人工肩关节置换课件

Reconstructions of the shoulder following tumor resection Reconstructions of the shoulde1Ways of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplastyWays of reconstructions Bone2ClassificationHemiarthroplasty(humeral head replacements)Total shoulder arthroplasty(TSA glenohumeral replacements)ClassificationHemiarthroplasty3HemiarthroplastyTSAUnconstrainedHemi-constrainedConstrainedBall-cotylaInverted typeHemiarthroplastyTSAUnconstrain4人工肩关节置换课件5Categories of bone neoplasm Giant cell tumors(GCT)chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor .Categories of bone neoplasm 6Enneking stages benign tumor 1 indolent 2 active 3 aggressive malignant tumor stage grade location metastatic IA low in not IB low out not IIA high in not IIB high out not III any any yesEnneking stages 7Malawer classification of shoulder girdle resectionsMalawer classification of shou8Type resection Intra-articular proximal humeral resection TypeA:abductors retained TypeB:abductors resectedType resection Intra-9Magnetic resonance imaging(MRI)Margin of resectionA margin of 3 to 4cm distal to the MRI extent of the tumor is sufficient and allows a type A resectionMagnetic resonance imaging(MR10Margin of resectionConfined to boneIntramedullaryMargin of resectionConfined to11Margin of resection Extraosseous extension that involves the deltoid,a typeB resection will be requiredMargin of resection Extr12Prosthesis ImplantationHemiarthroplastyTSABProsthesis ImplantationB13ComparisonHemiarthroplastyTSASimlper procedureAvoid looseningand instabilityPain reliefActivityActive range of motionComparisonHemiarthroplastyTSAS14人工肩关节置换课件15Despite the increased technical difficulty,longer operating time,and potential complications associated with the glenoid component,TSA appears to be our choiceChoiceDespiteChoice16Rotator cuffRotator cuff17Rotator cuff支点支点Rotator cuff支点18人工肩关节置换课件19Soft tissue reconstructiontype A resectionDeltoid（Supraspinatus）Rotator cuffSoft tissue reconstructiontype2015%15%21Dacron tapeDacron tape22Enhance tendon anchor(ETA)Enhance tendon anchor(ETA)23Soft tissue reconstructiontype B resectionObtain stability Mobilization(Dacron tape)elbowhandSoft tissue reconstructiontype24RehabilitationPassive motion exerciseActive exercisesActive resistive strengthening exercisesRehabilitationPassive motion e25ComplicationsRotator cuff tearingPostoperative glenohumeral instabilityPeriprosthetic humeral fractureComplicationsRotator cuff tear26ThanksThanks27