强生 狂关节置换与假体设计 课件.ppt

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1、,CORAIL SYSTEM,1,PPT课件,CORAIL SYSTEM DESIGNERSARTRO GROUP FOUNTED IN 1981,2,PPT课件,1984 TITAN stem launched钛合金柄上市 1985 Clinical trails of TITAN / HA临床试验 1986 1st implantation of the CORAIL stem 第一个假体柄植入体内 1996 FDA approval FDA 通过 2005 Corail AMT,HISTORICAL RECORD历史回顾,3,PPT课件,CORAIL DESIGN PRINCIPL设计原

2、理,SURFACE TREATMENT表面处理RANGE OF IMPLANTS假体尺寸SURGICAL TECHNIQUE外科技术CLINICAL RESULTS临床结果,4,PPT课件,RELIABLE PRIMARY STABILITY可靠的初始稳定性 LONG TERM BIOLOGICAL FIXATION长期的生物固定 PROXIMAL LOAD TRANSFER近端负荷传导,CORAIL DESIGN PRINCIPLES设计原理,5,PPT课件,CORAIL DESIGN PRINCIPLES设计原理,6,PPT课件,FEMORAL HEADS 股骨头Alumina (Biol

3、ox Forte)氧化铝Tribological properties摩擦学属性Compatible with alumina or cobalt chrome liners 与氧化铝或钴铬内衬匹配,CORAIL DESIGN PRINCIPLES设计原理,7,PPT课件,Straight stem直柄Thin distal tip远端较细,CORAIL DESIGN PRINCIPLES设计原理,8,PPT课件,135 neck angle 颈干角12/14 Morse taper锥度Progressive offset 偏心距逐渐扩大,CORAIL DESIGN PRINCIPLES设计原

4、理,9,PPT课件,四边形横截面轴向及旋转稳定性,CORAIL DESIGN PRINCIPLES设计原理,10,PPT课件,Double taper geometry gives stero-stability 双锥度设计提供 立体稳定性,CORAIL DESIGN PRINCIPLES设计原理,11,PPT课件,Progressive horizontal macrostructure on the proximal stem柄的近端逐渐扩大的横行结构,CORAIL DESIGN PRINCIPLES设计原理,12,PPT课件,Horizontal proximal macrostruct

5、ure近端横行结构 Size 9 = 11 grooves沟 Size 20 = 21 grooves沟,CORAIL DESIGN PRINCIPLES设计原理,13,PPT课件,Vertical distal macrostructre 远端垂直结构,CORAIL DESIGN PRINCIPLES设计原理,14,PPT课件,Optional collar for calcar loading股骨距负荷-带领，不带领,CORAIL DESIGN PRINCIPLES设计原理,15,PPT课件,HYDROXYAPATITEBioactive coating生物活性涂层,CORAIL DESI

6、GN PRINCIPLES设计原理,16,PPT课件,BONE COMPOSITION骨组成,ORGANIC PHASE 有机期 30% collagen胶元, specific proteins特殊蛋白质MINERAL PHASE 矿物质期 60% carbonated apatite 碳酸磷灰石WATER 水 10%,17,PPT课件,HYDROXYAPATITE羟基磷灰石,Chemical Formula化学分子式 Ca10 (PO4)6 (OH)2Similar to the mineral phase of human bone与人类骨的矿物质期相似 Biocompatible, n

7、on resorbable生物相容，不可吸收Osteo-conductive properties骨传导性,18,PPT课件,NON TOXIC无毒NON INFLAMMATORY不引起炎症反应NON ALLERGIC无过敏反应NON CARCINOGENIC不引起癌症,HYDROXYAPATITE,19,PPT课件,Coating thickness涂层厚度 = 150mCoatings 200mrisk of delamination 脱层的危险,HYDROXYAPATITE,20,PPT课件,ADVANTAGES优点 Increased bone ingrowth 增加骨内生No fib

8、rous tissue interposition无纤维组织插入Gap filling孔隙充填,HYDROXYAPATITE,21,PPT课件,New bone formation 新骨形成 HA coating HA涂层 Metal 金属,HYDROXYAPATITE,NO FIBROUS TISSUE INTERPOSITION 无纤维组织插入,22,PPT课件,HYDROXYAPATITE,Why is Corail fully coated ? 为何全涂层？Long term stability长期的稳定性Biological seal against wear debris生物性封闭

9、，以抵抗磨屑No distal granulomas 没有远端肉芽肿,23,PPT课件,LONG TERM STABILITY长期稳定性“The complete absence of femoral endosteal cortical osteolysis in spite of the abundance of particles is reassuring. The explanation may be that the extensive HA coating of the stem seals the whole interface and blocks the passage o

