NGHIEN CUfU - TRAO 061
NGHIEN CU'U KHAI THAC LTNG DUNG MAY TIEN TRUC C CHO GIA CONG 6 c CHAN CUNG
RESEARCHMENT, DEVELOPMENT AND APPLICATION BY USING CNC LATHE WITH C AXIS FOR FABRICATING PEDICLE SCREW
NguySn Minh T r i ' , Vo Vin T h a n h s Le Phan Hoang Chieu' 'Trung tam Thiet ke va Che tao Thiet bi mdi (NEPTECH)
^Hoi Cot song TP. Ho Chi Minh 'Trung tam CNTT va Truyen thong TR Ho Chi Minh.
TOMTAT
Oc Chdn Cung (OCC) dp dung cho cdc benh nhdn chdn thuong cgt sdng. Nghien cdu sdn xudt vd chUgo OCC coy nghia ldn trong nUdc vd cho cd cdc nudc ngheo trong khu vUc vd Iren the gidi. Viec che tgo thdnh cdng 6c chdn cung giup gidi quyet cdc benh ly kho vdi gid thdnh sdnphdm re hdn nhieu so vdi nudc ngodi, nhdm phuc vu cho ngddi lao dgng ngheg trong nUdc.
Bdi bdo ndy trinh bdi ket qud nghien cdu khd ndng che tao OCC. Viec dng dung vd khai thdc khd ndng tgo hinh cua mdy tiin true C (CNC lathe with C axis} Irong che tao bien dgng ren ddc thu cua OCC duoc khai thdc Iriet de. Cdc thd nghiem ldm sdng trong nghien cdu dd dUdc Ihdc hien vd mang lgi hieu qud cao ve mat nhdn dgo cdng nhd viec chu dgng ve cdng nghe che Igo d Viet Ngm.
Tii kh6a; Oc chdn cung chdn IhUdng chinh hinh.
ABSTRACT
Pedicle screws applied for the patients involving in spinal trauma. Research in the design and manufacture of surgical pedicle screw is significant in Viet Nam as well as developing countries in the region and around the world. Manufacturing spinal implants successfully helps tg treat difficult spinal disorders with cheaper cgst pedicle screws and rods than overseas products in order to serve poor patients.
This paper is aiming to present the results of a research project on Ihe probability of manufacturing pedicle screws by utilizing CNC axis lathe in manufacturing specific late profile ofpedn Ic screws.The clinical application has been done with not only humanitarian service but also with the promotion oj dnelopinghigh technology in Vietnam.
TAP CHl CO KHI VIET N W l ••* So 4 (Thang 4 r,.m: - I - ' B
NGHIEN CUTU - TRAO Ddi
I . D A T V A N D E
Sii gia tang cac benh ly chan thiidng va chinh hinh cot song d midc ta, dan den yeu cau sU dung OCC rat Icfn. Tuy nhien, hien nay, gia ban cac loai OCC cua nUcfc ngoai rat cao. Day la mot ganh nang rat 16n doi vdi benh nhan va ca quan chiic nang. Viec nghien ciiu san xuat va che tao 6c phdu thuat cot song co y nghia ldn doi vcfi Viet Nam. Cong nghe che tao cd khi cua chung ta dang phat trien vcfi sd dau til Icfn ve nhan sif, may moc va thiet bi mcfi hien dai du stCc trien khai mot mang trong gia cong OCC cho den nay chiia dUOc khai thac triet de tren may tien CNC true C.
Viec nghien ciiu va san xuat OCC da dUOc thUc hien bdi cac midc tien tien nhU: Phap, My, Diic v.v... Co rat nhieu nghien ciiu tren the gidi da va dang thiic hien hen quan den OCC cho thay dUcfc day la mot nhu cau thiet thiic va tinh cap thiet cua nghien ciiu. Tuy nhien, cac nghien ciiu chi la mpt mang nho trong OCC. Ve bien dang OCC da duoc trinh bay trong nhieu nghien ciiu [1,2,3], tac gia xac dinh cac trang thai liic va tai trong nham toi ifu thong so hinh dang cua OCC.
Cac nghien ciiu khac ve vat lieu dilOc dUa vao sii dung phu hop trong ca the ngiidi va kha nang che tao OCC diiOc trinh bay trong cac nghien ciiu [4]. Purvi S. P. [4] la mot nghien ciiu tiiong doi tong quat ve cac bien dang ren, vat lieu, va toi liu hda ket cau lien ket khi xet den cd tinh va vat lieu xiiOng, lam ccf sd trong viec che tao OCC. Ngoai ra, kha nang va trang thai chiu tai va hen ket cua OCC da dxiac the hien rd net trong nghien ciiu [5,6,7] .
