人工肩关节置换课件

人工肩关节置换人工肩关节置换人工肩关节置换人工肩关节置换12021/2/21人工肩关人工肩关节节置置换换人工肩关人工肩关节节置置换换人工肩关人工肩关节节置置换换ReconstruReconstructions of the shoulder following tumor resection 22021/2/21Reconstructions of the shouldeWays of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplasty32021/2/21Ways of reconstructions BoneClassificationHemiarthroplasty(humeral head replacements)Total shoulder arthroplasty(TSA glenohumeral replacements)42021/2/21ClassificationHemiarthroplastyHemiarthroplastyTSAUnconstrainedHemi-constrainedConstrainedBall-cotylaInverted type52021/2/21HemiarthroplastyTSAUnconstrain62021/2/2162021/2/21Categories of bone neoplasm Giant cell tumors(GCT)chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor .72021/2/21Categories of bone neoplasm Enneking 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 yes82021/2/21Enneking stages Malawer classification of shoulder girdle resections92021/2/21Malawer classification of shouType resection Intra-articular proximal humeral resection TypeA:abductors retained TypeB:abductors resected102021/2/21Type resection Intra-Magnetic 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 resection112021/2/21Magnetic resonance imaging(MRMargin of resectionConfined to boneIntramedullary122021/2/21Margin of resectionConfined toMargin of resection Extraosseous extension that involves the deltoid,a typeB resection will be required132021/2/21Margin of resection ExtrProsthesis ImplantationHemiarthroplastyTSAB142021/2/21Prosthesis ImplantationB1420ComparisonHemiarthroplastyTSASimlper procedureAvoid looseningand instabilityPain reliefActivityActive range of motion152021/2/21ComparisonHemiarthroplastyTSAS162021/2/21162021/2/21Despite the increased technical difficulty,longer operating time,and potential complications associated with the glenoid component,TSA appears to be our choiceChoice172021/2/21DespiteChoice172021/2/21Rotator cuff182021/2/21Rotator cuff182021/2/21Rotator cuff支点支点192021/2/21Rotator cuff支点支点192021/2/21202021/2/21202021/2/21Soft tissue reconstructiontype A resectionDeltoid（Supraspinatus）Rotator cuff212021/2/21Soft tissue reconstructiontype15%222021/2/2115%222021/2/21Dacron tape232021/2/21Dacron tape232021/2/21Enhance tendon anchor(ETA)242021/2/21Enhance tendon anchor(ETA)2420Soft tissue reconstructiontype B resectionObtain stability Mobilization(Dacron tape)elbowhand252021/2/21Soft tissue reconstructiontypeRehabilitationPassive motion exerciseActive exercisesActive resistive strengthening exercises262021/2/21RehabilitationPassive motion eComplicationsRotator cuff tearingPostoperative glenohumeral instabilityPeriprosthetic humeral fracture272021/2/21ComplicationsRotator cuff tearThanks282021/2/21Thanks282021/2/21谢谢！292021/2/21谢谢谢谢！292021/2/21