强生-狂关节置换与假体设计-课件

CORAILSYSTEM1PPT课件

CORAIL

SYSTEMDESIGNERS

ARTROGROUPFOUNTEDIN1981

2PPT课件

1984TITANstemlaunched钛合金柄上市1985ClinicaltrailsofTITAN/HA临床试验

19861stimplantationoftheCORAIL®stem第一个假体柄植入体内1996FDAapprovalFDA通过

2005

CorailAMTHISTORICALRECORD

历史回顾3PPT课件CORAILDESIGNPRINCIPL

设计原理SURFACETREATMENT表面处理RANGEOFIMPLANTS假体尺寸SURGICALTECHNIQUE外科技术CLINICALRESULTS临床结果4PPT课件RELIABLEPRIMARYSTABILITY可靠的初始稳定性LONGTERMBIOLOGICALFIXATION长期的生物固定PROXIMALLOADTRANSFER近端负荷传导CORAILDESIGNPRINCIPLES

设计原理5PPT课件CORAILDESIGNPRINCIPLES

设计原理6PPT课件FEMORALHEADS股骨头Alumina(BioloxForte)氧化铝Tribological

properties摩擦学属性Compatiblewithaluminaorcobaltchromeliners

与氧化铝或钴铬内衬匹配CORAILDESIGNPRINCIPLES

设计原理7PPT课件Straightstem直柄Thindistaltip远端较细CORAILDESIGNPRINCIPLES

设计原理8PPT课件135°neckangle颈干角12/14Morsetaper锥度Progressiveoffset偏心距逐渐扩大CORAILDESIGNPRINCIPLES

设计原理9PPT课件四边形横截面轴向及旋转稳定性CORAILDESIGNPRINCIPLES

设计原理10PPT课件Doubletapergeometry

gives

stero-stability

双锥度设计提供立体稳定性CORAILDESIGNPRINCIPLES

设计原理11PPT课件Progressivehorizontalmacrostructureontheproximalstem柄的近端逐渐扩大的横行结构CORAILDESIGNPRINCIPLES

设计原理12PPT课件Horizontalproximalmacrostructure近端横行结构

Size9=11grooves沟Size20=21grooves沟CORAILDESIGNPRINCIPLES

设计原理13PPT课件Verticaldistalmacrostructre

远端垂直结构CORAILDESIGNPRINCIPLES

设计原理14PPT课件Optional

collarforcalcar

loading股骨距负荷-带领，不带领CORAILDESIGNPRINCIPLES

设计原理15PPT课件HYDROXYAPATITEBioactivecoating生物活性涂层CORAILDESIGNPRINCIPLES

设计原理16PPT课件BONECOMPOSITION骨组成ORGANICPHASE有机期 30%

collagen胶元,specific

proteins特殊蛋白质MINERALPHASE矿物质期60%

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

羟基磷灰石ChemicalFormula 化学分子式Ca10(PO4)6(OH)2 Similartothemineralphaseofhuman

bone与人类骨的矿物质期相似Biocompatible,nonresorbable生物相容，不可吸收Osteo-conductive

properties骨传导性18PPT课件NONTOXIC无毒NONINFLAMMATORY不引起炎症反应NONALLERGIC无过敏反应NONCARCINOGENIC不引起癌症HYDROXYAPATITE19PPT课件Coating

thickness涂层厚度=150µmCoatings<75µm

early

resorbtion早期吸收Coatings>200µm riskofdelamination脱层的危险HYDROXYAPATITE20PPT课件ADVANTAGES优点

Increasedboneingrowth增加骨内生Nofibroustissueinterposition无纤维组织插入Gapfilling孔隙充填HYDROXYAPATITE21PPT课件Newboneformation新骨形成HAcoating

HA涂层

Metal金属HYDROXYAPATITENOFIBROUSTISSUEINTERPOSITION无纤维组织插入22PPT课件HYDROXYAPATITEWhy

isCorail®

fully

coated?为何全涂层？Longterm

stability

长期的稳定性Biological

seal

againstweardebris

生物性封闭，以抵抗磨屑Nodistalgranulomas

没有远端肉芽肿

23PPT课件LONGTERMSTABILITY

长期稳定性

“Thecompleteabsenceoffemoralendostealcorticalosteolysisinspiteoftheabundanceofparticlesisreassuring.TheexplanationmaybethattheextensiveHAcoatingofthestemsealsthewholeinterfaceandblocksthepassageofparticles.”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,1999HYDROXYAPATITE24PPT课件Preventionofthighpain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NewboneformationHYDROXYAPATITE25PPT课件FromCorailtoCorail

AMT26PPT课件Articul/ezeMiniTaper:AMTThinnerneck更薄的颈部设计=Improvedrangeofmotion更大的活动度27PPT课件Polishedtaper

抛光的锥部BetterresistancetoPEwear减少PE磨损Articul/ezeMiniTaper:AMT28PPT课件

AMTtaperOldtaperMinitaper短小的锥部12/14Improvedrangeofmotion更大的ROMNoskirteffect无假裙现象Articul/ezeMiniTaper:AMT29PPT课件Thinnerneck更薄的颈部设计Elliptico-trapezoidalshape2flatsurfacesFrontal(向位):12mmSagittal(矢向位):9.15mmArticul/ezeMiniTaper:AMT30PPT课件