Gia thanh O C C ban ra tren thi triidng cac midc chau Au va My rat cao. Khi nhap vao Viet Nam gia thanh cua OCC la ganh nang khdng chi rieng cho ca nhan va gia dinh benh nhan bi benh cdt sdng, ma cdn lam that thoat ngoai te rat ldn cho Nha nUdc, khi vdi hang ngan ca can phau thuat hang nam. Mpt sd midc chau A nhan thay van de nay va da trien khai nghien ciiu san xuat OCC nhii: Malaysia, Thai Lan, Han Quoc va Trung Quoc v.v... vdi gia ban thap hon cac niidc
Do do, neu chung ta co thi nghien ciiu san xuat tai Viet Nam phu h o p nhan trac hoc ngiJdi Viet va gia thanh hcfp ly so vdi gia san pham ban ngoai nhap. Dieu nay se giup benh nhan ngheo cd CO may dUcfc phau thuat vdi ky thuat cao va chi phi thap. Cac loai 6c chan cung dcfn true va da true tren the gidi diicfc tham khao d bang 1:
Bdng 1. Cdc tham khdo vi 6c chdn cung tren the gidi.
6 c dcfn true XIA CD MS SPINEWAY
MOSS MI- AMI AMT
X
dc da true XIA CD MS SPINEWAY
MOSS MI- AMI
X
CD Legacy
Nguon hang My My Phap My Thai My
Hien nay, 6 Viet Nam van chUa cd nghien ciiu hen quan san xuat va che tao OCC phuc vu cho phau thuat cpt song, nen van sii dung nhieu loai 6c do midc ngoai san xuat va ban sang nifdc ta. Xuat phat tii thiic trang tren, mpt sii phoi hop lien nganh ve tri tue cua Vi^t Nam, Trung tam Neptech cimg cac cong sU: nganh Y; Co khi che tao (cac ky sU Triidng Dai hpe Bach Khoa, bac si phau thuat vien Khoa Cdt song, Benh vien Chan thiiong Chinh hinh, v.v...) da ciing nhau giai quyet bai toan nay. Kha nang thiet ke, san xuat thif, thii nghiem lam sang va san xuat dai tra OCC hoan toan cd the thiic hien diiOc trong nildc.
a); Than 6c chan cung ddn true b); Than 6c chan cung da true.
Hinh 1. Md hinh 3D bien dgng ren cua 6c chdn cung.
TAP CHI C O KHf VIET NAM Sd 4 (Thang 4 nam 2013)
NGHIEN CUfU TRAO OCl
2. PHl/ONG P H A P NGHIEN CtJtJ 2,1, Thiic trang san xuat O O C hien nay
Bien dang ca khi dac thu cua OCC nhU hinh 1 diidc gia cdng va che tao tren eac thiet hi chuyen dimg. Cae thiet bi gia cong hang loat chuyen diing cua cae hang may gia edng ldn nhii Citizen, Cmcom, v.v...diiOc trinh bay trong hinh 2. Tuy nhien, vdi phi dau tU trang thiet bi va cdng nghe rat ldn.
ren cao. Mot md hinh may tien true C duoc trinh bay trong hinh 3.
(a) Mdy Cincon A20VI1 cua hdng. Citizen.
(b) Mdy Sigma cua hdng Tarnos.
Hinh 2. Mdy gia cong OCC chuyen dung.
May tien true C la may tien CNC ngoai hai tryc X va Z diipe trang hi them true C la true dao phay, cd khd nang khoan va phay hifdng tam, va phay hiidng true, dap iing nhieu nhu eau gia cfing chi tiet ehi trong mot lan ga dat. Hien nay, dnifdc ta may ti^n true C vdi sd liiong tiiong doi nhieu va chiing ta lam chu diioc cdng nghe gia cong vi dilu chinh may gia cdng tren may tien C. Do dd, vi?c ling dung may tien true C vao san xult OCC vdi cdc liu diem: May tien true C cd thl gia cong nhQng chi tiet ren cd biidc ren thay d5i, ren cd bien dang dac biet, chieu sau bien dang Wifing gi6ng nhau ma may tien CNC thiidng
"ldng, hoac khd thiic hien khi yeu cau dp bdng
Hinh 3. Mdy tien trucCSLSO cua hangHass.
3.2 Phuong phap sii dung may tien true C gia cdng ren OCC.
Do dac thu ling dung trong bat xiiOng, nen OCC ed eac yeu nhii sau: 6 e cd ren can dan (hoat ddng tdt khi siet chat hon vao xUOng hdn 6c CO ren deu); Khi da lap vao xiiOng song ngiidi benh, trong qua trinh sii dung khdng tii thao, lien ket phai bao dam; Bien dang ren dac thii, biidc ren phan buldng ldn.
