng quan nh\u1eefng thay \u0111\u1ed5i trong c\u00e1c \u0111\u1eb7c t\u00ednh v\u1eadt l\u00fd c\u1ee7a UHMWPE v\u1edbi s\u1ef1 suy tho\u00e1i in vivo c\u1ee7a c\u00e1c chuy\u1ec3n v\u1eadn c\u01a1 h\u1ecdc. UHMWPE th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1eed tr\u00f9ng b\u1eb1ng c\u00e1ch chi\u1ebfu tia gamma, v\u1edbi li\u1ec1u l\u01b0\u1ee3ng trung b\u00ecnh t\u1eeb 25 \u0111\u1ebfn 40 kGy. Qu\u00e1 tr\u00ecnh n\u00e0y d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c g\u1ed1c t\u1ef1 do, l\u00e0 ti\u1ec1n ch\u1ea5t c\u1ee7a qu\u00e1 tr\u00ecnh oxy h\u00f3a g\u00e2y ra t\u1eafc m\u1ea1ch. Ch\u1ec9 trong th\u1eadp k\u1ef7 qua, li\u00ean k\u1ebft ch\u00e9o b\u1ee9c x\u1ea1 m\u1edbi \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 khu\u1ebfch t\u00e1n chung. Qu\u00e1 tr\u00ecnh li\u00ean k\u1ebft ch\u00e9o n\u00e0y k\u1ebft h\u1ee3p v\u1edbi x\u1eed l\u00fd nhi\u1ec7t \u0111\u00e3 n\u1ed5i l\u00ean \u0111\u1ec3 t\u0103ng kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n v\u00e0 oxy h\u00f3a c\u1ee7a polyme v\u00e0 m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng l\u1edbn c\u00e1c nghi\u00ean c\u1ee9u trong ph\u00f2ng th\u00ed nghi\u1ec7m v\u00e0 l\u00e2m s\u00e0ng \u0111\u00e3 ch\u1ec9 ra k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c. Polyethylen li\u00ean k\u1ebft ch\u00e9o th\u01b0\u1eddng \u0111\u01b0\u1ee3c vi\u1ebft t\u1eaft l\u00e0 PEX ho\u1eb7c XLPE. Hi\u1ec7n nay, c\u00f3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p x\u1eed l\u00fd kh\u00e1c nhau, bao g\u1ed3m chi\u1ebfu x\u1ea1 v\u00e0 nung ch\u1ea3y, chi\u1ebfu x\u1ea1 v\u00e0 t\u00f4i luy\u1ec7n, chi\u1ebfu x\u1ea1 tu\u1ea7n t\u1ef1 v\u1edbi luy\u1ec7n, chi\u1ebfu x\u1ea1 theo sau l\u00e0 t\u1ea1o h\u00ecnh c\u01a1 h\u1ecdc, chi\u1ebfu x\u1ea1 v\u00e0 \u1ed5n \u0111\u1ecbnh v\u1edbi vitamin E. Li\u00ean k\u1ebft ch\u00e9o c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc c\u1ee7a UHMWPE, th\u01b0\u1eddng t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ef1 gi\u1ea3m \u0111\u1ed9 d\u1ebbo dai, c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc cu\u1ed1i c\u00f9ng, \u0111\u1ed9 c\u1ee9ng v\u00e0 \u0111\u1ed9 ch\u1eafc c\u1ee7a polyme. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn hi\u1ec7u su\u1ea5t c\u1ee7a b\u1ed9 ph\u1eadn gi\u1ea3 <em>in vivo. <\/em>C\u00e1c g\u1ed1c t\u1ef1 do c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh trong qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t, cho ph\u00e9p thay \u0111\u1ed5i qu\u00e1 tr\u00ecnh oxy h\u00f3a trong XLPE. K\u1ebft qu\u1ea3 l\u00e0, kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n c\u1ee7a polyme s\u1ebd gi\u1ea3m xu\u1ed1ng, chuy\u1ec3n v\u1eadn ng\u01b0\u1ee3c t\u1ea1o th\u00e0nh m\u1ed9t lo\u1ea1i ngh\u1ecbch l\u00fd. Muratoglu v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 nghi\u00ean c\u1ee9u t\u1eadp t\u00ednh m\u00e0i m\u00f2n c\u1ee7a UHMWPE, t\u00ecm th\u1ea5y nh\u1eefng thay \u0111\u1ed5i l\u1edbn l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a li\u00ean k\u1ebft ch\u00e9o; c\u00e1c t\u00e1c gi\u1ea3 n\u00e0y ph\u00e1t hi\u1ec7n ra r\u1eb1ng qu\u00e1 tr\u00ecnh n\u00e0y l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u1ecbnh h\u01b0\u1edbng v\u00e0 \u0111\u1ecbnh h\u01b0\u1edbng l\u1ea1i c\u1ee7a c\u00e1c ph\u00e2n t\u1eed, \u1ee9c ch\u1ebf c\u01a1 ch\u1ebf g\u00e2y m\u00f2n n\u00e0y. C\u0169ng c\u00f3 v\u1ebb nh\u01b0 m\u1ee9c \u0111\u1ed9 li\u00ean k\u1ebft ch\u00e9o, \u0111\u00e3 l\u1ea5n \u00e1t \u1ea3nh h\u01b0\u1edfng c\u1ee7a vi\u1ec7c gi\u1ea3m c\u00e1c \u0111\u1eb7c t\u00ednh v\u1eadt l\u00fd v\u00e0 c\u01a1 h\u1ecdc trong vi\u1ec7c ki\u1ec3m so\u00e1t t\u1eadp t\u00ednh m\u00e0i m\u00f2n c\u1ee7a UHMWPE. \u0110\u1ec3 c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t, XLPE n\u00ean \u0111\u01b0\u1ee3c li\u00ean k\u1ebft ch\u00e9o \u1edf m\u1ee9c b\u1ee9c x\u1ea1 ch\u00ednh x\u00e1c v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c n\u1ea5u ch\u1ea3y l\u1ea1i \u0111\u1ec3 lo\u1ea1i b\u1ecf c\u00e1c g\u1ed1c t\u1ef1 do. C\u00e1c g\u1ed1c t\u1ef1 do d\u01b0 th\u1eeba kh\u00f4ng ph\u1ea3n \u1ee9ng \u0111\u1ec3 t\u1ea1o li\u00ean k\u1ebft ch\u00e9o th\u00f4ng qua chi\u1ebfu x\u1ea1 ph\u1ea3i \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c d\u1ea1ng oxy h\u00f3a v\u00e0 s\u1ef1 t\u00e1i t\u1ed5 h\u1ee3p c\u1ee7a ch\u00fang. Vi\u1ec7c lo\u1ea1i b\u1ecf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua hai ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau: t\u00f4i luy\u1ec7n ho\u1eb7c n\u1ea5u l\u1ea1i; polyethylene li\u00ean k\u1ebft ngang cao (HXLPE) \u0111\u00e3 ch\u1ee9ng minh kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi v\u1eadt li\u1ec7u kh\u1eed tr\u00f9ng b\u1eb1ng tia gamma. B\u1eb1ng c\u00e1ch t\u00f4i luy\u1ec7n d\u01b0\u1edbi nhi\u1ec7t \u0111\u1ed9 n\u00f3ng ch\u1ea3y cao nh\u1ea5t c\u1ee7a polyme, m\u1ed9t s\u1ed1 v\u00f9ng tinh th\u1ec3 b\u1ecb n\u00f3ng ch\u1ea3y v\u00e0 n\u1ed3ng \u0111\u1ed9 g\u1ed1c t\u1ef1 do b\u1ecb gi\u1ea3m xu\u1ed1ng, nh\u01b0ng n\u00f3 v\u1eabn c\u00f3 th\u1ec3 \u0111o \u0111\u01b0\u1ee3c. M\u1eb7t kh\u00e1c, th\u00f4ng qua qu\u00e1 tr\u00ecnh n\u1ea5u ch\u1ea3y l\u1ea1i sau chi\u1ebfu x\u1ea1, c\u00e1c g\u1ed1c t\u1ef1 do c\u00f2n s\u00f3t l\u1ea1i \u0111\u01b0\u1ee3c gi\u1ea3m xu\u1ed1ng m\u1ee9c kh\u00f4ng th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c, \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng thi\u1ebft b\u1ecb c\u1ed9ng h\u01b0\u1edfng xoay \u0111i\u1ec7n t\u1eed hi\u1ec7n \u0111\u1ea1i. B\u1eb1ng qu\u00e1 tr\u00ecnh n\u00e0y, \u0111\u1ed9 k\u1ebft tinh b\u1ecb gi\u1ea3m sau b\u01b0\u1edbc n\u00f3ng ch\u1ea3y do b\u1ecb c\u1ea3n tr\u1edf b\u1edfi c\u00e1c li\u00ean k\u1ebft ch\u00e9o m\u1edbi, do \u0111\u00f3, \u0111\u1ed9 b\u1ec1n c\u01a1 h\u1ecdc v\u00e0 \u0111\u1ed9 b\u1ec1n m\u1ecfi c\u1ee7a polyme gi\u1ea3m. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean qu\u00e1 tr\u00ecnh oxy h\u00f3a <em>in vivo <\/em>c\u1ee7a XLPE \u0111\u01b0\u1ee3c n\u1ea5u l\u1ea1i ho\u1eb7c t\u00f4i luy\u1ec7n.<\/p>\n<p>Muratoglu v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ph\u00e2n t\u00edch c\u00e1c l\u1edbp l\u00f3t \u1ed5 c\u1ed1i XLPE \u0111\u01b0\u1ee3c thu h\u1ed3i, t\u00ecm th\u1ea5y qu\u00e1 tr\u00ecnh oxy h\u00f3a t\u1ed1i thi\u1ec3u, nh\u01b0ng h\u1ecd ph\u00e1t hi\u1ec7n ra r\u1eb1ng qu\u00e1 tr\u00ecnh oxy h\u00f3a t\u0103ng l\u00ean trong qu\u00e1 tr\u00ecnh b\u1ea3o qu\u1ea3n ch\u00fang tr\u00ean k\u1ec7 trong kh\u00f4ng kh\u00ed, g\u00e2y ra h\u01b0 h\u1ecfng nghi\u00eam tr\u1ecdng. H\u1ecd gi\u1ea3 \u0111\u1ecbnh r\u1eb1ng hai c\u01a1 ch\u1ebf c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i t\u00ednh \u1ed5n \u0111\u1ecbnh oxy h\u00f3a c\u1ee7a UHMWPE, t\u1ea3i theo chu k\u1ef3<em> in vivo <\/em>v\u00e0 h\u1ea5p th\u1ee5 lipid. Lipid c\u00f3 th\u1ec3 ph\u1ea3n \u1ee9ng v\u1edbi oxy v\u00e0 do \u0111\u00f3, t\u00e1ch c\u00e1c nguy\u00ean t\u1eed hydro t\u1eeb chu\u1ed7i polyethylen, k\u00edch th\u00edch s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c g\u1ed1c t\u1ef1 do.<\/p>\n<p>Rinitz v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 nghi\u00ean c\u1ee9u c\u00e1c kh\u1edbp thu h\u1ed3i ng\u1eafn h\u1ea1n v\u00e0 trung h\u1ea1n \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng HXLPE \u0111\u01b0\u1ee3c n\u1ea5u l\u1ea1i v\u00e0 t\u00f4i luy\u1ec7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem li\u1ec7u qu\u00e1 tr\u00ecnh oxy h\u00f3a c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn thay \u0111\u1ed5i t\u00ednh ch\u1ea5t c\u01a1 h\u1ecdc th\u00f4ng qua qu\u00e1 tr\u00ecnh c\u1eaft \u0111\u1ee9t chu\u1ed7i oxy h\u00f3a hay kh\u00f4ng. C\u00e1c nghi\u00ean c\u1ee9u c\u1ee7a h\u1ecd \u0111\u00e3 ch\u1ee9ng minh m\u1eadt \u0111\u1ed9 li\u00ean k\u1ebft ngang gi\u1ea3m, t\u01b0\u01a1ng \u1ee9ng v\u1edbi qu\u00e1 tr\u00ecnh oxy h\u00f3a t\u0103ng c\u01b0\u1eddng \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 v\u1eadt li\u1ec7u c\u00f3 li\u00ean k\u1ebft ngang, \u1ed5n \u0111\u1ecbnh nhi\u1ec7t cao. C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng kh\u00e1c \u0111\u00e3 nh\u1ea5n m\u1ea1nh t\u1ed1c \u0111\u1ed9 oxy h\u00f3a <em>in vivo <\/em>nhanh c\u1ee7a c\u00e1c kh\u1edbp thu h\u1ed3i \u0111\u01b0\u1ee3c x\u1eed l\u00fd nhi\u1ec7t sau chi\u1ebfu x\u1ea1.