強(qiáng)生-狂關(guān)節(jié)置換與假體設(shè)計(jì)-課件

CORAILSYSTEM1PPT課件

CORAIL

SYSTEMDESIGNERS

ARTROGROUPFOUNTEDIN1981

2PPT課件

1984TITANstemlaunched鈦合金柄上市1985ClinicaltrailsofTITAN/HA臨床試驗(yàn)

19861stimplantationoftheCORAIL?stem第一個(gè)假體柄植入體內(nèi)1996FDAapprovalFDA通過(guò)

2005

CorailAMTHISTORICALRECORD

歷史回顧3PPT課件CORAILDESIGNPRINCIPL

設(shè)計(jì)原理SURFACETREATMENT表面處理RANGEOFIMPLANTS假體尺寸SURGICALTECHNIQUE外科技術(shù)CLINICALRESULTS臨床結(jié)果4PPT課件RELIABLEPRIMARYSTABILITY可靠的初始穩(wěn)定性LONGTERMBIOLOGICALFIXATION長(zhǎng)期的生物固定PROXIMALLOADTRANSFER近端負(fù)荷傳導(dǎo)CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理5PPT課件CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理6PPT課件FEMORALHEADS股骨頭Alumina(BioloxForte)氧化鋁Tribological

properties摩擦學(xué)屬性Compatiblewithaluminaorcobaltchromeliners

與氧化鋁或鈷鉻內(nèi)襯匹配CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理7PPT課件Straightstem直柄Thindistaltip遠(yuǎn)端較細(xì)CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理8PPT課件135°neckangle頸干角12/14Morsetaper錐度Progressiveoffset偏心距逐漸擴(kuò)大CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理9PPT課件四邊形橫截面軸向及旋轉(zhuǎn)穩(wěn)定性CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理10PPT課件Doubletapergeometry

gives

stero-stability

雙錐度設(shè)計(jì)提供立體穩(wěn)定性CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理11PPT課件Progressivehorizontalmacrostructureontheproximalstem柄的近端逐漸擴(kuò)大的橫行結(jié)構(gòu)CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理12PPT課件Horizontalproximalmacrostructure近端橫行結(jié)構(gòu)

Size9=11grooves溝Size20=21grooves溝CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理13PPT課件Verticaldistalmacrostructre

遠(yuǎn)端垂直結(jié)構(gòu)CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理14PPT課件Optional

collarforcalcar

loading股骨距負(fù)荷-帶領(lǐng)，不帶領(lǐng)CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理15PPT課件HYDROXYAPATITEBioactivecoating生物活性涂層CORAILDESIGNPRINCIPLES

設(shè)計(jì)原理16PPT課件BONECOMPOSITION骨組成ORGANICPHASE有機(jī)期 30%

collagen膠元,specific

proteins特殊蛋白質(zhì)MINERALPHASE礦物質(zhì)期60%

carbonatedapatite碳酸磷灰石WATER 水 10% 17PPT課件HYDROXYAPATITE

羥基磷灰石ChemicalFormula 化學(xué)分子式Ca10(PO4)6(OH)2 Similartothemineralphaseofhuman

bone與人類骨的礦物質(zhì)期相似Biocompatible,nonresorbable生物相容，不可吸收Osteo-conductive

properties骨傳導(dǎo)性18PPT課件NONTOXIC無(wú)毒NONINFLAMMATORY不引起炎癥反應(yīng)NONALLERGIC無(wú)過(guò)敏反應(yīng)NONCARCINOGENIC不引起癌癥HYDROXYAPATITE19PPT課件Coating

thickness涂層厚度=150μmCoatings<75μm

early

resorbtion早期吸收Coatings>200μm riskofdelamination脫層的危險(xiǎn)HYDROXYAPATITE20PPT課件ADVANTAGES優(yōu)點(diǎn)

Increasedboneingrowth增加骨內(nèi)生Nofibroustissueinterposition無(wú)纖維組織插入Gapfilling孔隙充填HYDROXYAPATITE21PPT課件Newboneformation新骨形成HAcoating

HA涂層

Metal金屬HYDROXYAPATITENOFIBROUSTISSUEINTERPOSITION無(wú)纖維組織插入22PPT課件HYDROXYAPATITEWhy

isCorail?

fully

coated?為何全涂層？Longterm

stability

長(zhǎng)期的穩(wěn)定性Biological

seal

againstweardebris

生物性封閉，以抵抗磨屑Nodistalgranulomas

沒(méi)有遠(yuǎn)端肉芽腫

23PPT課件LONGTERMSTABILITY

長(zhǎng)期穩(wěn)定性

“Thecompleteabsenceoffemoralendostealcorticalosteolysisinspiteoftheabundanceofparticlesisreassuring.TheexplanationmaybethattheextensiveHAcoatingofthestemsealsthewholeinterfaceandblocksthepassageofparticles.”雖然有大量的磨損顆粒，但沒(méi)有股骨骨內(nèi)膜的皮質(zhì)骨溶解。原因可能是廣泛的HA涂層封閉了所有的交界面阻止了微粒的通道。