Trong nghien ciiu nay da sii dung may tien true C de tien hanh gia cdng ren OCC vdi cac trang thiet bi va thdng sd cdng nghe nhii sau:
May tien - Takisawa EX308; Can dao: ER32; Dao ngdn diidng kinh bang 4 (mm) - dd cdn 22" - Ban kinh mui dai Rl (mm); Vat lieu dao: Cubic Boron Nitride; Tdc dp vdng: n= 2400 (vdng/phut); BUdc tien s = 200 (mm/phiit); Vat lieu gia cdng: Tita- nium nguyen chat. Nguyen cdng phay ren OCC duoc trinh bay tren hinh 4.
a) b) Hinh 4. Nguyen cong phay ren OCC trin mdy tien true
Q
( a): Sd do diidng chuyen dao khi phay;
( b): AI(> hinh gill cong
TAP CHf CO KHf VIFT .NAM V Sd4("lhani!4 njm ^n! '^
NGHIEN CUfU-TRAO D61
3. KET QUA VA THAO LUAN 4. KET LUAN
Viec ling dung may tien true C trong viec gia cong OCC, dd la mpt thiic te mang tinh nhan dao, giiip cai thien kha nang dieu tri benh nhan cot song d Viet Nam. Tan dung tot cac trang thiet bi hien ed de giai quyet cdng viec tnidc mat, khi ta chUa du kha nang dau tU eac trang thiet bi chuyen dirng vdi ngudn kinh phi dau tU Idn trong gia cdng trang thiet hi phu trd trong y te. Nghien ciiu nay dupe xem la mdt tien de cua sii phoi hop dong bd cua cae nha khoa hoc va cac nganh ehiic nang trong sU phat trien va tien bd cua nUdc nha.
5. L O I CAM ON
Tac gia va nhdm nghien ciiu ehan thanh cam on sii ho trp nhiet tinh eua Hpi Cpt song TP.
Hd Chi Minh, Benh vien Chan thiiong Chinh hinh TP. Ho Chi Minh, trong viee gdp y thiet ke, thii nghiem lam sang nhiing 6c chan eung da che tao; Cong ty Pritic, Cdng ty JYS (Nhat Ban) ho a) Thdn 6c ddn true. b )Thdn 6c da true trd cung cap vat lieu gia cdng eung nhii danh viec
Hinh 5. Bien dgng ren ciia 6c chdn cung. bong OCC sau khi gia edng. • Ngay nhan bai: 15/3/2013
Ngay phan bien: 20/4/2013
Ngiidi phan bien: PGS, TS. Ha Minh Himg, Vien Nghien cUu Cd khi, Bd Cong ThUdng.
Cac chi tiet OCC da dUde gia cdng phan ren tren may tien true C dUdc trinh bay trong hinh 5. Ket qua nghien cUu va Ung dung thiet bi gia cdng may tien true C trong gia cdng che tao OCC diia tren thiet ke de dUa vao thd nghiem lam sang. Vdi cac ket qua tren nhdm nghien cUu xem day la ddng lUe eho hUdng nghien ciiu md rdng vdi ndi dung sau: 1) Nghien ciiu thU nghiem cac cdng nghe xd ly sau gia cdng; 2) Xay diing quy trinh kiem tra; 3) Chud'n hda quy trinh gia edng san xuat hang loat phii hdp vdi thiet bi hien tai; 4) Gia cdng lam md bang edng nghe tU trudng; 5) Cai tien bd trd dung eu cho phu hpp vdi kha nang iing dung trong dieu tri chan thUdng chinh hinh.
. * *
Tai lieu tham khao:
[!j. Po-Quang Chen, Tiie Optimal Design of Spinal Implants, Department of Orthopedic Surgery National Taiwan University Hospital Taipei, Taiwan ROC, 2010.
[2]. Beker S. Chavanne, A. et al.. Assessment of Different Screw Augumentation Techniques and Screw Design in Osteoporptic Spines, European Spine Journal, 2008.
13). Okuyama, K et al.. Influence of Bone Mineral Density cn Pedicle Screw Fixation; A Study cf Screw Fixation Augmenting Posterior Lumbar Interbody fusion In Elderly Patient, Spine Journal, 2001.
[4]. John Disegi, Unalloyed Titanium Implant iviaterial. Fifth Edition, Original Instruments and Implants of the Association for the Study of Internal Fixation-AO ASIF, 2003.
|5]. Purvi RS. Screw Fixation of Implants to the Spine, PhD Thesis submitted to the University of Birmimham, January- 2010.
[6]. Crawford, M.J. & Esses, S, I., Indication For Pedicle Fixation, Results of NASS/SRS Faculty Questionaire, 1994.
[7|. Havorson, T.L. et al. Effects of Bone Mineral Density on Pedicle Screw Fixation, Spine, 1994.
TAP CHi CO KHI VIET NAM • S6 4 (Thang 4 nam 2013)