<\/p>\n<p>K\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1edd c\u00e1c mi\u1ebfng l\u00f3t HXLPE k\u1ebft h\u1ee3p v\u1edbi ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng s\u1ee9 delta, nh\u01b0 trong nghi\u00ean c\u1ee9u b\u1edfi Kim v\u00e0 c\u1ed9ng s\u1ef1, t\u00ecm th\u1ea5y t\u1ec9 l\u1ec7 l\u00fan h\u00e0ng n\u0103m c\u1ee7a ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i v\u00e0o kho\u1ea3ng 0,022 mm\/n\u0103m. Hamai v\u00e0 c\u1ed9ng s\u1ef1 so s\u00e1nh t\u1ec9 l\u1ec7 hao m\u00f2n l\u00e2m s\u00e0ng c\u1ee7a l\u1edbp l\u00f3t HXLPE \u0111\u01b0\u1ee3c t\u00f4i luy\u1ec7n v\u00e0 n\u1ea5u l\u1ea1i b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p ch\u1ee5p <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/x-quang-trong-chan-thuong-chinh-hinh\/\">X-ray<\/a> tr\u00ean 36 c\u1eb7p m\u1eabu ph\u00f9 h\u1ee3p c\u1ee7a kh\u1edbp h\u00e1ng l\u1ea5y ra. H\u1ecd nh\u1eadn th\u1ea5y \u0111\u1ed9 nh\u00e3o l\u1edbn h\u01a1n \u0111\u00e1ng k\u1ec3 \u1edf ph\u1ea7n n\u1ea5u ch\u1ea3y l\u1ea1i so v\u1edbi ph\u1ea7n t\u00f4i luy\u1ec7n, nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa t\u1ed1c \u0111\u1ed9 m\u00e0i m\u00f2n \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh. Nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u c\u1ee7a Takada v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 so s\u00e1nh tr\u1ea1ng th\u00e1i m\u00e0i m\u00f2n gi\u1eefa HXLPE th\u1ebf h\u1ec7 th\u1ee9 hai \u0111\u01b0\u1ee3c t\u00f4i luy\u1ec7n v\u00e0 th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t. Li\u00ean quan \u0111\u1ebfn 123 kh\u1edbp h\u00e1ng thay l\u1ea7n \u0111\u1ea7u, nghi\u00ean c\u1ee9u c\u1ee7a h\u1ecd \u0111\u00e3 x\u00e1c nh\u1eadn kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao c\u1ee7a c\u1ea3 hai lo\u1ea1i HXLPE, nh\u01b0ng ph\u00e1t hi\u1ec7n ra r\u1eb1ng HXLPE \u0111\u01b0\u1ee3c t\u00f4i luy\u1ec7n th\u1ebf h\u1ec7 th\u1ee9 hai c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n t\u1ed1t h\u01a1n HXLPE th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t trong m\u1ed9t th\u1eddi gian ng\u1eafn theo d\u00f5i. Ngo\u00e0i ra, D\u2019antonio v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 hao m\u00f2n c\u1ee7a HXLPE \u0111\u01b0\u1ee3c t\u00f4i luy\u1ec7n th\u1ebf h\u1ec7 th\u1ee9 hai, so v\u1edbi polyethylen th\u00f4ng th\u01b0\u1eddng, gi\u1ea3m 72 \u2013 86% (t\u00f9y thu\u1ed9c v\u00e0o k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u kh\u00e1c). H\u1ecd ti\u1ebfp t\u1ee5c t\u00ecm th\u1ea5y m\u1ee9c gi\u1ea3m 58%, khi so s\u00e1nh \u0111\u1ed9 m\u00f2n tuy\u1ebfn t\u00ednh c\u1ee7a HXLPE t\u00f4i luy\u1ec7n th\u1ebf h\u1ec7 th\u1ee9 hai v\u00e0 th\u1ee9 nh\u1ea5t.<\/p>\n<p>\u0110\u1ed9 k\u1ebft tinh c\u1ee7a polyme l\u00e0 m\u1ed9t h\u00e0m c\u1ee7a li\u1ec1u chi\u1ebfu x\u1ea1 v\u00e0 x\u1eed l\u00fd nhi\u1ec7t. S\u1ef1 chi\u1ebfu x\u1ea1 d\u1eabn \u0111\u1ebfn c\u00e1c chu\u1ed7i nh\u1ecf h\u01a1n v\u1edbi t\u00ednh linh \u0111\u1ed9ng t\u0103ng l\u00ean, trong khi s\u1ef1 thay \u0111\u1ed5i \u0111\u1ed9 k\u1ebft tinh sau quy tr\u00ecnh nhi\u1ec7t ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec7t \u0111\u1ed9 \u0111\u1ea1t \u0111\u01b0\u1ee3c. N\u1ebfu x\u1eed l\u00fd \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi \u0111i\u1ec3m n\u00f3ng ch\u1ea3y 137\u00b0C, \u0111\u1ed9 linh \u0111\u1ed9ng c\u1ee7a chu\u1ed7i t\u0103ng l\u00ean, mang l\u1ea1i \u0111\u1ed9 k\u1ebft tinh cao h\u01a1n. N\u1ebfu quy tr\u00ecnh \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nhi\u1ec7t \u0111\u1ed9 cao h\u01a1n, s\u1ef1 k\u1ebft tinh c\u1ee7a polyme, trong qu\u00e1 tr\u00ecnh h\u1ea1 nhi\u1ec7t \u0111\u1ed9 xu\u1ed1ng nhi\u1ec7t \u0111\u1ed9 m\u00f4i tr\u01b0\u1eddng xung quanh, x\u1ea3y ra v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a li\u00ean k\u1ebft ch\u00e9o, l\u00e0m gi\u1ea3m \u0111\u1ed9 k\u1ebft tinh c\u1ee7a polyme v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n v\u1edbi nh\u1eefng thay \u0111\u1ed5i nh\u1ecf v\u1ec1 \u0111\u1ed9 d\u1ebbo dai.<\/p>\n<p>V\u1ec1 c\u01a1 b\u1ea3n, c\u00e1c c\u01a1 ch\u1ebf m\u00e0 UHMWPE c\u1ea3i thi\u1ec7n chu\u1ed7i c\u1ee7a n\u00f3 x\u1ea3y ra th\u00f4ng qua s\u1ef1 bi\u1ebfn d\u1ea1ng \u0111\u00e0n h\u1ed3i c\u1ee7a polyme, v\u1edbi s\u1ef1 li\u00ean k\u1ebft ph\u00e2n t\u1eed theo h\u01b0\u1edbng chuy\u1ec3n \u0111\u1ed9ng d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c s\u1ee3i m\u1ea3nh, k\u00e9o ra c\u00f3 h\u01b0\u1edbng song song v\u1edbi nhau. K\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 s\u1eafp x\u1ebfp n\u00e0y, b\u1ec1 m\u1eb7t ch\u1ecbu t\u1ea3i c\u1ee7a UHMWPE c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng d\u1ecdc theo h\u01b0\u1edbng tr\u01b0\u1ee3t, trong khi n\u00f3 y\u1ebfu \u0111i theo h\u01b0\u1edbng ngang. Do \u0111\u00f3, c\u00f3 m\u1ed9t nh\u1eadn \u0111\u1ecbnh \u0111\u1ec3 nh\u1eadn th\u1ea5y c\u00e1c polyme \u0111\u01b0\u1ee3c gia c\u1ed1 v\u1edbi \u0111\u1ed9 b\u1ec1n cao nh\u01b0 UHMWPE t\u1ef1 gia c\u1ed1. H\u1ed7n h\u1ee3p n\u00e0y v\u1ec1 c\u01a1 b\u1ea3n l\u00e0 m\u1ed9t ma tr\u1eadn kh\u00f4ng \u0111\u1ecbnh h\u01b0\u1edbng c\u1ee7a UHMWPE, n\u01a1i c\u00e1c h\u1ea1t gia c\u1ed1 c\u1ee7a c\u00f9ng m\u1ed9t v\u1eadt li\u1ec7u \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e2n t\u00e1n, t\u1ea1o ra m\u1ed9t polyme c\u00f3 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc cao, t\u0103ng t\u00ednh ch\u1ea5t c\u01a1 h\u1ecdc v\u00e0 c\u01a1 h\u1ed9i \u0111\u01b0\u1ee3c kh\u1eed tr\u00f9ng v\u00e0 li\u00ean k\u1ebft ch\u00e9o nh\u01b0 UHMWPE truy\u1ec1n th\u1ed1ng.<\/p>\n<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, m\u1ed9t h\u01b0\u1edbng kh\u00e1c \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh polyethylen. Tr\u1ed9n vitamin E v\u1edbi polyme tr\u01b0\u1edbc h\u1ebft c\u00f3 \u00fd ngh\u0129a nh\u01b0 m\u1ed9t ch\u1ea5t \u1ed5n \u0111\u1ecbnh an to\u00e0n \u0111\u00fang v\u1ec7 sinh, c\u00e1c h\u1ee3p ch\u1ea5t tocopherol \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t l\u00e0m ch\u1ea5t \u1ed5n \u0111\u1ecbnh cho polyolefin v\u00e0o nh\u1eefng n\u0103m 1980. N\u0103m 1994, Brach del Prever v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 gi\u1edbi thi\u1ec7u UHMWPE pha tr\u1ed9n v\u1edbi vitamin E \u0111\u1ec3 l\u00e0m kh\u1edbp nh\u00e2n t\u1ea1o. N\u0103m 2007, kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o UHMWPE \u0111\u01b0\u1ee3c chi\u1ebfu x\u1ea1, khu\u1ebfch t\u00e1n vitamin E \u0111\u1ea7u ti\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u l\u00e2m s\u00e0ng t\u1ea1i Hoa K\u1ef3 (Biomet Inc., Warsaw, IN, USA). S\u1ef1 pha tr\u1ed9n d\u1eabn \u0111\u1ebfn s\u1ef1 gi\u00e1n \u0111o\u1ea1n c\u1ee7a chu tr\u00ecnh oxy h\u00f3a b\u1eb1ng c\u00e1ch gi\u1ea3m kh\u1ea3 n\u0103ng ph\u1ea3n \u1ee9ng c\u1ee7a c\u00e1c g\u1ed1c, t\u1ea1o kh\u1edfi nguy\u00ean cho th\u1ebf h\u1ec7 th\u1ee9 ba c\u1ee7a polyethylen. N\u1ebfu vitamin E \u0111\u01b0\u1ee3c \u1ed5n \u0111\u1ecbnh, UHMWPE \u0111\u01b0\u1ee3c chi\u1ebfu x\u1ea1 tr\u1ea3i qua qu\u00e1 tr\u00ecnh gi\u00e0 h\u00f3a nhanh \u1edf nhi\u1ec7t \u0111\u1ed9 cao v\u00e0\/ho\u1eb7c trong s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a oxy tinh khi\u1ebft, n\u00f3 s\u1ebd b\u1ec1n v\u1ec1 m\u1eb7t oxy h\u00f3a h\u01a1n so v\u1edbi UHMWPE \u0111\u01b0\u1ee3c kh\u1eed tr\u00f9ng b\u1eb1ng gamma ho\u1eb7c \u0111\u01b0\u1ee3c chi\u1ebfu x\u1ea1 li\u1ec1u cao. C\u00e1c nghi\u00ean c\u1ee9u trong \u1ed1ng nghi\u1ec7m \u0111\u00e3 \u1ee7ng h\u1ed9 gi\u1ea3 thuy\u1ebft r\u1eb1ng s\u1ef1 pha tr\u1ed9n vitamin E s\u1ebd t\u0103ng c\u01b0\u1eddng t\u00ednh \u1ed5n \u0111\u1ecbnh oxy h\u00f3a c\u1ee7a XLPE. C\u0169ng c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf trong quy tr\u00ecnh: vi\u1ec7c t\u0103ng n\u1ed3ng \u0111\u1ed9 vitamin E trong h\u1ed7n h\u1ee3p kh\u00f4ng kh\u1ea3 thi, tr\u1edf ng\u1ea1i li\u00ean k\u1ebft ch\u00e9o khi c\u00f3 m\u1eb7t vitamin E quy \u0111\u1ecbnh vi\u1ec7c s\u1eed d\u1ee5ng n\u1ed3ng \u0111\u1ed9 th\u1ea5p h\u01a1n. Do \u0111\u00f3, c\u1ea7n c\u00f3 s\u1ef1 c\u00e2n b\u1eb1ng \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c m\u1eadt \u0111\u1ed9 li\u00ean k\u1ebft ch\u00e9o cao v\u00e0 \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh oxy h\u00f3a cao.<\/p>\n<ul>\n<li><strong>PEEK: <\/strong>Polyether-ether-ketone l\u00e0 m\u1ed9t polyme t\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc n\u1ed5i ti\u1ebfng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c \u1ee9ng d\u1ee5ng ch\u1ec9nh h\u00ecnh. N\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c coi l\u00e0 v\u1eadt li\u1ec7u ch\u1ecbu l\u1ef1c thay th\u1ebf cho kh\u1edbp \u0111\u1ed1t s\u1ed1ng do c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc thu\u1eadn l\u1ee3i v\u00e0 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc c\u1ee7a c\u00e1c m\u1ea3nh v\u1ee5n m\u00e0i m\u00f2n c\u1ee7a n\u00f3. PEEK \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m v\u1eadt li\u1ec7u sinh h\u1ecdc, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u1ed9t s\u1ed1ng, t\u1eeb nh\u1eefng n\u0103m 1980, do c\u1ea5u tr\u00fac c\u1ee7a n\u00f3 mang l\u1ea1i kh\u1ea3 n\u0103ng ch\u1ed1ng h\u00f3a ch\u1ea5t v\u01b0\u1ee3t tr\u1ed9i, t\u00ednh tr\u01a1 v\u00e0 \u1ed5n \u0111\u1ecbnh nhi\u1ec7t trong \u0111i\u1ec1u ki\u1ec7n <em>in vivo.<\/em> N\u0103m 1998, Wang v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p \u0111\u00e3 th\u1eed nghi\u1ec7m \u1ed5 c\u1ed1i l\u00e0m b\u1eb1ng PEEK tr\u00ean m\u1ed9t thi\u1ebft b\u1ecb m\u00f4 ph\u1ecfng kh\u1edbp h\u00e1ng trong 10 tri\u1ec7u chu k\u1ef3. H\u1ecd quan s\u00e1t th\u1ea5y t\u1ec9 l\u1ec7 m\u00e0i m\u00f2n gi\u1ea3m g\u1ea7n hai b\u1eadc so v\u1edbi c\u1eb7p \u0111\u00f4i UHMWPE\/kim lo\u1ea1i ho\u1eb7c UHMWPE\/g\u1ed1m th\u00f4ng th\u01b0\u1eddng. Tuy nhi\u00ean, b\u1ea5t ch\u1ea5p nh\u1eefng h\u1ee9a h\u1eb9n t\u1ed1t \u0111\u1eb9p xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u00ecnh hu\u1ed1ng \u1ee9ng su\u1ea5t ti\u1ebfp x\u00fac th\u1ea5p, trong \u1ed1ng nghi\u1ec7m, khi \u1edf trong m\u00f4i tr\u01b0\u1eddng \u1ee9ng su\u1ea5t ti\u1ebfp x\u00fac cao, v\u1eabn c\u00f3 nh\u1eefng c\u00e2u h\u1ecfi v\u1ec1 t\u00ednh ph\u00f9 h\u1ee3p c\u1ee7a v\u1eadt li\u1ec7u n\u00e0y nh\u01b0 \u1ed5 c\u1ed1i ho\u1eb7c b\u1ed9 ph\u1eadn m\u00e2m ch\u00e0y c\u1ee7a <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">knee joint<\/a>. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u l\u00e2m s\u00e0ng v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng n\u00f3.<\/li>\n<li><strong>Kim lo\u1ea1i:<\/strong> v\u1eadt li\u1ec7u kim lo\u1ea1i c\u00f3 \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i trong l\u0129nh v\u1ef1c y t\u1ebf v\u00e0 k\u1ef9 thu\u1eadt sinh h\u1ecdc v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u01b0 c\u00e1c th\u00e0nh ph\u1ea7n c\u1ea5y gh\u00e9p ch\u1ec9nh h\u00ecnh. C\u00e1c kim lo\u1ea1i truy\u1ec1n\u00a0th\u1ed1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho thay kh\u1edbp h\u00e1ng l\u00e0 th\u00e9p kh\u00f4ng g\u1ec9, h\u1ee3p kim titan (Ti6Al4V) v\u00e0 \u2013 ch\u1ee7 y\u1ebfu \u2013 h\u1ee3p kim coban-chrom-molybdenum (CoCrMo). Lo\u1ea1i th\u1ee9 hai c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng \u0103n m\u00f2n t\u1ed1t so v\u1edbi c\u00e1c kim lo\u1ea1i kh\u00e1c v\u00e0 \u0111\u1ed9 b\u1ec1n cao, ch\u1ed1ng m\u00e0i m\u00f2n cao v\u00e0 \u0111\u1ed9 c\u1ee9ng cao h\u01a1n (HV = 350) so v\u1edbi c\u00e1c kim lo\u1ea1i v\u00e0 polyme kh\u00e1c.<\/li>\n<li><strong>H\u1ee3p kim CoCrMo:<\/strong> kh\u1edbp MoM th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb h\u1ee3p kim CoCrMo. H\u1ee3p kim CoCrMo bao g\u1ed3m 58,9 \u2013 69,5% Co; 27,0 \u2013 30% Cr; 5,0 \u2013 7,0% Mo v\u00e0 m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf c\u00e1c nguy\u00ean t\u1ed1 kh\u00e1c (Mn, Si, Ni, Fe v\u00e0 C). C\u00e1c h\u1ee3p kim kim lo\u1ea1i n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh hai lo\u1ea1i: h\u1ee3p kim carbon cao (h\u00e0m l\u01b0\u1ee3ng carbon &gt; 0,20%) v\u00e0 h\u1ee3p kim carbon th\u1ea5p (h\u00e0m l\u01b0\u1ee3ng carbon &lt; 0,08%). Ngo\u00e0i ra, h\u1ee3p kim kim lo\u1ea1i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1eb1ng hai k\u1ef9 thu\u1eadt kh\u00e1c nhau nh\u01b0 \u0111\u00fac v\u00e0 r\u00e8n; k\u00edch th\u01b0\u1edbc h\u1ea1t c\u1ee7a h\u1ee3p kim r\u00e8n th\u01b0\u1eddng nh\u1ecf h\u01a1n 10 \u03bcm, trong khi k\u00edch th\u01b0\u1edbc h\u1ea1t c\u1ee7a v\u1eadt li\u1ec7u \u0111\u00fac n\u1eb1m trong kho\u1ea3ng t\u1eeb 30 \u2013 1.000 \u03bcm. C\u00e1c nghi\u00ean c\u1ee9u chuy\u00ean s\u00e2u \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1ec1 luy\u1ec7n kim cho h\u1ee3p kim CoCrMo v\u1edbi carbon; tuy nhi\u00ean, kh\u00f4ng c\u00f3 s\u01a1 \u0111\u1ed3 pha ho\u00e0n ch\u1ec9nh. \u0110i\u1ec1u n\u00e0y ch\u1ee7 y\u1ebfu l\u00e0 do c\u00e1c giai \u0111o\u1ea1n ph\u1ee9c t\u1ea1p t\u1ed3n t\u1ea1i trong h\u1ec7 th\u1ed1ng. Nhi\u1ec1u lo\u1ea1i carbua kh\u00e1c nhau, ch\u1eb3ng h\u1ea1n nh\u01b0 M23C6 v\u00e0 M6C c\u00f3 th\u1ec3 t\u1ed5 ch\u1ee9c d\u1ef1a tr\u00ean qu\u00e1 tr\u00ecnh x\u1eed l\u00fd nhi\u1ec7t. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 c\u1ea5u tr\u00fac vi m\u00f4 c\u1ee7a carbua, th\u00e0nh ph\u1ea7n h\u00f3a h\u1ecdc c\u1ee7a ch\u00fang v\u00e0 \u0111\u1ed9 c\u1ee9ng nano c\u00f3 li\u00ean quan \u0111\u1ebfn hi\u1ec7u su\u1ea5t m\u00e0i m\u00f2n.<\/li>\n<\/ul>\n<p>Coban v\u00e0 chrom \u0111\u1ec1u c\u00f3 trong m\u00f4i tr\u01b0\u1eddng v\u00e0 th\u1ef1c ph\u1ea9m. Ch\u00fang c\u1ea7n thi\u1ebft cho con ng\u01b0\u1eddi nh\u01b0 m\u1ed9t nguy\u00ean t\u1ed1 vi l\u01b0\u1ee3ng trong c\u01a1 th\u1ec3 nh\u01b0ng l\u1ea1i \u0111\u1ed9c h\u1ea1i khi \u1edf n\u1ed3ng \u0111\u1ed9 cao. B\u1ec7nh nh\u00e2n c\u00f3 c\u1eb7p MoM Co-Cr b\u1ecb m\u00e0i m\u00f2n gi\u1ea3i ph\u00f3ng coban v\u00e0 chrom v\u00e0o d\u1ecbch kh\u1edbp. Nh\u1eefng ch\u1ea5t n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng di chuy\u1ec3n v\u00e0o m\u00e1u tr\u01b0\u1edbc khi th\u1ea3i ra ngo\u00e0i qua n\u01b0\u1edbc ti\u1ec3u. Ngu\u1ed3n ki\u1ebfn th\u1ee9c h\u1ea1n h\u1eb9p v\u1ec1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a tu\u1ea7n ho\u00e0n Co v\u00e0 Cr; ch\u00fang c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng ch\u1ee7 y\u1ebfu \u0111\u1ebfn c\u00e1c ch\u1ee9c n\u0103ng sinh h\u1ecdc v\u00e0 t\u1ebf b\u00e0o v\u1edbi c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u1ec1m t\u00e0ng tr\u00ean h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch, g\u00e2y \u0111\u1ed9t bi\u1ebfn v\u00e0 sinh ung th\u01b0. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o MoM, m\u1ee9c cao c\u1ee7a c\u00e1c ion Co v\u00e0 Cr trong tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u1ea1o ra v\u00e0 c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan tuy\u1ebfn t\u00ednh thu\u1eadn v\u1edbi ph\u1ea3n \u1ee9ng t\u1ebf b\u00e0o lympho.<\/p>\n<ul>\n<li><strong>Kim lo\u1ea1i kh\u00e1c:<\/strong> v\u1eadt li\u1ec7u kim lo\u1ea1i c\u00f3 m\u00f4-\u0111un \u0111\u00e0n h\u1ed3i cao, gi\u00fap h\u1ea1n ch\u1ebf s\u1ef1 ph\u00e2n b\u1ed1 \u00e1p l\u1ef1c t\u1eeb d\u1ee5ng c\u1ee5 \u0111\u1ebfn x\u01b0\u01a1ng. V\u00ec th\u1ebf c\u00e1c b\u1ed9 ph\u1eadn kim lo\u1ea1i m\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u1edbi m\u00f4 \u0111un \u0111\u00e0n h\u1ed3i th\u1ea5p h\u01a1n v\u00e0 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n v\u00e0 \u0103n m\u00f2n cao h\u01a1n. C\u00e1c nghi\u00ean c\u1ee9u v\u1eabn ti\u1ebfp di\u1ec5n v\u1edbi c\u00e1c h\u1ee3p kim kim lo\u1ea1i m\u1edbi \u0111\u1ec3 \u1ee9ng d\u1ee5ng trong c\u00e1c b\u1ed9 ph\u1eadn gi\u1ea3 \u1edf h\u00e1ng \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc t\u1ed1t h\u01a1n c\u00f9ng v\u1edbi c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc v\u01b0\u1ee3t tr\u1ed9i. Tuy nhi\u00ean, b\u1eaft bu\u1ed9c ph\u1ea3i t\u00ecm ra s\u1ef1 h\u00f2a h\u1ee3p gi\u1eefa nhi\u1ec1u \u0111\u1eb7c t\u00ednh t\u1ed1i \u01b0u mong mu\u1ed1n cho v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p. H\u1ee3p kim Co-Cr-Mo c\u00f3 \u0111\u1ed9 tr\u01a1 h\u00f3a h\u1ecdc th\u1ea5p nh\u01b0ng kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao, trong khi h\u1ee3p kim th\u00e9p kh\u00f4ng g\u1ec9 c\u00f3 \u0111\u1ed9 b\u1ec1n v\u00e0 \u0111\u1ed9 d\u1ebbo th\u1ea5p. Zirconium (Zr) v\u00e0 tantalum (Ta) l\u00e0 c\u00e1c kim lo\u1ea1i ch\u1ecbu n\u00f3ng \u2013 do t\u00ednh \u1ed5n \u0111\u1ecbnh h\u00f3a h\u1ecdc cao v\u00e0 nhi\u1ec7t \u0111\u1ed9 n\u00f3ng ch\u1ea3y cao \u2013 v\u00e0 ch\u1ed1ng \u0103n m\u00f2n cao, do t\u00ednh \u1ed5n \u0111\u1ecbnh c\u1ee7a l\u1edbp oxit. V\u00ec vanadium l\u00e0 m\u1ed9t kim lo\u1ea1i t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed9c, m\u1ed9t s\u1ed1 n\u1ed7 l\u1ef1c \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 thay th\u1ebf n\u00f3 trong c\u00e1c h\u1ee3p kim Ti-6Al-4V ph\u1ed5 bi\u1ebfn. \u0110\u1ec3 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc v\u00e0 kh\u1ea3 n\u0103ng b\u1ec1n c\u01a1 h\u1ecdc, h\u1ee3p kim Ti-6Al-4V n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng s\u1eaft (Fe) ho\u1eb7c Niobium (Nb), thu \u0111\u01b0\u1ee3c c\u00e1c h\u1ee3p kim \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn Ti-5Al-2.5Fe v\u00e0 Ti-6Al-7Nb. Nh\u1eefng h\u1ee3p kim n\u00e0y so v\u1edbi Ti-6Al-4V truy\u1ec1n th\u1ed1ng c\u00f3 \u0111\u1ed9 c\u1ee9ng \u0111\u1ed9ng l\u1edbn h\u01a1n v\u00e0 m\u00f4-\u0111un \u0111\u00e0n h\u1ed3i th\u1ea5p h\u01a1n, cho ph\u00e9p ph\u00e2n ph\u1ed1i \u00e1p l\u1ef1c x\u01b0\u01a1ng\/d\u1ee5ng c\u1ee5 c\u1ea5y gh\u00e9p t\u1ed1t h\u01a1n. M\u1ed9t nh\u00f3m h\u1ee3p kim titan m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o l\u0129nh v\u1ef1c ch\u1ec9nh h\u00ecnh s\u1eed d\u1ee5ng molybdenum v\u1edbi n\u1ed3ng \u0111\u1ed9 l\u1edbn h\u01a1n 10%. Ch\u00fang\u00a0l\u00e0m \u1ed5n \u0111\u1ecbnh pha \u03b2 \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng; \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ee3p kim \u03b2-Ti. C\u00f3 m\u00f4 \u0111un \u0111\u00e0n h\u1ed3i \u00edt h\u01a1n 20%, ch\u00fang ho\u1ea1t \u0111\u1ed9ng g\u1ea7n v\u1edbi x\u01b0\u01a1ng th\u1eadt h\u01a1n v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ecbnh h\u00ecnh t\u1ed1t h\u01a1n. Chu\u00f4i x\u01b0\u01a1ng \u0111\u00f9i l\u00e0m b\u1eb1ng h\u1ee3p kim \u03b2 titan \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t ph\u1ea7n c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m thay th\u1ebf cho m\u00f4 h\u00ecnh kh\u1edbp h\u00e1ng t\u1eeb \u0111\u1ea7u nh\u1eefng n\u0103m 2000 nh\u01b0ng \u0111\u00e3 b\u1ecb C\u1ee5c Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m &amp; D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 (FDA) thu h\u1ed3i v\u00e0o n\u0103m 2011 do m\u1ee9c \u0111\u1ed9 m\u00e0i m\u00f2n cao. Yang v\u00e0 Hutchinson nh\u1eadn th\u1ea5y r\u1eb1ng tr\u1ea1ng th\u00e1i m\u00e0i m\u00f2n kh\u00f4 c\u1ee7a h\u1ee3p kim \u03b2 titan (TMZF (Ti-12Mo-6Zr-2Fe (wt.%)) r\u1ea5t gi\u1ed1ng v\u1edbi c\u1ee7a Ti64, trong khi tr\u1ea1ng th\u00e1i c\u1ee7a ch\u00fang ho\u00e0n to\u00e0n kh\u00e1c trong ch\u1ea5t l\u1ecfng c\u01a1 th\u1ec3 m\u00f4 ph\u1ecfng, n\u01a1i m\u00e0 s\u1ef1 m\u00e0i m\u00f2n c\u1ee7a TMZF \u0111\u01b0\u1ee3c t\u0103ng \u0111\u00e1ng k\u1ec3. M\u1ed9t v\u1eadt li\u1ec7u kim lo\u1ea1i kh\u00e1c \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u g\u1ea7n \u0111\u00e2y l\u00e0 zirconium b\u1ecb oxy h\u00f3a (Oxinium, b\u1edfi Smith &amp; Nephew), v\u1edbi l\u00f5i kim lo\u1ea1i v\u00e0 b\u1ec1 m\u1eb7t g\u1ed1m ch\u1ed1ng m\u00e0i m\u00f2n. H\u1ee3p kim niobium c\u1ee7a zirconium \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 m\u00e0i m\u00f2n UHMWPE v\u00e0 gi\u1ea3m s\u1ea3n xu\u1ea5t h\u1ea1t \u0111\u00e1ng k\u1ec3.