Titanium in medicine
In titanium of physicians attracts a primarily biological inertness in relation to living organism, combined with corrosion resistance, high mechanical quality, availability and relatively low cost. All these advantages have provided great interest to the Titan and conducting numerous clinical trials.
By this measure, the Titan is not inferior to platinum. This metal is stable in alkaline solutions and acids. In the lymph of which the chemical composition is close to seawater, the corrosion rate of titanium is 0,00002 mm (0.02 mm per 1000 years). Titanium alloys are resistant to hydrogen peroxide, formaldehyde, gasoline. Corrosion on titanium is not detected after multiple kipjachenii and autoclaving, aging for several months in a 3% strength solution of chlorine bleach, 96°ethanol and a solution of corrosive sublimate. From titanium alloys showed pitting after only keeping them in a 10% alcohol tincture of iodine for several days.
Another positive feature of titanium and its alloys — high fatigue strength under alternating loads. This is particularly important in the production of intraosseous fixator as well as internal and external prostheses, which are subjected to variable loads constantly.
Pure titanium is quite ductile metal lends itself to all kinds of mechanical processing: grinding, drilling, milling and cutting. The complexity of manufacturing of this metal in various designs the same as when working with stainless steel. Besides, titanium is non-magnetic material. This is a very valuable feature. Thanks to him, in the treatment of patients who in the body has a titanium design, you can use physical therapy. All these qualities make this metal is very promising for wide application in the medical field.
The most important conclusion made after years of research, was the fact that titanium is an inert metal towards the biological environment. Titanium design is perfectly tolerated by the human body and acquire muscle and bone tissue. Titan practically does not corrode in the body, the structure of the surrounding tissue is not changed for many years. Chemical indifference Titan is superior to all stainless steel and widely used alloy on cobalt basis («Vitallium»). Also valuable that in the commercially pure titanium impurities is much less than other alloys used in medicine.
Carefully the possibility of using titanium in medical technology has been studied in all-Union scientific research Institute of surgical instruments and tools. Recently, research work was joined by the specialists of the Institute of titanium and a number of medical associations. First titanium alloys used in surgical purpose for the creation of the implant of the eyeball. The long search for metal led experts to titanium alloy grade VT5. The resulting implants were two times lighter than similar steel products Х18Н9Т (given the diameter of 20 mm, the weight of the implant and the steel was equal to 3.2 g, and the titanium implant weighed 1.6 g). Long-term clinical observations and Toxicological studies have shown biological inertness of the product. After successful completion of the fabrication of titanium implant eyeball the metal was used in the other designs of prostheses, including those working parts which bear load.
Now in the clinical agencies used more than 200 names of various surgical instruments. Their trials were held in the Moscow scientific research Institute of eye diseases named after Helmholtz, Institute of surgery named after A. Vishnevsky, Zaporozhye Institute of doctors, Clinic of diseases of ear, nose and throat of the Central Institute of improvement of doctors. All tools were marked with positive comments from the experts.
Tools of the titanium alloys, different biological inertness, high corrosion resistance strength and ductility. Before the designers were tasked to create instruments of superior advantages such as stainless steel. During the research it was found that, if the manufacture of titanium tool for the conservation of its functional properties, the cross section need to increase by more than 30% compared to the same product made of steel, the development of this tool is not promising. The exception is the case when weight is not a dominant feature. To preserve the functional properties of metal in the construction of nonseparable instruments like forceps and clamps, the cross section of the individual elements increase by 10−30%, but the weight is reduced by 30−35% in comparison with the samples of steel. After heat treatment the hardness of the tools is HRC35−38.
Plate hooks, mirrors and anorexicly, that is, instruments with a large working area that do not experience heavy loads during operation, comply with cross-sections reduced by 30%, which in turn reduced the weight by 50%.
For cutting tools used combined circuit: removable working parts are made of suitable steel, and the handle of titanium alloy. Such products include surgical hooks, scalpels with detachable blades and chisels. For all-in-one cutting tools used in the steel, and the handles are made of titanium alloys. All the elements were put together with rivets or press fit — rod tools, raspatory, scissors.