10、f particles.” 虽然有大量的磨损颗粒，但没有股骨骨内膜的皮质骨溶解。原因可能是广泛的HA涂层封闭了所有的交界面阻止了微粒的通道。 Rokkum et al JBJS Vol 81B, 1999,HYDROXYAPATITE,24,PPT课件,Prevention of thigh pain大腿痛的防止 No fibrous tissue distally远端没有纤维组织 No distal micromotion没有远端微动Minimise thigh pain最小化大腿痛New bone formation,HYDROXYAPATITE,25,PPT课件,From Corail

11、to Corail AMT,26,PPT课件,Articul / eze Mini Taper: AMT,Thinner neck更薄的颈部设计=Improved range of motion更大的活动度,27,PPT课件,Polished taper 抛光的锥部Better resistance to PE wear减少PE磨损,Articul / eze Mini Taper: AMT,28,PPT课件,Mini taper短小的锥部12/14Improved range of motion 更大的ROMNo skirt effect无假裙现象,Articul / eze Mini Ta

12、per: AMT,29,PPT课件,Thinner neck更薄的颈部设计Elliptico-trapezoidal shape2 flat surfacesFrontal (向位): 12 mmSagittal (矢向位): 9.15 mm,Articul / eze Mini Taper: AMT,30,PPT课件,New impaction hole新打入孔,Articul / eze Mini Taper: AMT,31,PPT课件,Standard range:,KSAvailable sizes:(new) 8; 9; 10; 11; 12; 13; 14; 15; 16; 18;

13、 20Without collar outside of FranceNSA: 135Indications: Primary THR; Revision stage 1 and 2,32,PPT课件,Articul / eze Heads,Cobalt chrome-22.225 mm:+4medium+7 long,33,PPT课件,Cobalt chrome:28 mm:+1.5short neck+5medium (standard)+8.5long+12extra long,Articul / eze Heads,34,PPT课件,Articul / eze Range,Cerami

14、c:28 mm, 36mm:+1.5 short neck +5 medium (Standard) +8.5 long32 mm:+1short neck+5 medium (Standard)+9long,35,PPT课件,97.7% Survivorship at 10 years89% of patients without thigh pain (大腿痛）0.8% stress shielding Gr. III应力遮挡JP Vidalain and the Artro Group International Corail Conference, 1998,CORAIL Clinic

15、al results,36,PPT课件,100% Survivorship in 100 cases after 5 years0 % Thigh pain大腿痛0 % Stress shielding应力遮挡0 % migration移动Rokkum et al Journal of Arthroplasty Vol.14, 1999,CORAIL Clinical results,37,PPT课件,NORWEGIAN HIP REGISTER99.5% Survivorship in 1117 cases at 4.5 years Havelin L et al JBJS Vol. 77-

16、B, 1995,CORAIL Clinical results,38,PPT课件,IN PATIENTS UNDER 50 years99.1% Survivorship in 119 cases after 10 yearsVidalain JP et al European Hip Society, 1998,CORAIL Clinical results,39,PPT课件,IN PATIENTS UNDER 55 years94.4% Survivorship in 1039 cases after 6 yearsHavelin L et al JBJS Vol.79-B, 1997,C

17、ORAIL Clinical results,40,PPT课件,95.1% Survivorship in 5,130 cases at 15 yearsThe Norwegian Arthroplasty Register，1987-2004, 2005.,迄今为止最成功生物型股骨假体,Clinical Heritage Documented,41,PPT课件,FEATUREQUADI-LATERAL CROSS SECTION 横截面四边形,BENEFITACCURATE ROTATIONAL STABILITY 精确的旋转稳定性,CORAIL,42,PPT课件,FEATUREMACROS

18、TRUCTURE（横行，纵行）结构,BENEFITINCREASE THE SURFACE FOR BONE / IMPLANT CONTACT BY 15 % 增加骨与假体接触面积15%,CORAIL,43,PPT课件,FEATUREHORIZONTAL MACROSTRUCTURE 横行结构PROGRESSIVE逐渐增大,BENEFITTO PREVENT STEMSUBSIDENCE避免假体下沉TO OPTIMISE PROXIMAL LOAD TRANSFER优化近端负荷传导,CORAIL,44,PPT课件,FEATUREVERTICAL MACROSTRUCTURE 纵行结构,BEN

19、EFITTO IMPROVE ROTATIONAL STABILITY 改善旋转稳定性,CORAIL,45,PPT课件,FEATUREHYDROXYAPATITE COATING HA涂层,BENEFITGREATER SHEAR STRENGTH OF IMPLANT假体的剪力增大INCREASED BONE ONGROWTH增加骨表面增长,CORAIL,46,PPT课件,FEATUREHYDROXYAPATITE COATING HA涂层,BENEFITNO FIBROUS TISSUE INTERPOSITION没有纤维组织插入GAP FILLING空隙封闭,CORAIL,47,PPT课