<\/li>\n<li><strong>Ceramic:<\/strong> t\u1eeb g\u1ed1m b\u1eaft ngu\u1ed3n t\u1eeb ti\u1ebfng Hy L\u1ea1p, keramos, c\u00f3 ngh\u0129a l\u00e0 th\u1ee3 g\u1ed1m ho\u1eb7c \u0111\u1ed3 g\u1ed1m. G\u1ed1m s\u1ee9 \u0111\u01b0\u1ee3c Kingery \u0111\u1ecbnh ngh\u0129a l\u00e0 \u201cngh\u1ec7 thu\u1eadt v\u00e0 khoa h\u1ecdc ch\u1ebf t\u1ea1o v\u00e0 s\u1eed d\u1ee5ng c\u00e1c s\u1ea3n ph\u1ea9m r\u1eafn, l\u00e0 th\u00e0nh ph\u1ea7n thi\u1ebft y\u1ebfu c\u1ee7a ch\u00fang v\u00e0 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o ph\u1ea7n l\u1edbn t\u1eeb c\u00e1c v\u1eadt li\u1ec7u phi kim lo\u1ea1i v\u00f4 c\u01a1\u201d. C\u00f3 th\u1ec3 n\u00f3i r\u1eb1ng g\u1ed1m l\u00e0 b\u1ea5t k\u1ef3 v\u1eadt li\u1ec7u n\u00e0o kh\u00f4ng ph\u1ea3i l\u00e0 kim lo\u1ea1i, ch\u1ea5t b\u00e1n d\u1eabn hay polyme. G\u1ed1m s\u1ee9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e2y d\u1ef1ng c\u00e1c b\u1ed9 ph\u1eadn k\u1ef9 thu\u1eadt khi y\u00eau c\u1ea7u kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n, \u0111\u1ed9 c\u1ee9ng, \u0111\u1ed9 b\u1ec1n v\u00e0 kh\u1ea3 n\u0103ng ch\u1ecbu nhi\u1ec7t. G\u1ed1m s\u1ee9 c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u201cv\u1eadt li\u1ec7u c\u1ee7a t\u01b0\u01a1ng lai\u201d, v\u00ec ch\u00fang c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb c\u00e1t chi\u1ebfm kho\u1ea3ng 25% v\u1ecf tr\u00e1i \u0111\u1ea5t so v\u1edbi 1% \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c kim lo\u1ea1i. Trong nhi\u1ec1u th\u1eadp k\u1ef7 qua, v\u1eadt li\u1ec7u g\u1ed1m \u0111\u00e3 th\u1ec3 hi\u1ec7n s\u1ee9c h\u1ea5p d\u1eabn v\u00e0 lan t\u1ecfa l\u1edbn nh\u1edd c\u00e1c \u0111\u1eb7c t\u00ednh h\u00f3a h\u1ecdc v\u00e0 v\u1eadt l\u00fd c\u1ee7a ch\u00fang, thu h\u00fat s\u1ef1 quan t\u00e2m c\u1ee7a c\u00e1c nh\u00e0 khoa h\u1ecdc v\u00e0 c\u00f4ng ty y sinh. V\u1eadt li\u1ec7u g\u1ed1m \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u1edf thay kh\u1edbp h\u00e1ng h\u01a1n hai m\u01b0\u01a1i n\u0103m tr\u01b0\u1edbc \u0111\u1ec3 kh\u1eafc ph\u1ee5c v\u1ea5n \u0111\u1ec1 l\u1edbn v\u1ec1 m\u00e0i m\u00f2n polyethylen. &#8211; Alumina: \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u trong thay kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o v\u00e0o n\u0103m 1971, khi Boutin nh\u1eadn ra kh\u1edbp h\u00e1ng alumina-on-alumina, c\u00f3 k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng t\u1ed1t. G\u1ed1m alumina l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i g\u1ed1m ch\u00ednh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thay kh\u1edbp h\u00e1ng, d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c t\u00ednh ch\u1ecbu l\u1ef1c t\u1ed1t c\u1ee7a n\u00f3, c\u00f3 ngh\u0129a l\u00e0 m\u1ed9t tr\u1ea1ng th\u00e1i ma s\u00e1t thu\u1eadn l\u1ee3i v\u00e0 m\u1ed9t kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao. Tuy nhi\u00ean, n\u00f3 ch\u1ed1ng c\u01a1 h\u1ecdc y\u1ebfu h\u01a1n so v\u1edbi c\u00e1c v\u1eadt li\u1ec7u kh\u00e1c. N\u00f3 ch\u1ed1ng n\u00e9n t\u1ed1t, nh\u01b0ng kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ef1c k\u00e9o gi\u00e3n y\u1ebfu. G\u1ed1m alumina \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng v\u00ec \u0111\u1eb7c t\u00ednh ch\u1ecbu l\u1ef1c c\u1ee7a ch\u00fang do \u0111\u1ed9 c\u1ee9ng. Trong s\u1ed1 c\u00e1c lo\u1ea1i g\u1ed1m, alumina c\u00f3 l\u1ebd l\u00e0 v\u1eadt li\u1ec7u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t.<br \/>\nAlumina \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 thay kh\u1edbp h\u00e1ng kh\u00e1c bi\u1ec7t v\u1edbi th\u1ebf h\u1ec7 \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00f4ng nghi\u1ec7p. \u0110\u1eb7c bi\u1ec7t, th\u1ebf h\u1ec7 alumina \u0111\u1ea7u ti\u00ean cho th\u1ea5y c\u1ea5u tr\u00fac vi m\u00f4 k\u00e9m v\u1edbi m\u1eadt \u0111\u1ed9 th\u1ea5p, \u0111\u1ed9 tinh khi\u1ebft \u00edt v\u00e0 k\u00edch th\u01b0\u1edbc h\u1ea1t l\u1edbn. Th\u1ebf h\u1ec7 alumina n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 s\u1eed d\u1ee5ng trong y sinh. Nh\u1eefng n\u1ed7 l\u1ef1c li\u00ean t\u1ee5c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong l\u0129nh v\u1ef1c n\u00e0y cho ph\u00e9p c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u tinh ch\u1ebf v\u00e0 c\u1ea3i thi\u1ec7n qu\u00e1 tr\u00ecnh n\u00e0y, d\u1eabn \u0111\u1ebfn m\u1ed9t lo\u1ea1i alumina d\u00f9ng trong y t\u1ebf, c\u00f3 t\u00ean th\u01b0\u01a1ng m\u1ea1i l\u00e0 Biolox\u00ae. Ti\u00eau chu\u1ea9n ISO 6474, \u0111\u01b0\u1ee3c \u0111\u01b0a ra v\u00e0o n\u0103m 1980, nh\u1eb1m m\u1ee5c \u0111\u00edch c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a alumina cho thay kh\u1edbp h\u00e1ng v\u00e0 gi\u1ea3m s\u1ef1 c\u1ed1 \u0111\u1ee9t g\u00e3y. \u0110\u1eb7c t\u00ednh c\u1ee7a alumina li\u00ean quan \u0111\u1ebfn c\u00e1c kh\u00eda c\u1ea1nh kh\u00e1c nhau, ch\u1eb3ng h\u1ea1n nh\u01b0 m\u1eadt \u0111\u1ed9, \u0111\u1ed9 tinh khi\u1ebft v\u00e0 k\u00edch th\u01b0\u1edbc h\u1ea1t. \u0110\u1eb7c bi\u1ec7t, y\u1ebfu t\u1ed1 cu\u1ed1i c\u00f9ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ed1c \u0111\u1ed9 m\u00e0i m\u00f2n, v\u00ec n\u00f3 gi\u1ea3m khi k\u00edch th\u01b0\u1edbc h\u1ea1t nh\u1ecf h\u01a1n. V\u00e0o nh\u1eefng n\u0103m 90, kh\u1edbp h\u00e1ng b\u1eb1ng alumina \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a Biolox\u00ae forte tr\u00ean th\u1ecb tr\u01b0\u1eddng, c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o nh\u1eefng \u0111\u1ed5i m\u1edbi trong quy tr\u00ecnh s\u1ea3n xu\u1ea5t \u0111\u1ec3 cung c\u1ea5p c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc t\u1ed1t h\u01a1n nhi\u1ec1u. N\u00f3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng nguy\u00ean li\u1ec7u th\u00f4 c\u1ea3i ti\u1ebfn, v\u1edbi k\u00edch th\u01b0\u1edbc thu \u0111\u01b0\u1ee3c nh\u1ecf h\u01a1n, m\u1ee9c \u0111\u1ed9 t\u1ea1p ch\u1ea5t th\u1ea5p v\u00e0 \u0111\u01b0\u1ee3c nung k\u1ebft trong kh\u00f4ng kh\u00ed. Biolox\u00ae forte c\u00f3 m\u1eadt \u0111\u1ed9 3,98 g\/cm<sup>3<\/sup> v\u00e0 k\u00edch th\u01b0\u1edbc h\u1ea1t l\u00e0 3,2 m; trong khi \u0111\u1ed1i v\u1edbi Biolox\u00ae, c\u00e1c gi\u00e1 tr\u1ecb n\u00e0y l\u00e0 3,96 g\/cm<sup>3<\/sup> v\u00e0 4,2 m.<\/li>\n<\/ul>\n<p>G\u1ea7n \u0111\u00e2y, m\u1ed1i e ng\u1ea1i d\u1ea5y l\u00ean do c\u00f3 m\u1ed9t s\u1ed1 b\u00e1o c\u00e1o l\u00e2m s\u00e0ng v\u1ec1 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ti\u1ebfng \u1ed3n nghe \u0111\u01b0\u1ee3c \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n thay kh\u1edbp h\u00e1ng b\u1eb1ng g\u1ed1m. C\u00e1i g\u1ecdi l\u00e0 \u201cti\u1ebfng l\u00e1ch c\u00e1ch\u201d ho\u1eb7c \u201cti\u1ebfng m\u00e0i\u201d \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 sau thay kh\u1edbp h\u00e1ng, b\u1ea5t k\u1ec3 l\u00e0 metal-on-polyethylene (MoP), metal-on-metal (MoM), ceramic-on-ceramic (CoC) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Tuy nhi\u00ean, ti\u1ebfng \u201ck\u00edt\u201d d\u01b0\u1eddng nh\u01b0 b\u1ecb h\u1ea1n ch\u1ebf \u0111\u1ed1i v\u1edbi nh\u1eefng c\u1eb7p ch\u1ecbu l\u1ef1c c\u1ee9ng. N\u00f3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn thi\u1ebft k\u1ebf b\u1ed9 ph\u1eadn gi\u1ea3 ho\u1eb7c \u0111\u1ecbnh h\u01b0\u1edbng \u1ed5 c\u1ed1i v\u00e0 c\u0103n nguy\u00ean ch\u00ednh x\u00e1c c\u1ee7a ti\u1ebfng k\u00edt l\u00e0 ch\u1ee7 \u0111\u1ec1 c\u1ee7a c\u00e1c cu\u1ed9c tranh lu\u1eadn; kh\u00f4ng c\u00f3 \u0111\u1ecbnh ngh\u0129a c\u1ee5 th\u1ec3 n\u00e0o cho ti\u1ebfng k\u00edt sau ph\u1eabu thu\u1eadt c\u0169ng nh\u01b0 kh\u00f4ng c\u00f3 ph\u00e2n lo\u1ea1i chung cho c\u00e1c ti\u1ebfng k\u00eau n\u00e0y.