分流系统Codman教材ppt课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Codman Valves for Hydrocephalus,Codman Valves for Hydrocephalu,1,The Hakim Valve mechanism,Technology developed to provide long-term accuracy and reliability in valve performance.,Hakim,阀能保持长期的精确性,和稳定性,The Hakim Valve mechanismTechn,2,Original Valve,最初的阀门,Original Valve最初的阀门,3,Long valve sometimes a “pain in the neck”,Long valve sometimes a “pain,4,MicroValve,显微阀门,MicroValve显微阀门,5,MicroValve + Rickham,MicroValve + Rickham,6,Hakim shunt housing development,Hakim shunt housing developmen,7,Hakim Valves,Hakim Valves,8,Hakim Valve,Is available as,Valve only,单一阀门,System (with separate catheters),系统（带单独的导管）,Unitised system,合成系统,Valve with pre-attached distal catheter and,separate ventricular catheter,带预置装置的远端导管与阀门，以及独立的脑室导管,Hakim ValveIs available as,9,Hakim Valve,Lets talk about the valve mechanism,让我们讨论阀门机械装置,Hakim ValveLets talk about the,10,MicroValve,显微阀门,MicroValve显微阀门,11,MicroValve,显微阀门,Ruby ball and collar,红宝石球,Flat spring,弹簧片,Spring pillar,弹簧柱,Micro adjustable fulcrum,显微调节支点,MicroValve显微阀门Ruby ball and co,12,Hakim precision,Hakim precision,13,Flow through design,Flow through design,14,MicroValve,Anti reflux valve,防逆流阀,Pre-chamber,前腔,To stop reverse flow,防止倒流,Injection in,Sampling out,Pumping,注射取样泵,MicroValveAnti reflux valvePre,15,Hakim valve construction,Hakim valve construction,16,Anti reflux mechanism,防逆流装置,Anti reflux mechanism防逆流装置,17,No longer required,不再需要,Reflux pressure presses the ball down onto,the collar closing the valve,逆流压力将球压入轴环关闭阀门,No longer required不再需要Reflux p,18,MicroValve,微型阀门,Accurate to +/- 1mm H,2,O,精确度,+/-1mm,水柱,Quoted and independently verified to +/-10mm H,2,O,Flat pressure / flow curve,水平压力/流量曲线,MicroValve微型阀门Accurate to +/-,19,Pressure definition,压力定义,area,atmospheric pressure,大气压力,hydrostatic pressure,流体静压,weight,area,=,=,area,g h,h,Pressure definition压力定义areaat,20,Flow definition,流量定义,Flow,流量,p,压力差,Resistance,阻力,=,p,Flow definition流量定义Flow p压力差,21,Flow in a shunt is controlled by the pressure differential,分流管内的流量是由压力差控制的,p,Flow in a shunt is controlled,22,Opening pressures (mm H,2,0),0,50,100,150,200,250,HAKIM,Precision,Valve,CORDIS,HAKIM,P-S,MEDICAL,P-S,MEDICAL,P-S,MEDICAL,Opening pressures,开放压力,Opening pressures (mm H20)0,23,Opening pressures,开放压力,Means what it says,So a wide band means you are not sure at what pressure that valve will open,给定的是一压力范围意味着你不能确定阀门究竟在哪个压力下开放,Customers feel it is an operating band,顾客感觉是一压力带,But there is no top and bottom,没有上下限,Only a bottom,只有基线,This helps customers know what they are implanting - if performance is reliable,Opening pressures开放压力Means wha,24,Opening pressures,Maybe,But the thrust of our argument is that they should think about it more,争论的焦点将是医生必须考虑更多,Their decisions affect the quality of the whole of a childs life,医生的决定影响一个孩子一生的生命质量,Is a 50% revision rate good enough? 50,的翻修率够好吗？,Next logical step in this argument is Programmability,下一个讨论焦点是阀门的可调性,Opening pressuresMaybe,25,Opening pressures (mm H,2,0),0,50,100,150,200,250,HAKIM,Precision,Valve,CORDIS,HAKIM,P-S,MEDICAL,P-S,MEDICAL,P-S,MEDICAL,HOLTER,Opening pressures,Opening pressures (mm H20)0,26,Pressure responsive or Flow responsive?,Some of our competitors confuse the doctors by suggesting one mechanism is superior to the other.,我们的竞争对手常误导医生，为了证明其阀门优于其它,“Ah but yours is not a flow responsive system,”,“,他们不是流量响应系统”,The truth is a little more simple,Pressure responsive or Flow r,27,Pressure responsive