20、件,FEATUREFULL HA COATING完全的HA涂层,BENEFITNO THIGH PAIN没有大腿痛BARRIER TO THE INGRESS OF WEAR DEBRIS阻止磨屑进入,CORAIL,48,PPT课件,FEATURE21 YEAR EXPERIENCE21年经验,BENEFITOVER 130,000 IMPLANTATIONS假体植入CLINICAL RESULTS,CORAIL,49,PPT课件,FEATURESURGICAL TECHNIQUE外科技术,BENEFITEASY & REPRODUCIBLE容易，可重复性强NO CONTRA-INDICATI

21、ONS没有禁忌症,CORAIL,50,PPT课件,CORAIL - Positioning 产品定位,Key selling points宣传要点Superior Design 上乘的设计Proximal Loading and Fully HA Coated近端负重及HA全涂层21 Years of Clinical Heritage21年的临床验证130 000 implantations Easy Surgical Technique手术技术简单Stems for all surgeons 满足各种需求Perfect fit for MI适合于MI手术 .,51,PPT课件,Simple

22、 and comprehensive instrumentation 简单易操作的工具,CORAIL Surgical technique,52,PPT课件,Simple procedure简单的手术步骤One step broaching (non agressive)一步扩髓腔（不锋利）No prior reaming of the canal不先进行扩髓Preserving cancellous bone保护松质骨Living bony mantle respected and compacted有活力的松质骨得到重视并压实,CORAIL Surgical technique,53,PP

23、T课件,STEP 1Neck resection at 45 45度颈部截骨Level determined during preop planning术前计划决定截骨水平,CORAIL Surgical technique,54,PPT课件,STEP 2Proximal compaction before broaching锉髓腔前近端松质骨压实No distal reaming 远端不扩髓Cancellous bone is preserved保护松质骨,CORAIL Surgical technique,55,PPT课件,Canal Finder股骨探髓,Canal probe esta

24、blish a direct pathway to the medullary canal髓腔探棒找到正确髓腔位置,靠后外侧，紧贴梨状窝进入，找到正确髓腔位置，中立位进入，避免内翻,56,PPT课件,STEP 3Progressive broaching until complete stability is achieved进行性扩髓直到获得完全的稳定性,CORAIL Surgical technique,57,PPT课件,STEP 4Calcar milling锉平台,CORAIL Surgical technique,58,PPT课件,STEP 5Trial reduction with

25、 trial neck segment试模颈进行试模复位,CORAIL Surgical technique,59,PPT课件,STEP 6Definitive implant insertion确定的假体插入,CORAIL Surgical technique,60,PPT课件,STEP 7Proximal bone compaction in the remaining gaps to establish a complete seal between implant & cortex残留间隙处近端骨压实以建立完全的假体与皮质骨的空隙封闭,CORAIL Surgical technique

26、,61,PPT课件,STEP 8Femoral head impaction股骨头打入,CORAIL Surgical technique,62,PPT课件,Anteversion 前倾,Anteversion by first broach control前倾角由第一把髓腔锉来控制,髓腔锉尽量靠后靠外，避免假体内翻,63,PPT课件,Getting The Correct Implant Size获得正确的假体尺寸,When the last broach is rotationally stable当最后的锉在旋转时取得稳定时,建议最后锉打击至截骨面下12mm,64,PPT课件,Avoid

27、 early impaction避免过早的打压,Corail Insertion 假体植入,65,PPT课件,Corail Insertion 假体植入,用手将假体沿准备好的髓腔方向推入，避免假体和髓腔错误对线,66,PPT课件,Sepcial Case 特殊病例,67,PPT课件,Young Male patients年轻男性病人,Challenge（挑战）： usually you will find it is difficult to put the stem in. 通常比较难以将柄植入Reason（原因）：This is because young male patients ha

28、ve higher chance for narrower canal (especially in the conjunction of metaphysis and diaphysis of the femur).这是由于很多年轻男性病人髓腔比较狭窄（特别是在股骨干骺端连接处）Tips (小技巧）：ream a little bit at the distal part of the narrow canal to make sure we can choose a right Corail implant that can fully fit in proximal part of th

29、e femur. 在远端髓腔狭窄处用细钻钻一下，确保我们可以选择一个完全匹配股骨近端的正确的假体We can use the Srom 6/7mm canal reamer to help us during the operation.我们可以使用S-Rom 工具中的6/7mm的髓腔钻,68,PPT课件,CORAIL,CASE REVIEW,PRE-OP,9 YEARS,2 WEEKS,69,PPT课件,Postoperation Ideal X-ray术后好的X光片,Remained Cancellous Bone保留的松质骨,70,PPT课件,CORAIL,CASE REVIEW,PRE-OP,8 YEARS,3 MONTHS,71,PPT课件,Thank You !,72,PPT课件,