<\/p>\n<ul>\n<li><strong>Zirconia:<\/strong> c\u00f3 \u0111\u1ed9 c\u1ee9ng cao v\u00e0 t\u00ednh c\u01a1 h\u1ecdc; trong s\u1ed1 t\u1ea5t c\u1ea3 c\u00e1c g\u1ed1m nguy\u00ean kh\u1ed1i, n\u00f3 c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng n\u1ee9t v\u01b0\u1ee3t tr\u1ed9i; \u0111\u00e2y l\u00e0 nh\u1eefng l\u00fd do ch\u00ednh khi\u1ebfn cho zirconia tr\u1edf th\u00e0nh m\u1ed9t v\u1eadt li\u1ec7u thay th\u1ebf r\u1ea5t r\u1ed9ng r\u00e3i cho alumina trong thay kh\u1edbp h\u00e1ng. Nh\u1eefng n\u1ed7 l\u1ef1c \u0111\u1ea7u ti\u00ean t\u1eadp trung v\u00e0o zirconia \u0111\u01b0\u1ee3c \u1ed5n \u0111\u1ecbnh m\u1ed9t ph\u1ea7n magie (MgPSZ), kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u00e1c y\u00eau c\u1ea7u v\u1ec1 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n. Do \u0111\u00f3, nh\u1eefng ph\u00e1t tri\u1ec3n ti\u1ebfp theo \u0111\u00e3 t\u1eadp trung v\u00e0o oxit \u1ed5n \u0111\u1ecbnh yttria (Y-TZP), m\u1ed9t lo\u1ea1i g\u1ed1m \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh ho\u00e0n to\u00e0n b\u1edfi c\u00e1c h\u1ea1t c\u00f3 k\u00edch th\u01b0\u1edbc si\u00eau nh\u1ecf, \u0111\u1ea1i di\u1ec7n cho ti\u00eau chu\u1ea9n hi\u1ec7n t\u1ea1i cho \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n<p>Y-TZP bao g\u1ed3m c\u00e1c h\u1ea1t t\u1ee9 gi\u00e1c c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf h\u01a1n 0,5 \u03bcm, m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng t\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc, s\u1ef1 ph\u00e2n b\u1ed1 v\u00e0 n\u1ed3ng \u0111\u1ed9 c\u1ee7a oxit \u1ed5n \u0111\u1ecbnh yttria. C\u00e1c th\u00f4ng s\u1ed1 c\u1ea5u tr\u00fac vi m\u00f4 nh\u01b0 v\u1eady x\u00e1c \u0111\u1ecbnh c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 h\u1ecdc c\u1ee7a Y-TZP. C\u00e1c h\u1ea1t t\u1ee9 gi\u00e1c c\u00f3 th\u1ec3 bi\u1ebfn \u0111\u1ed5i th\u00e0nh c\u00e1c h\u1ea1t \u0111\u01a1n t\u00e0, t\u1ea1o ra s\u1ef1 gi\u00e3n n\u1edf th\u1ec3 t\u00edch 3 \u2013 4%, \u0111\u00f3 l\u00e0 l\u00fd do t\u1ea1o ra \u0111\u1ed9 b\u1ec1n c\u1ee7a g\u1ed1m v\u00e0 kh\u1ea3 n\u0103ng ti\u00eau t\u00e1n n\u0103ng l\u01b0\u1ee3ng \u0111\u1ee9t g\u00e3y c\u1ee7a n\u00f3. Khi m\u1ed9t \u00e1p su\u1ea5t t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ea1t, v\u00ed d\u1ee5, m\u1ed9t v\u1ebft n\u1ee9t ti\u1ebfn tri\u1ec3n trong v\u1eadt li\u1ec7u, ch\u00fang chuy\u1ec3n sang pha \u0111\u01a1n t\u00e0, ti\u00eau t\u00e1n n\u0103ng l\u01b0\u1ee3ng v\u1ebft n\u1ee9t theo hai c\u00e1ch: bi\u1ebfn \u0111\u1ed5i T-M v\u00e0 gi\u00e3n n\u1edf th\u1ec3 t\u00edch. Ngo\u00e0i ra c\u00f2n c\u00f3 c\u00e1c ph\u1ea7n h\u1ea1t pha t\u1ee9 gi\u00e1c n\u1eeda b\u1ec1n, trong \u0111\u00f3 s\u1ef1 h\u00ecnh th\u00e0nh ph\u1ee5 thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc h\u1ea1t, n\u1ed3ng \u0111\u1ed9 oxit \u1ed5n \u0111\u1ecbnh v\u00e0 ch\u1ea5t n\u1ec1n h\u1ea1n ch\u1ebf. Tr\u00ean 100\u00b0C, c\u00e1c h\u1ea1t si\u00eau b\u1ec1n trong m\u00f4i tr\u01b0\u1eddng \u1ea9m \u01b0\u1edbt c\u00f3 th\u1ec3 t\u1ef1 ph\u00e1t bi\u1ebfn th\u00e0nh c\u00e1c h\u1ea1t \u0111\u01a1n t\u00e0. Khi qu\u00e1 tr\u00ecnh bi\u1ebfn \u0111\u1ed5i di\u1ec5n ra, c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y s\u1ef1 gi\u1ea3m m\u1eadt \u0111\u1ed9 v\u1eadt li\u1ec7u c\u0169ng nh\u01b0 \u0111\u1ed9 b\u1ec1n v\u00e0 \u0111\u1ed9 d\u1ebbo dai c\u1ee7a g\u1ed1m. C\u1ea5u tr\u00fac c\u1ee7a Y-TZP \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng thu \u0111\u01b0\u1ee3c b\u1edfi c\u00e1c h\u1ea1t c\u00f3 k\u00edch th\u01b0\u1edbc si\u00eau nh\u1ecf ph\u00e1t tri\u1ec3n trong qu\u00e1 tr\u00ecnh nung k\u1ebft; do \u0111\u00f3 c\u1ea7n ph\u1ea3i b\u1eaft \u0111\u1ea7u t\u1eeb b\u1ee5i k\u00edch th\u01b0\u1edbc si\u00eau nh\u1ecf (v\u00ed d\u1ee5, 0,02 \u03bcm) v\u00e0 \u0111\u01b0a v\u00e0o m\u1ed9t s\u1ed1 ch\u1ea5t tr\u1ee3 nung k\u1ebft \u0111\u1ec3 h\u1ea1n ch\u1ebf hi\u1ec7n t\u01b0\u1ee3ng.<\/p>\n<p>\u0110\u1ed1i v\u1edbi kim lo\u1ea1i, Y-TZP cho th\u1ea5y \u0111\u1eb7c t\u00ednh th\u1ea5m v\u01b0\u1ee3t tr\u1ed9i cho ph\u00e9p t\u1ea1o m\u00e0ng ch\u1ea5t l\u1ecfng gi\u1eefa c\u00e1c b\u1ec1 m\u1eb7t kh\u1edbp c\u1ee7a d\u1ee5ng c\u1ee5. Ngay c\u1ea3 khi trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i Y-TZP ch\u1ec9 \u0111\u01b0\u1ee3c gh\u00e9p v\u1edbi \u1ed5 c\u1ed1i UHMWPE, c\u00e1c th\u1eed nghi\u1ec7m \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean Y-TZP so v\u1edbi alumina \u0111\u00e3 cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng. Chi\u1ebfn d\u1ecbch \u0111i\u1ec1u tra r\u1ed9ng r\u00e3i v\u1ec1 hi\u1ec7u su\u1ea5t m\u00e0i m\u00f2n c\u1ee7a UHMWPE v\u00e0 zirconia, cho th\u1ea5y \u0111\u1ed9 m\u00f2n kh\u00f4ng cao h\u01a1n UHMWPE v\u00e0 alumina. S\u1ef1 kh\u00e1c bi\u1ec7t trong k\u1ebft qu\u1ea3 ch\u1ee7 y\u1ebfu xu\u1ea5t ph\u00e1t t\u1eeb s\u1ef1 kh\u00e1c bi\u1ec7t trong c\u00e1c v\u1eadt li\u1ec7u s\u1ed1 l\u01b0\u1ee3ng l\u1edbn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ph\u00f2ng th\u00ed nghi\u1ec7m, trong qu\u00e1 tr\u00ecnh ho\u00e0n thi\u1ec7n c\u1ee7a ch\u00fang, quy tr\u00ecnh th\u1eed nghi\u1ec7m,\u2026 C\u00f3 m\u1ed1i quan t\u00e2m l\u1edbn trong c\u1ed9ng \u0111\u1ed3ng ch\u1ec9nh h\u00ecnh v\u1ec1 t\u01b0\u01a1ng lai c\u1ee7a zirconia cho b\u1ed9 ph\u1eadn gi\u1ea3. Th\u1ecb tr\u01b0\u1eddng \u0111\u00e3 gi\u1ea3m h\u01a1n 90% t\u1eeb n\u0103m 2001 \u0111\u1ebfn n\u0103m 2002 (t\u01b0\u01a1ng \u1ee9ng v\u1edbi vi\u1ec7c thu h\u1ed3i v\u00e0 t\u1eeb b\u1ecf Prozyr\u00ae, b\u1edfi Saint Gobain). H\u01a1n 600.000 ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i Y-TZP \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o kh\u1edbp h\u00e1ng tr\u00ean to\u00e0n th\u1ebf gi\u1edbi, ch\u1ee7 y\u1ebfu \u1edf ch\u00e2u \u00c2u v\u00e0 Hoa K\u1ef3. Cu\u1ed9c tranh lu\u1eadn v\u1ec1 t\u01b0\u01a1ng lai Y-TZP l\u00e0 do \u01b0u v\u00e0 nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a n\u00f3; n\u00f3 th\u1ec3 hi\u1ec7n c\u00e1c t\u00ednh ch\u1ea5t c\u01a1 h\u1ecdc t\u1ed1t nh\u1ea5t (kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ea1i s\u1ef1 lan truy\u1ec1n v\u1ebft n\u1ee9t) nh\u01b0ng d\u1ec5 b\u1ecb gi\u00e0 h\u00f3a khi c\u00f3 n\u01b0\u1edbc.<\/p>\n<p>C\u00e1c nh\u00e0 s\u1ea3n xu\u1ea5t zirconia \u0111\u00e3 c\u1ed1 g\u1eafng thu h\u1eb9p v\u1ea5n \u0111\u1ec1 n\u00e0y, cho r\u1eb1ng n\u00f3 \u0111\u00e3 b\u1ecb h\u1ea1n ch\u1ebf trong \u0111i\u1ec1u ki\u1ec7n <em>in vivo <\/em>cho \u0111\u1ebfn n\u0103m 2001 khi kho\u1ea3ng 400 ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i b\u1ecb h\u1ecfng trong m\u1ed9t th\u1eddi gian ng\u1eafn. S\u1ef1 ki\u1ec7n n\u00e0y li\u00ean quan \u0111\u1ebfn qu\u00e1 tr\u00ecnh gi\u00e0 h\u00f3a nhanh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hai l\u00f4 Prozyr\u00ae. Ngay c\u1ea3 khi l\u00fd do \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh \u0111\u1ec3 x\u1eed l\u00fd v\u00e0 ki\u1ec3m so\u00e1t, s\u1ef1 ki\u1ec7n n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ed1i v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng Y-TZP, khi\u1ebfn m\u1ed9t s\u1ed1 b\u00e1c s\u0129 ph\u1eabu thu\u1eadt ph\u1ea3i quay l\u1ea1i c\u00e1c gi\u1ea3i ph\u00e1p kh\u00e1c. V\u1ea5n \u0111\u1ec1 gi\u00e0 h\u00f3a v\u00e0 s\u1ef1 ki\u1ec7n Prozyr\u00ae v\u1eabn c\u00f2n l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 v\u00e0 c\u1ea7n ph\u1ea3i n\u1ed7 l\u1ef1c h\u01a1n n\u1eefa \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c ni\u1ec1m tin t\u1eeb c\u1ed9ng \u0111\u1ed3ng ch\u1ec9nh h\u00ecnh. Theo c\u00e1ch n\u00e0y, t\u01b0\u01a1ng lai d\u01b0\u1eddng nh\u01b0 d\u1ef1a tr\u00ean s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a zirconia v\u00e0 alumina \u0111\u1ec3 thu \u0111\u01b0\u1ee3c v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p ti\u00ean ti\u1ebfn.<\/p>\n<ul>\n<li><strong>Alumina c\u01b0\u1eddng l\u1ef1c zirconia:<\/strong> v\u00e0o n\u1eeda sau c\u1ee7a nh\u1eefng n\u0103m 1970, m\u1ed9t lo\u1ea1i v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p m\u1edbi d\u1ef1a tr\u00ean g\u1ed1m \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n. V\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p m\u1edbi n\u00e0y c\u00f3 t\u1edbi h\u01a1n 25% tr\u1ecdng l\u01b0\u1ee3ng c\u1ee7a zirconia \u0111\u01b0a v\u00e0o ma tr\u1eadn alumin; v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 alumina c\u01b0\u1eddng l\u1ef1c zirconia (ZTA). Vi\u1ec7c b\u1ed5 sung m\u1ed9t ph\u1ea7n zirconia v\u00e0o alumina khi\u1ebfn cho v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p n\u00e0y t\u0103ng \u0111\u1ed9 d\u1ebbo dai. V\u00e0o nh\u1eefng n\u0103m 2000, v\u1eadt li\u1ec7u ZTA \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u trong ph\u00f2ng kh\u00e1m l\u00e0 m\u1ed9t h\u1ed7n h\u1ee3p \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn v\u1edbi t\u00ean th\u01b0\u01a1ng m\u1ea1i l\u00e0 Biolox\u00ae Delta.<\/li>\n<\/ul>\n<p>V\u1eadt li\u1ec7u n\u00e0y cung c\u1ea5p kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ea1i s\u1ef1 xu\u1ea5t hi\u1ec7n v\u00e0 lan truy\u1ec1n c\u1ee7a v\u1ebft n\u1ee9t. H\u1ed7n h\u1ee3p ZTA n\u00e0y k\u1ebft h\u1ee3p c\u00e1c \u0111\u1eb7c t\u00ednh t\u1ed1t nh\u1ea5t c\u1ee7a c\u1ea3 alumina v\u00e0 zirconia: \u0111\u1ed9 b\u1ec1n v\u00e0 \u0111\u1ed9 d\u1ebbo dai c\u1ee7a zirconia v\u00e0 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao, t\u00ednh \u1ed5n \u0111\u1ecbnh h\u00f3a h\u1ecdc v\u00e0 th\u1ee7y nhi\u1ec7t c\u1ee7a alumina. S\u1ef1 k\u1ebft h\u1ee3p n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua s\u1ef1 ph\u00e2n b\u1ed1 \u0111\u1ed3ng \u0111\u1ec1u c\u00e1c h\u1ea1t c\u00f3 k\u00edch th\u01b0\u1edbc nano c\u1ee7a zirconia t\u1ee9 gi\u00e1c \u1ed5n \u0111\u1ecbnh yttria (Y-TZP) trong ma tr\u1eadn alumina. M\u1ed9t t\u1ec9 l\u1ec7 nh\u1ecf oxit chrom (Cr<sub>2<\/sub>O<sub>3<\/sub>) \u0111\u01b0\u1ee3c th\u00eam v\u00e0o \u0111\u1ec3 \u0111\u1ed1i tr\u1ecdng v\u1edbi s\u1ef1 gi\u1ea3m \u0111\u1ed9 c\u1ee9ng do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a zirconia. Strontium oxit (SrO) \u0111\u01b0\u1ee3c th\u00eam v\u00e0o v\u1eadt li\u1ec7u, trong qu\u00e1 tr\u00ecnh nung k\u1ebft, \u0111\u1ec3 t\u1ea1o th\u00e0nh c\u00e1c \u0111\u0129a strontium aluminat (SrAl12 \u2013 xCrxO19). Nh\u1eefng tinh th\u1ec3 ph\u1eb3ng v\u00e0 d\u00e0i n\u00e0y l\u00e0m ti\u00eau hao n\u0103ng l\u01b0\u1ee3ng c\u1ee7a c\u00e1c v\u1ebft n\u1ee9t v\u00e0 h\u1ea1n ch\u1ebf s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a ch\u00fang, v\u00ec n\u00f3 s\u1ebd c\u1ea7n th\u00eam n\u0103ng l\u01b0\u1ee3ng \u0111\u1ec3 v\u1ebft n\u1ee9t v\u01b0\u1ee3t qua tinh th\u1ec3. H\u1ed7n h\u1ee3p cu\u1ed1i c\u00f9ng l\u00e0 h\u1ed7n h\u1ee3p c\u1ee7a kho\u1ea3ng 75% alumin, 25% zirconia v\u00e0 d\u01b0\u1edbi 1% oxit chrom v\u00e0 oxit strontium. Deville v\u00e0 c\u1ed9ng s\u1ef1 nh\u1eadn th\u1ea5y r\u1eb1ng v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p alumina Y-TZP c\u00f3 bi\u1ec3u hi\u1ec7n gi\u00e0 h\u00f3a \u0111\u00e1ng k\u1ec3, nh\u01b0ng qu\u00e1 tr\u00ecnh n\u00e0y di\u1ec5n ra ch\u1eadm h\u01a1n nhi\u1ec1u so v\u1edbi th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong g\u1ed1m Y-TZP, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a alumina. M\u1eb7t kh\u00e1c, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c ng\u01b0ng k\u1ebft zirconia \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a s\u1ef1 nh\u1ea1y c\u1ea3m v\u1edbi gi\u00e0 h\u00f3a. Nh\u1eadn th\u1ea5y s\u1ef1 ph\u00e2n t\u00e1n t\u1ed1i \u01b0u \u1edf m\u00f4i tr\u01b0\u1eddng acid c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c ng\u01b0ng k\u1ebft zirconia, nh\u01b0ng ngay khi v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng th\u1ea5m th\u1ea5u (16% th\u1ec3 t\u00edch), kh\u00f4ng th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c qu\u00e1 tr\u00ecnh gi\u00e0 h\u00f3a.