During the research it was found that titanium alloys should be used where medical tools requires high corrosion resistance for low hardness of the metal. The fact that titanium has high hardness and cutting properties, prevents the wider use of the metal in surgical tools. Therefore, giving the Titan cutting properties and increase its hardness are of paramount importance. The main difficulty here lies in the fact that modern industrial methods of hardening, it is impossible to apply in respect of medical instruments — here thereto make special demands. Additionally medical tools and devices working in specific conditions (contact with iodine, saline solution, sterilization by boiling).
All-Union scientific research Institute of surgical instruments and tools in order to increase the hardness of the metal, the wear resistance and reduce coefficient of friction, carried out chemical-thermal and thermal processing (i.e. Alferova and nitriding). With the help of anodizing on the products received color film of various shades (purple, green, purple, Golden). All samples were subjected to sterilization using an autoclave at 180 °C. After each cycle studied the discoloration of the coating and spotting of corrosion. The most durable and corrosion-resistant film was an oxide film Golden, lilac and purple flowers.
Titanium medical instruments lighter than steel products by 20−30%, and they are more comfortable and durable, and possess better corrosion resistance. Employees of all-Union scientific research Institute on the basis of information developed and produced a prototype tool sets made of titanium alloys for dentistry, ENT and General surgery. Kit for General surgery came in hemostatic clamps, plate tweezers and double-sided hooks, V-shaped wire hook, a scalpel with detachable blades, liver mirror and other products — a total of 27 items (the weight of all tools — 1.59 kg). ENT kit ENT operations included tracheotomy retractor spring, retractor Lira, ear forceps, tracheotomy hook, ear tampon forceps and a funnel (total weight — 235 grams). A set of dental tools passed all the tests at the Central research Institute of dentistry.
Currently, fractured bones are often treated with metal osteosynthesis. For him use rods that ensures the immobility of the fragments, contributing to the process of consolidation of the fracture. But many patients later experience various complications associated with the use of stainless steel. The heterogeneity of the steel, both chemical and structural, often causes the destruction of retainers, and this leads to fracture of the whole structure. The bone damaged by the corrosion products observed phenomena of electrical conductivity and ionization. Iron ions begin to interact with physiological salts of the body, which causes inflammation and severe pain. Therefore, even the highest quality stainless steel is the best material for osteosynthesis.
The use for the manufacture of bone fasteners of titanium allowed us to avoid the above described complications due to the biological neutrality of the metal. So titanium structures can be used for long-term (or even permanent) stay in the human body. This is especially important if the osteosynthesis is carried out for the elderly, because the use of titanium is able to save the patient from surgery to remove the fixator.
With Titan you can apply the design of a complex configuration in the treatment of periarticular fractures. Previously, such designs are not used because of the difficulty to remove them. Now in the technique of skeletal traction began to use terminals (titanium staples). In the Soviet Union titanium design has successfully used N. K. Mityunin and G. M. Frolov (Leningrad), S. I. Kutnowski (Novosibirsk), G. I. Tatevosov (Monchegorsk), B. S. Gavrilenko and V. V. Volkov (Zaporozhye).
Articular prostheses and various other Titan designs successfully developed by the staff of the Moscow Central Institute of traumatology and orthopedics under the guidance of Professor K. M. Sivash. From competing metals titanium compares favorably to biological inertness and valuable mechanical properties. Titanium rod with a diameter of 10 mm has a tensile strength as the rod of iron with a diameter of 14 mm. Titanium — is a construction material that allows to make the product stronger, while retaining its size, or to weight savings of up to 40% without sacrificing strength and to reduce the volume of the structure. Therefore, for internal prostheses titanium is the best metal. The most effective is the use of titanium in arthroplasty of the hip.
In the manufacture of plastic dental prostheses in order to obtain a cosmetic effect, in the domestic dentistry is used white crystalline substance, which is titanium dioxide. But dentures can be used as titanium compounds, oxygen, and structural titanium is biologically inert, durable, light enough and well machinable metal.
Clinic of oral and maxillofacial surgery under the guidance of associate Professor K. I. Tatarintseva (Zaporozhye) proposed a new method of treatment of fractures of the mandible with U-shaped staples made of titanium BT1−00. Activity data legs of the brackets provide secure fastening in the correct position of all the fragments of the jaw. This method, in the period from 1971 to 1973, we treated about fifty patients with single and bilateral fractures of the mandible. The results demonstrate that the new technology reduces the time of wound healing, thereby the workability is returned much faster.
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