RokkumetalJBJSVol81B,1999HYDROXYAPATITE24PPT課件Preventionofthighpain大腿痛的防止

Nofibroustissuedistally

遠(yuǎn)端沒(méi)有纖維組織Nodistalmicromotion

沒(méi)有遠(yuǎn)端微動(dòng)Minimisethighpain最小化大腿痛NewboneformationHYDROXYAPATITE25PPT課件FromCorailtoCorail

AMT26PPT課件Articul/ezeMiniTaper:AMTThinnerneck更薄的頸部設(shè)計(jì)=Improvedrangeofmotion更大的活動(dòng)度27PPT課件Polishedtaper

拋光的錐部BetterresistancetoPEwear減少PE磨損Articul/ezeMiniTaper:AMT28PPT課件

AMTtaperOldtaperMinitaper短小的錐部12/14Improvedrangeofmotion更大的ROMNoskirteffect無(wú)假裙現(xiàn)象Articul/ezeMiniTaper:AMT29PPT課件Thinnerneck更薄的頸部設(shè)計(jì)Elliptico-trapezoidalshape2flatsurfacesFrontal(向位):12mmSagittal(矢向位):9.15mmArticul/ezeMiniTaper:AMT30PPT課件

Newimpactionhole新打入孔Articul/ezeMiniTaper:AMT31PPT課件Standardrange:KSAvailablesizes:

(new)

8;9;10;11;12;13;14;15;16;18;20WithoutcollaroutsideofFranceNSA:135?Indications:PrimaryTHR;Revisionstage1and232PPT課件Articul/ezeHeadsCobaltchrome-22.225mm:+4 medium+7 long33PPT課件Cobaltchrome:28mm: +1.5 shortneck +5 medium(standard) +8.5 long +12 extralong

Articul/ezeHeads34PPT課件Articul/ezeRangeCeramic:28mm,36mm: +1.5 shortneck

+5 medium(Standard)

+8.5 long

32mm: +1 shortneck

+5 medium(Standard)

+9 long 35PPT課件97.7%Survivorship

at10years89%ofpatientswithout

thighpain(大腿痛）0.8%stressshieldingGr.III應(yīng)力遮擋JPVidalainandtheArtroGroupInternationalCorailConference,1998CORAIL

Clinical

results36PPT課件100%Survivorshipin100casesafter5years0%Thighpain大腿痛0%Stressshielding應(yīng)力遮擋0%migration移動(dòng)RokkumetalJournalofArthroplastyVol.14,1999

CORAIL

Clinical

results37PPT課件NORWEGIANHIPREGISTER99.5%Survivorshipin1117casesat4.5years

HavelinLetalJBJSVol.77-B,1995CORAIL

Clinical

results38PPT課件INPATIENTSUNDER50years99.1%Survivorshipin119casesafter10yearsVidalainJPetalEuropeanHipSociety,1998CORAIL

Clinical

results39PPT課件INPATIENTSUNDER55years94.4%Survivorshipin1039casesafter6yearsHavelinLetalJBJSVol.79-B,1997CORAIL

Clinical

results40PPT課件95.1%Survivorshipin5,130casesat15yearsTheNorwegianArthroplastyRegister，1987-2004,2005.迄今為止最成功生物型股骨假體ClinicalHeritageDocumented41PPT課件FEATUREQUADI-LATERALCROSSSECTION橫截面四邊形BENEFITACCURATEROTATIONALSTABILITY精確的旋轉(zhuǎn)穩(wěn)定性CORAIL42PPT課件FEATUREMACROSTRUCTURE（橫行，縱行）結(jié)構(gòu)BENEFITINCREASETHESURFACEFORBONE/IMPLANTCONTACTBY15%

增加骨與假體接觸面積15%CORAIL43PPT課件FEATUREHORIZONTALMACROSTRUCTURE橫行結(jié)構(gòu)PROGRESSIVE逐漸增大BENEFITTOPREVENTSTEM

SUBSIDENCE避免假體下沉TOOPTIMISEPROXIMALLOADTRANSFER優(yōu)化近端負(fù)荷傳導(dǎo)CORAIL44PPT課件FEATUREVERTICALMACROSTRUCTURE