<\/p>\n<p>C\u00e1c v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p n\u00e0y \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 b\u1ec1n \u0111\u1ee9t g\u00e3y (KIC) l\u00ean \u0111\u1ebfn 12MPa\u00b7m<sup>1\/2 <\/sup>v\u00e0 \u0111\u1ed9 b\u1ec1n u\u1ed1n l\u00ean \u0111\u1ebfn 700 MPa. Do m\u00f4-\u0111un \u0111\u00e0n h\u1ed3i kh\u00e1c nhau c\u1ee7a hai th\u00e0nh ph\u1ea7n, c\u00e1c v\u1ebft n\u1ee9t s\u1ebd c\u00f3 xu h\u01b0\u1edbng di chuy\u1ec3n qua c\u00e1c h\u1ea1t zirconia \u00edt c\u1ee9ng h\u01a1n, g\u00e2y ra s\u1ef1 chuy\u1ec3n \u0111\u1ed5i pha T-M c\u1ee7a ch\u00fang l\u00e0m ti\u00eau tan n\u0103ng l\u01b0\u1ee3ng v\u1ebft n\u1ee9t.<\/p>\n<h3><strong>2.2. L\u1ef1a ch\u1ecdn v\u1eadt li\u1ec7u s\u1eed d\u1ee5ng<\/strong><\/h3>\n<p>B\u1ed1n lo\u1ea1i ch\u1ecbu l\u1ef1c ch\u00ednh \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 \u1ee9ng d\u1ee5ng cho kh\u1edbp h\u00e1ng bao g\u1ed3m: metal-on-polyethylen (MoP), metal-on-metal (MoM), ceramic-on-ceramic (CoC) v\u00e0 ceramic-on-polyethylen (CoP). G\u1ea7n \u0111\u00e2y, c\u00e1c t\u1ed5 h\u1ee3p lai \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra nh\u01b0 ch\u1ecfm g\u1ed1m v\u00e0 chu\u00f4i kim lo\u1ea1i (CoM). Nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 l\u1ef1a ch\u1ecdn gi\u1eefa c\u00e1c lo\u1ea1i ch\u1ecbu l\u1ef1c n\u00e0y, ch\u1eb3ng h\u1ea1n nh\u01b0 chi ph\u00ed, \u0111\u1ed9 tu\u1ed5i v\u00e0 m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n, bi\u1ebfn ch\u1ee9ng trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt,\u2026 C\u00e1c kh\u1edbp MoM \u0111\u01b0\u1ee3c McKee v\u00e0 Farrar \u0111\u01b0a ra n\u0103m 1950, c\u00f3 k\u1ebft qu\u1ea3 kh\u00f4ng nh\u01b0 mong mu\u1ed1n nh\u01b0 hai trong s\u1ed1 ba kh\u1edbp nh\u00e2n t\u1ea1o \u0111\u00e3 b\u1ecb lo\u1ea1i b\u1ecf sau 1 n\u0103m do b\u1ecb l\u1ecfng v\u00e0 kh\u1edbp th\u1ee9 ba \u0111\u01b0\u1ee3c l\u1ea5y ra do b\u1ecb g\u00e3y. Sau nhi\u1ec1u l\u1ea7n c\u1ea3i ti\u1ebfn ch\u1ecbu t\u1ea3i, ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u l\u1ea1i v\u00e0o n\u0103m 1960, khi t\u1ed1c \u0111\u1ed9 m\u00e0i m\u00f2n dao \u0111\u1ed9ng t\u1eeb 1 \u2013 5 mm<sup>3<\/sup> m\u1ed7i n\u0103m (th\u1ea5p h\u01a1n kho\u1ea3ng 20 l\u1ea7n so v\u1edbi lo\u1ea1i MoP \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd).<\/p>\n<p>C\u00e1c kh\u1edbp MoM \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho c\u1ea3 thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n v\u00e0 t\u00e1i t\u1ea1o l\u1ea1i b\u1ec1 m\u1eb7t kh\u1edbp h\u00e1ng (HR), c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0 b\u1ea3o t\u1ed3n ch\u1ecfm v\u00e0 c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i, d\u1eabn \u0111\u1ebfn ph\u1eabu thu\u1eadt \u00edt x\u00e2m l\u1ea5n h\u01a1n v\u00e0 t\u1ec9 l\u1ec7 tr\u1eadt kh\u1edbp th\u1ea5p h\u01a1n. Trong nh\u1eefng n\u0103m 2000, v\u1ea5n \u0111\u1ec1 v\u1ec1 m\u1ea3nh v\u1ee5n kim lo\u1ea1i \u0111\u01b0\u1ee3c \u0111\u01b0a ra \u00e1nh s\u00e1ng, vi\u1ec7c thay th\u1ebf MoM g\u1ea7n nh\u01b0 b\u1ecb d\u1eebng ho\u00e0n to\u00e0n. V\u00e0o \u0111\u1ea7u gi\u1eefa nh\u1eefng n\u0103m 2000, lo\u1ea1i kh\u1edbp nh\u00e2n t\u1ea1o n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho h\u01a1n 1\/5 tr\u01b0\u1eddng h\u1ee3p \u1edf Anh v\u00e0 1\/3 \u1edf M\u1ef9. Ng\u00e0y nay, ch\u00fang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u00edt h\u01a1n 1% trong t\u1ed5ng s\u1ed1 ca ph\u1eabu thu\u1eadt. C\u00e1c kh\u1edbp MoM \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u1edf l\u1ea1i trong hai th\u1eadp k\u1ef7 qua, nh\u1edd s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c k\u1ef9 thu\u1eadt ho\u00e0n thi\u1ec7n b\u1ec1 m\u1eb7t m\u1edbi gi\u00fap c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n c\u1ee7a ch\u00fang. M\u1eb7t kh\u00e1c, ch\u1ecbu t\u1ea3i MoM nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111\u1ea3m b\u1ea3o kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n cao, kh\u1ea3 n\u0103ng s\u1ea3n xu\u1ea5t t\u1ed1t v\u00e0 m\u00f4-men xo\u1eafn ma s\u00e1t th\u1ea5p. Tuy nhi\u00ean, ngay c\u1ea3 khi kh\u1ed1i l\u01b0\u1ee3ng m\u00e0i m\u00f2n th\u1ea5p h\u01a1n, c\u00e1c h\u1ea1t r\u1ea5t nh\u1ecf v\u1eabn \u0111\u01b0\u1ee3c t\u1ea1o ra. L\u01b0\u1ee3ng ion kim lo\u1ea1i c\u00f3 trong huy\u1ebft thanh v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ed9c ti\u1ec1m \u1ea9n c\u1ee7a ch\u00fang c\u1ea3 t\u1ea1i ch\u1ed7 v\u00e0 to\u00e0n th\u00e2n l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m. H\u01a1n n\u1eefa, m\u00e0i m\u00f2n tr\u01a1n b\u00f3ng, \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi c\u00e1c m\u1ea3nh v\u1ee5n, t\u1ea1o ra b\u1edfi ho\u1ea1t \u0111\u1ed9ng m\u00e0i m\u00f2n c\u1ee7a cacbua, \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c kh\u1edbp h\u1ee3p kim Co-Cr khi thu h\u1ed3i.<\/p>\n<p>Cho \u0111\u1ebfn gi\u1eefa nh\u1eefng n\u0103m 1990, kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 c\u00e1c c\u1eb7p MoP ho\u1ea1t \u0111\u1ed9ng t\u1ed1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i v\u00e0 \u00edt v\u1eadn \u0111\u1ed9ng h\u01a1n. Tuy nhi\u00ean, hai v\u1ea5n \u0111\u1ec1 li\u00ean quan v\u1eabn c\u00f2n l\u00e0 m\u1ed1i quan t\u00e2m: l\u1ecfng v\u00f4 tr\u00f9ng do c\u1ed1 \u0111\u1ecbnh ban \u0111\u1ea7u kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 g\u00e2y ra b\u1edfi s\u1ef1 ti\u00eau h\u1ee7y x\u01b0\u01a1ng do c\u00e1c ph\u1ea7n t\u1eed t\u1ea1o ra xung quanh v\u1eadt gh\u00e9p v\u00e0 tr\u1eadt kh\u1edbp h\u00e1ng.<\/p>\n<p>V\u00e0o nh\u1eefng n\u0103m 80, khi qu\u00e1 tr\u00ecnh l\u1ecfng v\u00f4 tr\u00f9ng v\u00e0 ti\u00eau h\u1ee7y x\u01b0\u01a1ng ph\u00e1t sinh nh\u01b0 nh\u1eefng v\u1ea5n \u0111\u1ec1 ch\u00ednh trong c\u00e1c kh\u1edbp h\u00e1ng MoP, c\u00e1c c\u1eb7p CoC \u0111\u1ea7u ti\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra, b\u1eaft \u0111\u1ea7u v\u1edbi alumina v\u00e0 zirconia. G\u1ed1m zirconia \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ec3 c\u1ea5y gh\u00e9p ch\u1ec9nh h\u00ecnh nh\u01b0 m\u1ed9t v\u1eadt li\u1ec7u g\u1ed1m th\u1ee9 c\u1ea5p, c\u00f9ng v\u1edbi alumin trong v\u00e0i n\u0103m. \u01afu \u0111i\u1ec3m ch\u00ednh c\u1ee7a g\u1ed1m cho thay kh\u1edbp h\u00e1ng l\u00e0 \u0111\u1ed9 c\u1ee9ng, kh\u1ea3 n\u0103ng ch\u1ed1ng tr\u1ea7y x\u01b0\u1edbc v\u00e0 b\u1ea3n ch\u1ea5t tr\u01a1 c\u1ee7a c\u00e1c m\u1ea3nh v\u1ee5n. Nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y th\u00fac \u0111\u1ea9y vi\u1ec7c s\u1eed d\u1ee5ng kh\u1edbp CoC v\u00e0 b\u1ea3n ch\u1ea5t tr\u01a1 c\u1ee7a c\u00e1c m\u1ea3nh v\u1ee5n m\u00e0i m\u00f2n khi\u1ebfn ch\u00fang tr\u1edf th\u00e0nh l\u1ef1a ch\u1ecdn t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i. M\u1eb7t kh\u00e1c, vi\u1ec7c s\u1eed d\u1ee5ng ch\u00fang r\u1ea5t t\u1ed1n k\u00e9m v\u00e0 vi\u1ec7c \u0111\u1eb7t n\u00f3 v\u00e0o \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 m\u1ed9t \u0111\u1ed9i ng\u0169 ph\u1eabu thu\u1eadt xu\u1ea5t s\u1eafc \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 s\u1ee9t m\u1ebb c\u1ee7a b\u1ec1 m\u1eb7t ti\u1ebfp x\u00fac.<\/p>\n<p>S\u1ef1 ra \u0111\u1eddi c\u1ee7a m\u1ed9t t\u1ed5 h\u1ee3p lai ti\u00ean ti\u1ebfn ch\u1ecbu l\u1ef1c c\u1ee9ng \u2013 c\u1ee9ng lai g\u1ed3m ch\u1ecfm ceramic v\u00e0 chu\u00f4i kim lo\u1ea1i \u0111\u01b0\u1ee3c tuy\u00ean b\u1ed1 l\u00e0 l\u00e0m gi\u1ea3m s\u1ef1 gi\u1ea3i ph\u00f3ng ion v\u00e0 s\u1ea3n sinh h\u1ea1t m\u00e0i m\u00f2n c\u00f3 th\u1ec3 g\u00e2y v\u1ee1 chu\u00f4i b\u1eb1ng g\u1ed1m. Trong c\u00e1c nghi\u00ean c\u1ee9u <em>in vitro<\/em> v\u1ec1 c\u00e1c kh\u1edbp CoM cho th\u1ea5y c\u00e1c h\u1ea1t t\u1ea1o ra nh\u1ecf h\u01a1n v\u00e0 \u0111\u1ed9 m\u00f2n th\u1ea5p h\u01a1n.