狂关节置换与假体设计培训课件

狂关狂关节节置置换换与假体与假体设计设计医学医学课课件件 CORAIL SYSTEM DESIGNERSARTRO GROUP FOUNTED IN 19811984TITANstemlaunched钛合金柄上市1985ClinicaltrailsofTITAN/HA临床试验19861stimplantationoftheCORAILstem第一个假体柄植入体内1996FDAapprovalFDA通过2005CorailAMTHISTORICAL RECORD历史回顾CORAIL DESIGN PRINCIPL设计原理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RELIABLEPRIMARYSTABILITY可靠的初始稳定性LONGTERMBIOLOGICALFIXATION长期的生物固定PROXIMALLOADTRANSFER近端负荷传导CORAIL DESIGN PRINCIPLES设计原理CORAIL DESIGN PRINCIPLES设计原理FEMORALHEADS股骨头Alumina(BioloxForte)氧化铝Tribologicalproperties摩擦学属性Compatiblewithaluminaorcobaltchromeliners与氧化铝或钴铬内衬匹配CORAIL DESIGN PRINCIPLES设计原理Straightstem直柄Thindistaltip远端较细CORAIL DESIGN PRINCIPLES设计原理135neckangle颈干角12/14Morsetaper锥度Progressiveoffset偏心距逐渐扩大CORAIL DESIGN PRINCIPLES设计原理四边形横截面轴向及旋转稳定性CORAIL DESIGN PRINCIPLES设计原理Doubletapergeometrygivesstero-stability双锥度设计提供立体稳定性CORAIL DESIGN PRINCIPLES设计原理Progressivehorizontalmacrostructureontheproximalstem柄的近端逐渐扩大的横行结构CORAIL DESIGN PRINCIPLES设计原理Horizontalproximalmacrostructure近端横行结构Size9=11grooves沟Size20=21grooves沟CORAIL DESIGN PRINCIPLES设计原理Verticaldistalmacrostructre远端垂直结构CORAIL DESIGN PRINCIPLES设计原理Optionalcollarforcalcarloading股骨距负荷-带领，不带领CORAIL DESIGN PRINCIPLES设计原理HYDROXYAPATITEBioactivecoating生物活性涂层CORAIL DESIGN PRINCIPLES设计原理BONE COMPOSITION骨组成ORGANIC PHASE 有机期 30%collagen胶元,specificproteins特殊蛋白质MINERAL PHASE 矿物质期 60%carbonatedapatite碳酸磷灰石WATER 水10%HYDROXYAPATITE羟基磷灰石ChemicalFormula化学分子式Ca10(PO4)6(OH)2Similartothemineralphaseofhumanbone与人类骨的矿物质期相似Biocompatible,nonresorbable生物相容，不可吸收Osteo-conductiveproperties骨传导性NONTOXIC无毒NONINFLAMMATORY不引起炎症反应NONALLERGIC无过敏反应NONCARCINOGENIC不引起癌症HYDROXYAPATITECoatingthickness涂层厚度=150mCoatings200mriskofdelamination脱层的危险HYDROXYAPATITEADVANTAGES优点Increasedboneingrowth增加骨内生Nofibroustissueinterposition无纤维组织插入Gapfilling孔隙充填HYDROXYAPATITENewboneformation新骨形成HAcoatingHA涂层Metal金属HYDROXYAPATITENO FIBROUS TISSUE INTERPOSITION 无纤维组织插入HYDROXYAPATITEWhyisCorailfullycoated?为何全涂层？Longtermstability长期的稳定性Biologicalsealagainstweardebris生物性封闭，以抵抗磨屑Nodistalgranulomas没有远端肉芽肿LONGTERMSTABILITY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 of 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。RokkumetalJBJSVol81B,1999HYDROXYAPATITEPreventionofthighpain大腿痛的防止Nofibroustissuedistally远端没有纤维组织Nodistalmicromotion没有远端微动Minimisethighpain最小化大腿痛NewboneformationHYDROXYAPATITEFrom Corail to Corail AMTArticul/eze Mini Taper:AMTThinnerneck更薄的颈部设计=Improvedrangeofmotion更大的活动度Polishedtaper抛光的锥部BetterresistancetoPEwear减少PE磨损Articul/eze Mini Taper:AMT AMT taperOld taperMinitaper短小的锥部12/14Improvedrangeofmotion更大的ROMNoskirteffect无假裙现象Articul/eze Mini Taper:AMTThinnerneck更薄的颈部设计Elliptico-trapezoidalshape2flatsurfacesFrontal(向位):12mmSagittal(矢向位):9.15mmArticul/eze Mini Taper:AMTNew impaction hole新打入孔Articul/eze Mini Taper:AMTStandard range:KSAvailablesizes:(new)8;9;10;11;12;13;14;15;16;18;20WithoutcollaroutsideofFranceNSA:135Indications:PrimaryTHR;Revisionstage1and2Articul/eze HeadsCobaltchrome-22.225mm:+4medium+7longCobaltchrome:28mm:+1.5 shortneck+5medium(standard)+8.5 long+12 extralongArticul/eze HeadsArticul/eze RangeCeramic:28mm,36mm:+1.5 shortneck+5medium(Standard)+8.5 long32mm:+1shortneck+5medium(Standard)+9long97.7%Survivorshipat10years89%ofpatientswithoutthighpain(大腿痛）0.8%stressshieldingGr.III应力遮挡JP Vidalain and the Artro Group International Corail Conference,1998CORAIL Clinical results100%Survivorshipin100casesafter5years0%Thighpain大腿痛0%Stressshielding应力遮挡0%migration移动Rokkum et al Journal of Arthroplasty Vol.14,1999CORAIL Clinical