縱行結(jié)構(gòu)BENEFITTOIMPROVEROTATIONALSTABILITY

改善旋轉(zhuǎn)穩(wěn)定性CORAIL45PPT課件FEATUREHYDROXYAPATITECOATINGHA涂層BENEFITGREATERSHEARSTRENGTHOFIMPLANT假體的剪力增大INCREASEDBONEONGROWTH增加骨表面增長(zhǎng)CORAIL46PPT課件FEATUREHYDROXYAPATITECOATINGHA涂層BENEFITNOFIBROUSTISSUEINTERPOSITION沒(méi)有纖維組織插入GAPFILLING空隙封閉CORAIL47PPT課件FEATUREFULLHACOATING完全的HA涂層BENEFITNOTHIGHPAIN沒(méi)有大腿痛BARRIERTOTHEINGRESSOFWEARDEBRIS阻止磨屑進(jìn)入CORAIL48PPT課件FEATURE21YEAREXPERIENCE21年經(jīng)驗(yàn)BENEFITOVER130,000IMPLANTATIONS假體植入CLINICALRESULTSCORAIL49PPT課件FEATURESURGICALTECHNIQUE外科技術(shù)BENEFITEASY&REPRODUCIBLE容易，可重復(fù)性強(qiáng)NOCONTRA-INDICATIONS沒(méi)有禁忌癥CORAIL50PPT課件CORAIL?-Positioning產(chǎn)品定位Keysellingpoints宣傳要點(diǎn)SuperiorDesign上乘的設(shè)計(jì)ProximalLoadingandFullyHACoated近端負(fù)重及HA全涂層21YearsofClinicalHeritage21年的臨床驗(yàn)證130000implantationsEasySurgicalTechnique手術(shù)技術(shù)簡(jiǎn)單Stemsforallsurgeons滿足各種需求PerfectfitforMI適合于MI手術(shù)….51PPT課件Simpleandcomprehensiveinstrumentation簡(jiǎn)單易操作的工具CORAIL

Surgicaltechnique52PPT課件Simpleprocedure簡(jiǎn)單的手術(shù)步驟Onestep

broaching(nonagressive)一步擴(kuò)髓腔（不鋒利）Noprior

reamingofthecanal不先進(jìn)行擴(kuò)髓Preserving

cancellous

bone

保護(hù)松質(zhì)骨"Livingbony

mantle

respectedandcompacted?

有活力的松質(zhì)骨得到重視并壓實(shí)CORAIL

Surgicaltechnique53PPT課件STEP1Neckresectionat45°45度頸部截骨Leveldeterminedduringpreopplanning術(shù)前計(jì)劃決定截骨水平CORAIL

Surgicaltechnique54PPT課件STEP2Proximalcompactionbefore

broaching銼髓腔前近端松質(zhì)骨壓實(shí)Nodistalreaming遠(yuǎn)端不擴(kuò)髓Cancellous

bone

is

preserved保護(hù)松質(zhì)骨CORAIL

Surgicaltechnique55PPT課件CanalFinder

股骨探髓

Canalprobeestablishadirectpathwaytothemedullarycanal髓腔探棒找到正確髓腔位置靠后外側(cè)，緊貼梨狀窩進(jìn)入，找到正確髓腔位置，中立位進(jìn)入，避免內(nèi)翻56PPT課件STEP3Progressivebroaching

until

complete

stability

is

achieved進(jìn)行性擴(kuò)髓直到獲得完全的穩(wěn)定性CORAIL

Surgicaltechnique57PPT課件STEP4Calcar

milling銼平臺(tái)CORAIL

Surgicaltechnique58PPT課件STEP5Trialreduction

withtrialnecksegment試模頸進(jìn)行試模復(fù)位CORAIL

Surgicaltechnique59PPT課件STEP6Definitiveimplantinsertion確定的假體插入CORAIL

Surgicaltechnique60PPT課件STEP7Proximalbonecompactionintheremaininggapstoestablishacomplete

seal

betweenimplant&cortex殘留間隙處近端骨壓實(shí)以建立完全的假體與皮質(zhì)骨的空隙封閉CORAIL

Surgicaltechnique61PPT課件STEP8Femoral

headimpaction股骨頭打入CORAIL

Surgicaltechnique62PPT課件Anteversion

前傾Anteversionbyfirstbroach

control前傾角由第一把髓腔銼來(lái)控制髓腔銼盡量靠后靠外，避免假體內(nèi)翻63PPT課件Getting

TheCorrectImplantSize

獲得正確的假體尺寸Whenthelastbroach

is

rotationallystable當(dāng)最后的銼在旋轉(zhuǎn)時(shí)取得穩(wěn)定時(shí)建議最后銼打擊至截骨面下1~2mm64PPT課件Avoid

early