<\/p>\n<p>Ng\u00e0y nay, kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng kim lo\u1ea1i, g\u1ed1m v\u00e0 v\u1eadt li\u1ec7u nh\u1ef1a d\u1ebbo. \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u nh\u1ea5t l\u00e0 h\u1ee3p kim titan, th\u00e9p kh\u00f4ng g\u1ec9, h\u1ee3p kim \u0111\u1eb7c bi\u1ec7t c\u00f3 \u0111\u1ed9 b\u1ec1n cao, alumin, zirconia, alumin c\u01b0\u1eddng l\u1ef1c zirconia (ZTA) v\u00e0 UHMWPE. Th\u00f4ng th\u01b0\u1eddng, chu\u00f4i v\u00e0 c\u1ed5 \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng kim lo\u1ea1i, trong khi ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i c\u00f3 th\u1ec3 l\u00e0 c\u1ea3 kim lo\u1ea1i v\u00e0 g\u1ed1m v\u00e0 t\u1ea5m \u0111\u1ec7m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng kim lo\u1ea1i, g\u1ed1m ho\u1eb7c polyme. C\u00f3 m\u1ed9t s\u1ed1 c\u00e1ch k\u1ebft h\u1ee3p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c v\u1eadt li\u1ec7u n\u00e0y v\u1edbi m\u1ee5c ti\u00eau kh\u1edbp nh\u00e2n t\u1ea1o \u00edt m\u00e0i m\u00f2n nh\u1ea5t v\u00e0 tu\u1ed5i th\u1ecd kh\u1edbp cao nh\u1ea5t.<\/p>\n<h2><strong>3. KH\u1edaP G\u1ed0I<\/strong><\/h2>\n<h3><strong>3.1. \u0110\u1eb7c \u0111i\u1ec3m c\u00e1c lo\u1ea1i v\u1eadt li\u1ec7u<\/strong><\/h3>\n<p><strong><a href=\"https:\/\/bsvothanhtoan.com\/en\/\">Th\u00e9p kh\u00f4ng g\u1ec9<\/a>: <\/strong>do h\u1ea1n ch\u1ebf v\u1ec1 kh\u1ea3 n\u0103ng ch\u1ecbu \u0103n m\u00f2n trong c\u01a1 th\u1ec3 con ng\u01b0\u1eddi trong th\u1eddi gian d\u00e0i, th\u00e9p kh\u00f4ng g\u1ec9 th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thay kh\u1edbp g\u1ed1i. N\u00f3 ph\u00f9 h\u1ee3p h\u01a1n \u0111\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 c\u00e1c b\u1ed9 ph\u1eadn c\u1ea5y gh\u00e9p t\u1ea1m th\u1eddi nh\u01b0 n\u1eb9p v\u00e0 v\u00edt.<\/p>\n<p><strong>H\u1ee3p kim coban-chrom:<\/strong> l\u00e0 kim lo\u1ea1i c\u1ee9ng, d\u1ebbo dai, ch\u1ed1ng \u0103n m\u00f2n, t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc. C\u00f9ng v\u1edbi titan, chrom coban l\u00e0 m\u1ed9t trong nh\u1eefng kim lo\u1ea1i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t trong thay kh\u1edbp g\u1ed1i. Kh\u00f4ng c\u00f3 s\u1ef1 th\u1ed1ng nh\u1ea5t v\u1ec1 vi\u1ec7c v\u1eadt li\u1ec7u n\u00e0o t\u1ed1t h\u01a1n v\u00e0 ph\u00f9 h\u1ee3p h\u01a1n.<\/p>\n<p>M\u1eb7c d\u00f9 t\u1ec9 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng h\u1ee3p kim coban-chrom l\u00e0 r\u1ea5t th\u1ea5p, m\u1ed9t l\u0129nh v\u1ef1c \u0111\u00e1ng quan t\u00e2m l\u00e0 v\u1ea5n \u0111\u1ec1 c\u00e1c h\u1ea1t nh\u1ecf (ion kim lo\u1ea1i) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng v\u00e0o c\u01a1 th\u1ec3 do chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a kh\u1edbp. Nh\u1eefng h\u1ea1t n\u00e0y \u0111\u00f4i khi c\u00f3 th\u1ec3 g\u00e2y ra ph\u1ea3n \u1ee9ng trong c\u01a1 th\u1ec3 con ng\u01b0\u1eddi, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb d\u1ecb \u1ee9ng v\u1edbi c\u00e1c kim lo\u1ea1i \u0111\u1eb7c bi\u1ec7t nh\u01b0 niken.<\/p>\n<p><strong>Titan v\u00e0 h\u1ee3p kim titan:<\/strong> titan nguy\u00ean ch\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u1ea5y gh\u00e9p \u1edf nh\u1eefng n\u01a1i kh\u00f4ng c\u1ea7n \u0111\u1ed9 b\u1ec1n cao. V\u00ed d\u1ee5, \u0111\u00f4i khi titan nguy\u00ean ch\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 t\u1ea1o s\u1ee3i kim lo\u1ea1i, m\u1ed9t l\u1edbp s\u1ee3i kim lo\u1ea1i li\u00ean k\u1ebft v\u1edbi b\u1ec1 m\u1eb7t c\u1ee7a b\u1ed9 ph\u1eadn gi\u1ea3 cho ph\u00e9p x\u01b0\u01a1ng ph\u00e1t tri\u1ec3n v\u00e0o b\u1ed9 ph\u1eadn n\u00e0y ho\u1eb7c cho ph\u00e9p xi m\u0103ng li\u00ean k\u1ebft t\u1ed1t h\u01a1n v\u1edbi b\u1ed9 ph\u1eadn gi\u1ea3 \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh ch\u1eafc ch\u1eafn h\u01a1n.<\/p>\n<p>H\u1ee3p kim titan c\u00f3 b\u1ea3n ch\u1ea5t t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc. Ch\u00fang th\u01b0\u1eddng ch\u1ee9a m\u1ed9t l\u01b0\u1ee3ng vanadium v\u00e0 aluminum ngo\u00e0i titan. H\u1ee3p kim titan \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u nh\u1ea5t trong thay kh\u1edbp g\u1ed1i l\u00e0 Ti6Al4V. Titan v\u00e0 h\u1ee3p kim titan c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng \u0103n m\u00f2n cao, khi\u1ebfn cho ch\u00fang tr\u1edf th\u00e0nh v\u1eadt li\u1ec7u sinh h\u1ecdc tr\u01a1 (c\u00f3 ngh\u0129a l\u00e0 ch\u00fang s\u1ebd kh\u00f4ng thay \u0111\u1ed5i sau khi \u0111\u01b0\u1ee3c c\u1ea5y v\u00e0o c\u01a1 th\u1ec3).<\/p>\n<p>Titan v\u00e0 c\u00e1c h\u1ee3p kim c\u1ee7a n\u00f3 c\u00f3 m\u1eadt \u0111\u1ed9 th\u1ea5p h\u01a1n so v\u1edbi c\u00e1c kim lo\u1ea1i kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thay kh\u1edbp g\u1ed1i. Ngo\u00e0i ra, b\u1ea3n ch\u1ea5t \u0111\u00e0n h\u1ed3i c\u1ee7a titan v\u00e0 h\u1ee3p kim titan th\u1ea5p h\u01a1n so v\u1edbi c\u00e1c kim lo\u1ea1i kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thay kh\u1edbp g\u1ed1i. Do \u0111\u00f3, b\u1ed9 ph\u1eadn gi\u1ea3 titan ho\u1ea1t \u0111\u1ed9ng gi\u1ed1ng nh\u01b0 kh\u1edbp t\u1ef1 nhi\u00ean h\u01a1n v\u00e0 do \u0111\u00f3, gi\u1ea3m nguy c\u01a1 m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng nh\u01b0 ti\u00eau x\u01b0\u01a1ng v\u00e0 teo x\u01b0\u01a1ng.<\/p>\n<p><strong><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" target=\"_blank\" rel=\"noopener\">Tantalium<\/a>: <\/strong>tantalium l\u00e0 m\u1ed9t lo\u1ea1i kim lo\u1ea1i tinh khi\u1ebft, c\u00f3 c\u00e1c \u0111\u1eb7c t\u00ednh sinh h\u1ecdc v\u00e0 v\u1eadt l\u00fd cao, c\u1ee5 th\u1ec3 l\u00e0 t\u00ednh linh ho\u1ea1t, ch\u1ed1ng \u0103n m\u00f2n v\u00e0 t\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc. G\u1ea7n \u0111\u00e2y, m\u1ed9t ch\u1ea5t x\u1ed1p m\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng tantalum c\u00f3 t\u00ean l\u00e0 Trabecular Metal. N\u00f3 c\u00f3 ch\u1ee9a c\u00e1c l\u1ed7 r\u1ed7ng, k\u00edch th\u01b0\u1edbc c\u1ee7a n\u00f3 l\u00e0m cho v\u1eadt li\u1ec7u n\u00e0y r\u1ea5t t\u1ed1t cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a x\u01b0\u01a1ng. Ngo\u00e0i ra, Trabecular Metal c\u00f3 t\u00ednh ch\u1ea5t \u0111\u00e0n h\u1ed3i h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o x\u01b0\u01a1ng.<\/p>\n<p><strong>Polyethylen:<\/strong> c\u00e1c b\u1ed9 ph\u1eadn x\u01b0\u01a1ng ch\u00e0y v\u00e0 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/trat-xuong-banh-che\/\">x\u01b0\u01a1ng b\u00e1nh ch\u00e8<\/a> trong thay kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c l\u00e0m b\u1eb1ng polyethylen. M\u1eb7c d\u00f9 b\u1ec1 m\u1eb7t polyethylen ti\u00eau chu\u1ea9n th\u01b0\u1eddng b\u1ecb m\u00e0i m\u00f2n trong kh\u1edbp h\u00e1ng nh\u00e2n t\u1ea1o, nh\u01b0ng m\u00e0i m\u00f2n \u00edt l\u00e0 v\u1ea5n \u0111\u1ec1 h\u01a1n trong kh\u1edbp g\u1ed1i v\u00ec b\u1ec1 m\u1eb7t ch\u1ecbu l\u1ef1c ph\u1eb3ng h\u01a1n v\u00e0 kh\u00f4ng d\u1eabn \u0111\u1ebfn m\u00e0i m\u00f2n gi\u1ed1ng nhau. Vi\u1ec7c s\u1eed d\u1ee5ng polyethylen li\u00ean k\u1ebft ch\u00e9o c\u1ef1c cao (UHXLPE) ho\u1eb7c polyethylen tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed c\u1ef1c cao (UHMWPE) l\u00e0m gi\u1ea3m ngay c\u1ea3 s\u1ef1 m\u00e0i m\u00f2n t\u1ed1i thi\u1ec3u cho ph\u00e9p kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o c\u00f3 tu\u1ed5i th\u1ecd l\u00e2u h\u01a1n nhi\u1ec1u.<\/p>\n<p><strong>Zirconium:<\/strong> h\u1ee3p kim zirconium v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c b\u1ed9 ph\u1eadn x\u01b0\u01a1ng ch\u00e0y d\u1ebbo: h\u1ee3p kim zirconium \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o b\u1eb1ng s\u1ee9 m\u1edbi. H\u1ee3p kim zirconium \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t b\u1ed9 ph\u1eadn m\u00e2m ch\u00e0y ho\u00e0n to\u00e0n b\u1eb1ng nh\u1ef1a, thay th\u1ebf khay kim lo\u1ea1i v\u00e0 mi\u1ebfng ch\u00e8n nh\u1ef1a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c thi\u1ebft b\u1ecb thay kh\u1edbp g\u1ed1i kh\u00e1c. Ng\u01b0\u1eddi ta tin r\u1eb1ng lo\u1ea1i kh\u1edbp g\u1ed1i m\u1edbi n\u00e0y c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i trong 20 \u2013 25 n\u0103m, h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi 15 \u2013 20 n\u0103m m\u00e0 h\u1ee3p kim coban chrom v\u00e0 polyethylen. S\u1ef1 k\u1ebft h\u1ee3p m\u1edbi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00f4i tr\u01a1n, d\u1eabn \u0111\u1ebfn s\u1ef1 \u0103n kh\u1edbp th\u00f4ng qua nh\u1ef1a tr\u01a1n tru v\u00e0 d\u1ec5 d\u00e0ng h\u01a1n.<\/p>\n<p>M\u1ed9t \u0111\u1eb7c t\u00ednh quan tr\u1ecdng kh\u00e1c c\u1ee7a v\u1eadt li\u1ec7u n\u00e0y l\u00e0 n\u00f3 c\u00f3 t\u00ednh t\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc, ngh\u0129a l\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb d\u1ecb \u1ee9ng niken v\u00e0 kh\u00f4ng th\u1ec3 thay kh\u1edbp g\u1ed1i c\u00f3 h\u1ee3p kim chrom coban (v\u00ec niken l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ee3p kim chrom coban). Thay kh\u1edbp b\u1eb1ng h\u1ee3p kim Zirconium lo\u1ea1i b\u1ecf nguy c\u01a1 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng niken v\u00ec v\u1eadt li\u1ec7u m\u1edbi n\u00e0y kh\u00f4ng ch\u1ee9a niken.