or Flow responsive?,Flow occurs when there is a pressure differential,当有压力差时才会产生液体流动,It is the case that flow can add to that pressure but a pressure responsive valve responds to that pressure how ever it is generated,事实上流速会增加压力但压力响应系统只对应产生时的压力,Pressure responsive or Flow r,28,Pressure responsive or Flow responsive?,There is only one valve that can claim to be a flow responsive mechanism,只有一种阀门称得上是流量响应阀门,BUT,但是,Clinical studies have shown it makes no difference,临床试验证明并无多大区别,Does that stop doctors pontificating,Not a chance!,Pressure responsive or Flow r,29,Flow,Hakim designed to react to pressure not flow Hakim,设计反映的是压力而非流量,He wanted a pressure / flow curve that was a straight line,他希望的压力/流量曲线是一条直线,This was an idea behind his original design,这是设计者的初衷,Improved upon with the Precision,随着精确性而不断提高,The achievement of his goal is confirmed by the UK MDA report,这一结果得到了英国,MDA,的认证,FlowHakim designed to react to,30,Artefact,Metal in the valve will show on a scan,MRI or CT,阀门的金属会在,CT,或,MRI,有伪影,The artefact is not usually in the area to be studied,但通常并不影响研究,“But it has metal in it!”,Yes, thats because we find it gives better and more predictable performance in the long term,金属能保证长期的稳定性和可预见性,Silicone can calcify - 52% underdrainage?!,硅橡胶会钙化导致52引流不够,ArtefactMetal in the valve wil,31,Programmability,可调性,Shunt registry tells us 55% revisions are pressure related,注册证上显示的是55的翻修率,Patients needs change,患者需要调整压力,Shunt misbehaves,Hakim Programmable has 18 pressure Hakim,可调压阀共有18级调压范围,From 30mm to 200mm H2O,从30,mm,水柱到200,mm,水柱,Programmability可调性Shunt regis,32,Programming,Programming,33,Combining high quality bio-compatible materials with expertise in micro-machining and micro-assembly.,高质量的生物相容性材料与专业的显微 制造技术的完美结合,Combining high quality bio-com,34,Hakim programmable,Hakim programmable,35,Programming the valve,The programmer head emits,a series of magnetic pulses that control the angular position of the valve rotor,调压器发出的一系列磁脉冲控制转轴的角度,This allows the valve opening pressure to be adjusted non-invasively,保证无侵袭地调整开放压力,1,2,Programming the valveThe progr,36,How does it work ?,Rotor,转子,Magnet,磁铁,valve base plate,Stator,固定片,rotor axis,转轴,10 magnets are integrated in the rotor,转子中共有10个磁极,a cross shaped stator is integrated in the base plate,十字形固定片固定在底座上,this system constitutes a stepping motor, that can be activated by an external magnetic field,系统还包含一个步进马达，可被外部磁场激活,How does it work ?Rotor转子Magne,37,Valve positioning for easy programming,Valve positioning for easy pro,38,Valve programming,Valve programming,39,Programming,Programming,40,Programming,Programming,41,Programming,Programming,42,Programming steps,Programming steps,43,Taking the radiological picture,Taking the radiological pictur,44,Check X-Ray,Check X-Ray,45,Programmability,Programmability,46,Catheters,Ventricular catheter,脑室导管,CathetersVentricular catheter脑,47,Catheters,Distal catheters,远端导管,CathetersDistal catheters远端导管,48,Shunts - components,Ventricular catheter,脑室导管,Valve,阀门,Peritoneal cathete,腹膜导管,Accessories,附件,Shunts - componentsVentricular,49,Shunt implantation,Ventricular catheter connection,脑室导管连接,Introducing distal catheter,引导远端导管,Shunt implantation,50,Ventricular catheters:,Standard,标准,Dotted,点列式,Right angle,右角型,Right angle with reservoir,带储液囊右角型,with spring,带弹簧型,“flanged”,凸缘式,Ventricular catheters: Standar,51,Shunt reservoirs,Rickham reservoir,Salomon reservoir,Other ACCU-FLO reservoirs,Shunt reservoirsRickham reserv,52,Pre-chamber functions,1.,Aspirate