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

(new)

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

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

+5 medium(Standard)

+8.5 long

32mm: +1 shortneck

+5 medium(Standard)

+9 long 35PPT课件97.7%Survivorship

at10years89%ofpatientswithout

thighpain(大腿痛）0.8%stressshieldingGr.III应力遮挡JPVidalainandtheArtroGroupInternationalCorailConference,1998CORAIL

Clinical

results36PPT课件100%Survivorshipin100casesafter5years0%Thighpain大腿痛0%Stressshielding应力遮挡0%migration移动RokkumetalJournalofArthroplastyVol.14,1999

CORAIL

Clinical

results37PPT课件NORWEGIANHIPREGISTER99.5%Survivorshipin1117casesat4.5years

HavelinLetalJBJSVol.77-B,1995CORAIL

Clinical

results38PPT课件INPATIENTSUNDER50years99.1%Survivorshipin119casesafter10yearsVidalainJPetalEuropeanHipSociety,1998CORAIL

Clinical

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

Clinical

results40PPT课件95.1%Survivorshipin5,130casesat15yearsTheNorwegianArthroplastyRegister，1987-2004,2005.迄今为止最成功生物型股骨假体ClinicalHeritageDocumented41PPT课件FEATUREQUADI-LATERALCROSSSECTION横截面四边形BENEFITACCURATEROTATIONALSTABILITY精确的旋转稳定性CORAIL42PPT课件FEATUREMACROSTRUCTURE（横行，纵行）结构BENEFITINCREASETHESURFACEFORBONE/IMPLANTCONTACTBY15%

增加骨与假体接触面积15%CORAIL43PPT课件FEATUREHORIZONTALMACROSTRUCTURE横行结构PROGRESSIVE逐渐增大BENEFITTOPREVENTSTEM

SUBSIDENCE避免假体下沉TOOPTIMISEPROXIMALLOADTRANSFER优化近端负荷传导CORAIL44PPT课件FEATUREVERTICALMACROSTRUCTURE

纵行结构BENEFITTOIMPROVEROTATIONALSTABILITY

改善旋转稳定性CORAIL45PPT课件FEATUREHYDROXYAPATITECOATINGHA涂层BENEFITGREATERSHEARSTRENGTHOFIMPLANT假体的剪力增大INCREASEDBONEONGROWTH增加骨表面增长CORAIL46PPT课件FEATUREHYDROXYAPATITECOATINGHA涂层BENEFITNOFIBROUSTISSUEINTERPOSITION没有纤维组织插入GAPFILLING空隙封闭CORAIL47PPT课件FEATUREFULLHACOATING完全的HA涂层BENEFITNOTHIGHPAIN没有大腿痛BARRIERTOTHEINGRESSOFWEARDEBRIS阻止磨屑进入CORAIL48PPT课件FEATURE21YEAREXPERIENCE21年经验BENEFITOVER130,000IMPLANTATIONS假体植入CLINICALRESULTSCORAIL49PPT课件FEATURESURGICALTECHNIQUE外科技术BENEFITEASY&REPRODUCIBLE容易，可重复性强NOCONTRA-INDICATIONS没有禁忌症CORAIL50PPT课件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….51PPT课件Simpleandcomprehensiveinstrumentation简单易操作的工具CORAIL

Surgicaltechnique52PPT课件Simpleprocedure简单的手术步骤Onestep

broaching(nonagressive)一步扩髓腔（不锋利）Noprior

reamingofthecanal不先进行扩髓Preserving

cancellous

bone

保护松质骨"Livingbony

mantle

respectedandcompacted«

有活力的松质骨得到重视并压实CORAIL

Surgicaltechnique53PPT课件STEP1Neckresectionat45°45度颈部截骨Leveldeterminedduringpreopplanning术前计划决定截骨水平CORAIL

Surgicaltechnique54PPT课件STEP2Proximalcompactionbefore

broaching锉髓腔前近端松质骨压实Nodistalreaming远端不扩髓Cancellous

bone

is

preserved保护松质骨CORAIL

Surgicaltechnique55PPT课件CanalFinder

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56PPT课件STEP3Progressivebroaching

until

complete

stability

is

achieved进行性扩髓直到获得完全的稳定性CORAIL

Surgicaltechnique57PPT课件STEP4Calcar

milling锉平台CORAIL

Surgicaltechnique58PPT课件STEP5Trialreduction

withtrialnecksegment试模颈进行试模复位CORAIL

Surgicaltechnique59PPT课件STEP6Definitiveimplantinsertion确定的假体插入CORAIL

Surgicaltechnique60PPT课件STEP7Proximalbonecompactionintheremaininggapstoestablishacomplete

seal

betweenimplant&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

Surgicaltechnique61PPT课件STEP8Femoral

headimpaction股骨头打入CORAIL

Surgicaltechnique62PPT课件Anteversion

前倾Anteversionbyfirstbroach

control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63PPT课件Getting

TheCorrectImplantSize

获得正确的假体尺寸Whenthelastbroach

is

rotationallystable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1~2mm64PPT课件Avoid

early