<\/p>\n<p>&#8211; Zirconium b\u1ecb oxy h\u00f3a oxinium: l\u00e0 m\u1ed9t v\u1eadt li\u1ec7u m\u1edbi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thay kh\u1edbp g\u1ed1i t\u1eeb n\u0103m 2001. V\u1ec1 c\u01a1 b\u1ea3n, n\u00f3 l\u00e0 m\u1ed9t h\u1ee3p kim kim lo\u1ea1i \u0111\u01b0\u1ee3c bi\u1ebfn \u0111\u1ed5i c\u00f3 b\u1ec1 m\u1eb7t ch\u1ecbu l\u1ef1c b\u1eb1ng g\u1ed1m. N\u00f3 ch\u1ee9a h\u1ee3p kim zirconium v\u00e0 niobium \u0111\u01b0\u1ee3c oxy h\u00f3a \u0111\u1ec3 chuy\u1ec3n b\u1ec1 m\u1eb7t v\u1eadt li\u1ec7u th\u00e0nh zirconia ceramic. \u01afu \u0111i\u1ec3m c\u1ee7a kim lo\u1ea1i n\u00e0y l\u00e0 ch\u1ec9 c\u1ea7n thay \u0111\u1ed5i b\u1ec1 m\u1eb7t, n\u00ean ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a b\u1ed9 ph\u1eadn gi\u1ea3 l\u00e0 kim lo\u1ea1i c\u00f3 \u0111\u1ed9 b\u1ec1n cao. M\u1eb7c d\u00f9 n\u00f3 c\u1ee9ng g\u1ea5p \u0111\u00f4i so v\u1edbi h\u1ee3p kim chrom coban, n\u00f3 cung c\u1ea5p m\u1ed9t n\u1eeda ma s\u00e1t do \u0111\u00f3 ho\u1ea1t \u0111\u1ed9ng v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng cao h\u01a1n v\u00e0 k\u00e9o d\u00e0i trong th\u1eddi gian d\u00e0i h\u01a1n.<\/p>\n<h3><strong>3.2. L\u1ef1a ch\u1ecdn v\u1eadt li\u1ec7u s\u1eed d\u1ee5ng<\/strong><\/h3>\n<p>Khoa h\u1ecdc v\u1eadt li\u1ec7u trong thay kh\u1edbp g\u1ed1i nh\u1eb1m m\u1ee5c \u0111\u00edch c\u1ea3i thi\u1ec7n c\u00e1c \u0111\u1eb7c t\u00ednh ma s\u00e1t c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n kh\u1edbp nh\u00e2n t\u1ea1o. Ma s\u00e1t h\u1ecdc l\u00e0 khoa h\u1ecdc v\u1ec1 c\u00e1c b\u1ec1 m\u1eb7t t\u01b0\u01a1ng t\u00e1c trong chuy\u1ec3n \u0111\u1ed9ng. Ma s\u00e1t h\u1ecdc \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi ma s\u00e1t, b\u00f4i tr\u01a1n v\u00e0 m\u00e0i m\u00f2n. C\u00f3 hai c\u00e1ch ti\u1ebfp c\u1eadn c\u01a1 b\u1ea3n \u0111\u1ed1i v\u1edbi k\u1ef9 thu\u1eadt v\u1eadt li\u1ec7u trong thay kh\u1edbp g\u1ed1i, th\u1ee9 nh\u1ea5t c\u1ea3i thi\u1ec7n b\u1ea3n th\u00e2n v\u1eadt li\u1ec7u v\u00e0 th\u1ee9 hai c\u1ea3i thi\u1ec7n \u0111\u1ed9 m\u00e0i m\u00f2n m\u1eb7t ti\u1ebfp x\u00fac v\u00e0 \u0111\u1ed9 b\u1ec1n c\u1ee7a c\u00e1c b\u1ed9 ph\u1eadn nh\u00e2n t\u1ea1o. C\u1ea3i ti\u1ebfn v\u1eadt li\u1ec7u c\u00f3 ngh\u0129a l\u00e0 ph\u00e1t tri\u1ec3n c\u00e1c v\u1eadt li\u1ec7u m\u1edbi cho b\u1ed9 ph\u1eadn x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng ch\u00e0y nh\u01b0ng c\u0169ng l\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n v\u1eadt li\u1ec7u th\u00edch h\u1ee3p cho l\u1edbp ph\u1ee7 \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf gi\u1eefa c\u00e1c th\u00e0nh ph\u1ea7n. V\u00ed d\u1ee5, g\u1ea7n \u0111\u00e2y, vitamin E \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u, gi\u00fap \u1ed5n \u0111\u1ecbnh polyethylen v\u00e0 ng\u0103n ng\u1eeba s\u1ef1 tho\u00e1i h\u00f3a v\u00e0 gi\u00e0 h\u00f3a do oxy h\u00f3a c\u1ee7a v\u1eadt li\u1ec7u. Nh\u1edd \u0111\u00f3, c\u00e1c \u0111\u1eb7c t\u00ednh c\u01a1 sinh h\u1ecdc \u0111\u01b0\u1ee3c b\u1ea3o to\u00e0n.<\/p>\n<p>H\u1ee3p kim coban-chrom \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng trong nhi\u1ec1u th\u1eadp k\u1ef7 v\u00e0 \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng. C\u00f3 hai m\u1ed1i quan t\u00e2m ch\u00ednh \u0111\u1ed1i v\u1edbi h\u1ee3p kim coban-chrom: \u0111\u1ed9 m\u00f2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp v\u00e0 nguy c\u01a1 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn. Tuy nhi\u00ean, v\u1eabn c\u00f2n nghi v\u1ea5n li\u1ec7u m\u1ed9t b\u1ed9 ph\u1eadn gi\u1ea3 kh\u1edbp g\u1ed1i l\u00e0m b\u1eb1ng h\u1ee3p kim coban-chrom c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng hay kh\u00f4ng.<\/p>\n<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00e1c v\u1eadt li\u1ec7u \u00edt g\u00e2y d\u1ecb \u1ee9ng kh\u00e1c nh\u01b0 h\u1ee3p kim titan ho\u1eb7c zirconium \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u. Titan tr\u01a1 v\u1ec1 m\u1eb7t sinh h\u1ecdc nh\u01b0ng cho th\u1ea5y s\u1ef1 \u0103n m\u00f2n v\u00e0 ma s\u00e1t. V\u00ec v\u1eady, titan l\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 titan-aluminum (Ti-6Al-4V) v\u00e0 titan-niobium (Ti-6Al-7Nb).<\/p>\n<p>K\u1ec3 t\u1eeb n\u0103m 2001, zirconium b\u1ecb oxy h\u00f3a, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t v\u1eadt li\u1ec7u m\u1edbi cho c\u00e1c b\u1ed9 ph\u1eadn x\u01b0\u01a1ng \u0111\u00f9i c\u1ee7a kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng zirconi b\u1ecb oxy h\u00f3a t\u1ea1o ra PE \u00edt b\u1ecb m\u00e0i m\u00f2n h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi chrom. Vi\u1ec7c s\u1eed d\u1ee5ng zirconium \u0111\u1ec3 thay l\u1ea1i kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n l\u00e0 kh\u00e1 kh\u00f3 x\u1ea3y ra do th\u1ef1c t\u1ebf l\u00e0 s\u1ef1 gia t\u0103ng \u00e1p l\u1ef1c g\u00e2y ra c\u00e1c khuy\u1ebft x\u01b0\u01a1ng tr\u00ean b\u1ed9 ph\u1eadn gi\u1ea3 v\u00e0 do \u0111\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra g\u00e3y b\u1ed9 ph\u1eadn n\u00e0y. M\u1eb7c d\u00f9 thi\u1ebfu s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, \u0111\u1ed9 nh\u00e1m b\u1ec1 m\u1eb7t b\u1ed9 ph\u1eadn c\u1ee7a zirconium b\u1ecb oxy h\u00f3a d\u01b0\u1eddng nh\u01b0 th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi \u0111\u1ed9 nh\u00e1m c\u1ee7a b\u1ed9 ph\u1eadn coban-chrom.<\/p>\n<p>Tantalium chia s\u1ebb m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m v\u1edbi titan, bao g\u1ed3m t\u00ednh linh ho\u1ea1t cao, kh\u1ea3 n\u0103ng ch\u1ed1ng \u0103n m\u00f2n cao v\u00e0 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc cao. Tantalium c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c m\u00f4 ph\u1ecfng b\u1eb1ng c\u00e1c b\u00e8 kim lo\u1ea1i c\u00f3 \u0111\u1ed9 x\u1ed1p v\u00e0 \u0111\u00e0n h\u1ed3i cao v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng l\u00e0m m\u1eb7t kh\u1edbp sau trong kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o nh\u01b0ng c\u0169ng \u0111\u1ec3 gia c\u1ed1 c\u00e1c khuy\u1ebft x\u01b0\u01a1ng nghi\u00eam tr\u1ecdng c\u1ee7a \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i ho\u1eb7c \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y.<\/p>\n<p>T\u00f3m l\u1ea1i, h\u1ee3p kim coban-chrom v\u1eabn \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng. Titan tr\u01a1 v\u1ec1 m\u1eb7t sinh h\u1ecdc nh\u01b0ng th\u1ec3 hi\u1ec7n s\u1ef1 \u0103n m\u00f2n v\u00e0 ma s\u00e1t. Zirconium oxy h\u00f3a, m\u1ed9t l\u1edbp l\u00f3t b\u1ec1 m\u1eb7t b\u1eb1ng g\u1ed1m, \u0111\u00e3 hi\u1ec7n di\u1ec7n nh\u01b0 m\u1ed9t v\u1eadt li\u1ec7u m\u1edbi cho c\u00e1c b\u1ed9 ph\u1eadn gi\u1ea3 x\u01b0\u01a1ng \u0111\u00f9i. Tantalium \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u g\u1ea7n \u0111\u00e2y h\u01a1n v\u00e0 c\u00f3 m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m v\u1edbi titan, bao g\u1ed3m t\u00ednh d\u1ebbo cao, kh\u1ea3 n\u0103ng ch\u1ed1ng \u0103n m\u00f2n cao v\u00e0 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng th\u00edch sinh h\u1ecdc cao.<\/p>\n<h2><strong>4. K\u1ebeT LU\u1eacN<\/strong><\/h2>\n<p>Hi\u1ec7n nay, ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 nhi\u1ec1u l\u1ef1a ch\u1ecdn v\u1eadt li\u1ec7u trong thay kh\u1edbp, nh\u01b0ng ch\u01b0a c\u00f3 v\u1eadt li\u1ec7u n\u00e0o th\u1eadt s\u1ef1 \u01b0u th\u1ebf h\u01a1n c\u00e1c v\u1eadt li\u1ec7u kh\u00e1c. Nhu c\u1ea7u v\u1ec1 v\u1eadt li\u1ec7u sinh h\u1ecdc m\u1edbi d\u01b0\u1eddng nh\u01b0 l\u00e0 hi\u1ec3n nhi\u00ean v\u00e0 hi\u1ec7n \u0111ang th\u00fac \u0111\u1ea9y nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n th\u00e0nh c\u00e1c kh\u1edbp ch\u1ecbu l\u1ef1c, b\u1ec1 m\u1eb7t kh\u00e1ng khu\u1ea9n t\u1ed1t h\u01a1n v\u00e0 lo\u1ea1i b\u1ecf s\u1ef1 gi\u1ea3i ph\u00f3ng ion kim lo\u1ea1i \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 t\u00edch t\u1ee5 trong c\u1ea3 c\u00e1c c\u01a1 quan xa \u1edf c\u00e1c b\u1ec7nh nh\u00e2n thay kh\u1edbp g\u1ed1i v\u00e0 h\u00e1ng theo th\u1eddi gian. Khi nh\u1eefng c\u00f4ng ngh\u1ec7 m\u1edbi h\u01a1n tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn, h\u1ecd s\u1ebd c\u1ea7n cho th\u1ea5y hi\u1ec7u qu\u1ea3 chi ph\u00ed tr\u01b0\u1edbc khi \u00e1p d\u1ee5ng ho\u00e0n to\u00e0n v\u00e0o ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n. Nh\u1eefng ti\u1ebfn b\u1ed9 trong v\u1eadt li\u1ec7u sinh h\u1ecdc s\u1ebd ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi c\u00e1c nhu c\u1ea7u l\u00e2m s\u00e0ng ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng. \u201cG\u1ed1m s\u1ee9 l\u00e0 s\u00e0nh \u0111i\u1ec7u v\u00e0 nh\u1eefng v\u1eadt li\u1ec7u m\u1edbi h\u01a1n \u0111ang c\u1ea7n!\u201d.<\/p>","protected":false},"featured_media":1312,"comment_status":"open","ping_status":"closed","template":"","tags":[136,145],"chuyen-muc":[58],"class_list":["post-1951","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-thay-khop-goi","tag-thay-khop-hang","chuyen-muc-dieu-tri-co-ban-trong-chan-thuong-chinh-hinh"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=1951"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1951\/revisions"}],"predecessor-version":[{"id":4500,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1951\/revisions\/4500"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1312"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=1951"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=1951"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=1951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}