and sample of CSF,脑脊液取样,2. Flushing obstructed ventricular catheter,冲洗堵塞的脑室导管,3. Flushing obstructed valve,冲洗堵塞的阀门,Pre-chamber functions1. Aspir,53,Shunt implantation,Shunt implantation,54,Valves accessories - distal catheters passers,附件远端导管引导器,Reusable,Disposable,Valves accessories - distal ca,55,System components,Atrial,Catheters,心室导管,System componentsAtrial,56,System components,系统组成,A system is complete,Ventricular catheter with connector and stylet,带连接器和穿刺针的脑室导管,Valve,阀门,Distal catheter,远端导管,Introducer,导引器,Instructions,说明书,System components系统组成A system,57,Systems,Standard valve,标准阀门,Unitised standard valve,合成标准阀门,Unitised MicroValve,合成微型阀门,Unitised MicroValve with Rickham,带,Rickham,储液囊的合成微型阀门,Standard valve only,单独的标准阀门,MicroValve valve only,单独的微型阀门,MicroValve with Rickham,valve only,单独的,带,Rickham,储液囊的微型阀门,SystemsStandard valve标准阀门,58,Pressures available,Very Low 10mm,Low40mm,Medium70mm,Medium high100mm,High130mm,Programmable30mm to 200mm,All measured in mm H2O,所有压力都以水柱表示,Pressures availableVery Low,59,Thats the Original valveand the MicroValve,那就是初始阀门和显微阀门,Thats the Original valveand,60,New Hakim Product shapes,新的,Hakim,产品形式,New Hakim Product shapes新的Hak,61,New,Valve Housings,新的阀门构架,New housing design,新颖的结构设计,- In line,- Burr hole,Self sealing reservoir,自封性储液囊,Pumping Chamber,泵,Swiss technology,瑞士技术,New Valve Housings新的阀门构架New h,62,2 New Shapes,Right angle / Burr hole,In-Line,2 New ShapesRight angle / Burr,63,2 New Formats,Right angle / Burr hole,with integrated,SiphonGuard,In-Line,2 New FormatsRight angle / Bur,64,Right Angle / Burr Hole,Right Angle / Burr Hole,65,Precision / Programmable,Precision / Programmable,66,New Marketing Support Package,New Marketing Support Package,67,分流系统Codman教材ppt课件,68,分流系统Codman教材ppt课件,69,分流系统Codman教材ppt课件,70,New Detail Aid in 3 Languages,New Detail Aid in 3 Languages,71,分流系统Codman教材ppt课件,72,分流系统Codman教材ppt课件,73,分流系统Codman教材ppt课件,74,分流系统Codman教材ppt课件,75,分流系统Codman教材ppt课件,76,分流系统Codman教材ppt课件,77,分流系统Codman教材ppt课件,78,分流系统Codman教材ppt课件,79,Clinical Proof,PaperPatientsAgesDatePublication,Romner583Prem 891999Neurofocus,Yamashita1793 days 881999J. Neurosurgery,Rohde605 days141998Acta Neurochurgica,Carmel3771999Neurofocus,Black131994Neurosurgery,Reinprecht907 weeks851995Acta Neurochurgica,Belliard501996Neurochirurgie,Clinical ProofPaperPatients,80,Clinical Proof,For the best patient management of hydrocephalus, the ability to re-programme the valve pressure has been found to significantly benefit patients,Clinical Proof For the best pa,81,Clinical Proof,The Codman Hakim Programmable valve is suitable for all age groups of patients with hydrocephalus.,Codman Hakim,可调压式分流管适用于所有,年龄范围的脑积水患者,Clinical Proof The Codman Haki,82,Clinical Proof,临床验证,The Codman Hakim Programmable valve is particularly effective in the management of Hydrocephalus in cases of: Codman Hakim,分流管能有效治疗下列各类型脑积水,Idiopathic NPH,先天性,NPH,Slit ventricle syndrome,脑室狭小综合症,Aqueductal stenosis,中导水管狭窄症,Myelomeningocele,脊髓脊膜突出症,DandyWalker cysts DandyWalker,囊肿,Meningitis,脑膜炎,Clinical Proof临床验证 The Codman,83,Clinical Proof,Published clinical studies have demonstrated that incremental pressure changes as fine as 10 mm H,2,O are essential for best patient outcome,有临床研究报道精确至10,mm,水柱的压力,调整最适宜患者康复,Clinical Proof Published clini,84,Clinical Proof,The Codman Hakim Programmable valve saves time and money, compared to fixed pressure valve systems.,Codman Hakim,的可调式分流管相比那些固定压力的阀门系统要更节省精力和费用,Clinical ProofThe Codman Hakim,85,