resultsNORWEGIANHIPREGISTER99.5%Survivorshipin1117casesat4.5years Havelin L et al JBJS Vol.77-B,1995CORAIL Clinical resultsINPATIENTSUNDER50years99.1%Survivorshipin119casesafter10yearsVidalain JP et al European Hip Society,1998CORAIL Clinical resultsINPATIENTSUNDER55years94.4%Survivorshipin1039casesafter6yearsHavelin L et al JBJS Vol.79-B,1997CORAIL Clinical results95.1%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ClinicalHeritageDocumentedFEATUREQUADI-LATERAL CROSS SECTION 横截面四边形BENEFITACCURATE ROTATIONAL STABILITY 精确的旋转稳定性CORAIL FEATUREMACROSTRUCTURE（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 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 FEATUREVERTICAL MACROSTRUCTURE 纵行结构BENEFITTO IMPROVE ROTATIONAL STABILITY 改善旋转稳定性CORAIL 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 FEATUREHYDROXYAPATITE COATING HA涂层BENEFITNO FIBROUS TISSUE INTERPOSITION没有纤维组织插入GAP FILLING空隙封闭CORAIL 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 FEATURE21 YEAR EXPERIENCE21年经验BENEFITOVER 130,000 IMPLANTATIONS假体植入CLINICAL RESULTSCORAIL FEATURESURGICAL TECHNIQUE外科技术BENEFITEASY&REPRODUCIBLE容易，可重复性强NO CONTRA-INDICATIONS没有禁忌症CORAIL CORAIL-Positioning 产品定位Keysellingpoints宣传要点SuperiorDesign上乘的设计ProximalLoadingandFullyHACoated近端负重及HA全涂层21YearsofClinicalHeritage21年的临床验证130000implantationsEasySurgicalTechnique手术技术简单Stemsforallsurgeons满足各种需求PerfectfitforMI适合于MI手术.Simpleandcomprehensiveinstrumentation简单易操作的工具CORAIL Surgical techniqueSimpleprocedure简单的手术步骤Onestepbroaching(nonagressive)一步扩髓腔（不锋利）Nopriorreamingofthecanal不先进行扩髓Preservingcancellousbone保护松质骨Livingbonymantlerespectedandcompacted有活力的松质骨得到重视并压实CORAIL Surgical techniqueSTEP1Neckresectionat4545度颈部截骨Leveldeterminedduringpreopplanning术前计划决定截骨水平CORAIL Surgical techniqueSTEP2Proximalcompactionbeforebroaching锉髓腔前近端松质骨压实Nodistalreaming远端不扩髓Cancellousboneispreserved保护松质骨CORAIL Surgical techniqueCanal Finder股骨探髓Canalprobeestablishadirectpathwaytothemedullarycanal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STEP3Progressivebroachinguntilcompletestabilityisachieved进行性扩髓直到获得完全的稳定性CORAIL Surgical techniqueSTEP4Calcarmilling锉平台CORAIL Surgical techniqueSTEP5Trialreductionwithtrialnecksegment试模颈进行试模复位CORAIL Surgical techniqueSTEP6Definitiveimplantinsertion确定的假体插入CORAIL Surgical techniqueSTEP7Proximalbonecompactionintheremaininggapstoestablishacompletesealbetweenimplant&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 techniqueSTEP8Femoralheadimpaction股骨头打入CORAIL Surgical techniqueAnteversion 前倾Anteversionbyfirstbroachcontrol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Getting The Correct Implant Size获得正确的假体尺寸Whenthelastbroachisrotationallystable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12mmAvoid early impaction避免过早的打压Corail Insertion 假体植入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SepcialCase特殊病例Young Male patients年轻男性病人Challenge（挑战）：usuallyyouwillfinditisdifficulttoputthestemin.通常比较难以将柄植入Reason（原因）：Thisisbecauseyoungmalepatientshavehigherchancefornarrowercanal(especiallyintheconjunctionofmetaphysisanddiaphysisofthefemur).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）：reamalittlebitatthedistalpartofthenarrowcanaltomakesurewecanchoosearightCorailimplantthatcanfullyfitinproximalpartofthefemur.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WecanusetheSrom6/7mmcanalreamertohelpusduringtheoperation.我们可以使用S-Rom工具中的6/7mm的髓腔钻CORAIL CASEREVIEW PRE-OP 9 YEARS2 WEEKSPostoperation Ideal X-ray术后好的X光片 RemainedCancellousBone保留的松质骨CORAIL CASEREVIEWPRE-OP 8 YEARS3 MONTHS Thank You!