股骨柄假体的设计和临床应用选择.ppt

髋关节假体的设计 和 临床应用选择,应 明 MD,PhD,股骨柄临床成功的重要因素,非骨水泥股骨柄材料,钛合金(钛铝钒,钛铝铌)钴铬钼合金 不锈钢,非骨水泥股骨柄经典设计,方型柄 圆形柄 锥形柄 解剖柄 组配柄,方形柄,圆形柄,锥形柄,解剖柄,组配柄,非骨水泥股骨柄植入后的稳定,非骨水泥股骨柄初期稳定的部位,非骨水泥股骨柄远期稳定的实现,粗糙表面上的骨长上,多孔表面上的骨长入,采用多种不同的工艺，在非骨水泥柄表面形成具有一定厚度的多孔涂层，以利骨长入多孔内而获得柄远期稳定,对表面多孔涂层的要求,孔隙率对骨长入的影响,孔隙大小对骨长入的影响,孔隙大小对术后抗剪力强度的影响,各种不同多孔表面的骨接触百分比,多孔涂层比较,VPS,VPS,VPS原理,涂层形成过程,多孔表面上的骨长入,非骨水泥柄的选择中的其他考虑,假体选择的正确髓腔评价 型号选择的准确术前计划 并发症的预见（应力遮挡、大腿疼痛）颈干角/颈距/颈长/颈高/肢体长度,股骨柄的发展,1950,1960,1970,1980,1990,2000,骨水泥柄,非骨水泥柄,对非骨水泥柄热情下降骨水泥柄回潮,非骨水泥柄回潮,骨水泥柄的两种基本设计理念,骨水泥柄的两种基本设计,骨水泥柄的两种基本设计,骨水泥柄设计的两种思想,骨水泥柄中的“法国悖论”,髓腔锉与植入柄同号 尽可能植入较大号柄 可去除较多的松质骨 无需均匀的骨水泥层 柄可直接与骨质接触,A,Neck-stem angle is reduced.B,Neck is attached at more medial position on stem.,Large-diameter head with trapezoidal neck(A)has greater range of motion and less impingement than smaller diameter head and skirted modular neck(B).,Definition PM stem.Proximal longitudinal grooves and surface texturing promote mechanical interlock with cement.Integral proximal and distal polymethyl methacrylate spacers ensure neutral positioning in canal and adequate thickness of cement mantle.(Courtesy of Stryker Orthopaedics,Kalamazoo,Mich.),Omnifit EON stem(Stryker Orthopaedics,Kalamazoo,Mich).Normalized proximal texturing converts shear forces to compressive forces.A,Standard offset.B,Enhanced offset.,Spectron EF stem.Rounded,rectangular shape and longitudinal groove improve rotational stability.A,High offset.B,Standard offset.(Courtesy of Smith&Nephew,Memphis,Tenn.),CPT hip stem(Zimmer,Warsaw,Ind).Collarless,polished,tapered design allows controlled subsidence and maintains compressive stresses within cement mantle.,Basic cementless stem shapes(Stryker Orthopaedics,Kalamazoo,Mich).A,Meridian TMZF straight stem is symmetrical and fits either femur.B,Citation TMZF anatomical stem design incorporates proximal posterior bow and anteverted femoral neck.,Synergy porous stem(Smith&Nephew,Memphis,Tenn).Tapered straight stem design.Proximal flutes provide additional rotational stability.A,Standard offset.B,High offset.Shown with oxidized zirconia heads.,APR stem(Zimmer,Warsaw,Ind).Collared anatomical design.Standard(A)and large body(B)components provide variable proximal fit for given distal stem size.,Taperloc stem.Plasma-sprayed titanium porous surface.Collarless,flat,wedge-shaped geometry is available with two femoral offsets.(Courtesy of Biomet,Warsaw,Ind.),VerSys stem.Collared titanium alloy stem with titanium fiber metal circumferential porous surface.Trapezoidal proximal geometry and distal flutes promote rotational stability.(Courtesy of Zimmer,Warsaw,Ind.),S-ROM modular stem.A,Multiple proximal sleeve sizes can be combined with given diameter stem.Stem can be rotated in relation to sleeve to correct rotational deformity of femur.Distal flutes improve rotational stability.B,Long,curved stem.Distal part of stem is slotted in coronal plane to diminish bending stiffness.(Courtesy of Johnson&Johnson,DePuy,Warsaw,Ind.),Extensively porous-coated stems.A,AML stem for primary and revision arthroplasties when isthmus is intact.B,Extensively coated Solution long stem used for revisions when proximal bone loss is severe.C,Calcar replacement long stem.(Courtesy of Johnson&Johnson,DePuy,Warsaw,Ind.),Noncircumferential porous coating.Despite excellent ingrowth into porous pad,debris may migrate to distal aspect of stem through adjacent smooth channels(arrow).,Alloclassic stem(Zimmer,Warsaw,Ind).Conical straight stem with rectangular cross section.Titanium alloy with grit-blast,nonporous surface.,Corail stem(Johnson&Johnson,DePuy,Warsaw,Ind).Titanium alloy stem with extensive hydroxyapatite coating.Proximal ridges and distal grooves provide additional stability.,Specialized femoral components for replacement of variable length of proximal femur.Orthogenesis Limb Preservation System.Modular segmental replacement stem for replacement of large segment of proximal femur.Stem can be combined with total knee replacement to replace entire femur.(Courtesy of Johnson&Johnson,DePuy,Warsaw,Ind.),Endurance CDH stem.Straight small-diameter stem design is ideal for use in patients with developmental(congenital)hip dysplasia or small stature.(Courtesy of Johnson&Johnson,DePuy,Warsaw,Ind.),Acetabular component designed for cement fixation.Textured surface and polymethyl methacrylate spacers optimize cement mantle and cement-prosthesis interface.(Courtesy of Smith&Nephew,Memphis,Tenn.),Contour antiprotrusio cage(Smith&Nephew,Memphis,Tenn)has titanium support ring fixed to ilium and ischium with screws.Alternatively,inferior fin can be impacted into ischium without screws.,Universal acetabular component(Biomet,Warsaw,Ind).Titanium plasma spray coating with dome and rim screw fixation options.,Interfit acetabular component.Hemispherical design with gradual transition to enlargement in peripheral rim for improved initial stability and peripheral stress transfer.(Courtesy of Smith&Nephew,Memphis,Tenn.),Array of liner options available with contemporary modular acetabular system:standard flat liner(A);posterior lip without anteversion(B);4-mm lateralized flat(C);anteverted 20 degrees(D).(Courtesy of Smith&Nephew,Memphis,Tenn.),Constrained acetabular liners.A,Tripolar design with small bipolar shell captured within outer liner(Stryker Orthopaedics,Kalamazoo,Mich).B,Peripheral locking ring design(Johnson&Johnson,DePuy,Warsaw,Ind).,Specialized acetabular components.A,Oblong component used for superior segmental deficiencies.B,Deep profile component used for protrusio deformity or medial cavitary deficiency.(Courtesy of Johnson&Johnson,DePuy,Warsaw,Ind.),Trabecular metal acetabular component with modular augments that can be secured to implant with bone cement(Zimmer,Warsaw,Ind).,了解,选择,应用,thank you for your attention!,