狂关节置换与假体设计PPT演示课件

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CORAIL

SYSTEMDESIGNERS

ARTROGROUPFOUNTEDIN1981

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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2023/4/43CORAILDESIGNPRINCIPL

设计原理SURFACETREATMENT表面处理RANGEOFIMPLANTS假体尺寸SURGICALTECHNIQUE外科技术CLINICALRESULTS临床结果2023/4/44RELIABLEPRIMARYSTABILITY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2023/4/45CORAILDESIGNPRINCIPLES

设计原理2023/4/46FEMORALHEADS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CORAILDESIGNPRINCIPLES

设计原理2023/4/47Straightstem直柄Thindistaltip远端较细CORAILDESIGNPRINCIPLES

设计原理2023/4/48135°neckangle颈干角12/14Morsetaper锥度Progressiveoffset偏心距逐渐扩大CORAILDESIGNPRINCIPLES

设计原理2023/4/49四边形横截面轴向及旋转稳定性CORAILDESIGNPRINCIPLES

设计原理2023/4/410Doubletapergeometrygivesstero-stability

双锥度设计提供立体稳定性CORAILDESIGNPRINCIPLES

设计原理2023/4/411Progressivehorizontalmacrostructureontheproximalstem柄的近端逐渐扩大的横行结构CORAILDESIGNPRINCIPLES

设计原理2023/4/412Horizontalproximalmacrostructure近端横行结构

Size9=11grooves沟Size20=21grooves沟CORAILDESIGNPRINCIPLES

设计原理2023/4/413Verticaldistalmacrostructre远端垂直结构CORAILDESIGNPRINCIPLES

设计原理2023/4/414Optionalcollarforcalcarloading股骨距负荷-带领，不带领CORAILDESIGNPRINCIPLES

设计原理2023/4/415HYDROXYAPATITEBioactivecoating生物活性涂层CORAILDESIGNPRINCIPLES

设计原理2023/4/416BONECOMPOSITION骨组成ORGANICPHASE有机期 30%collagen胶元,specificproteins特殊蛋白质MINERALPHASE矿物质期60%carbonatedapatite碳酸磷灰石WATER 水 10% 2023/4/417HYDROXYAPATITE

羟基磷灰石ChemicalFormula 化学分子式Ca10(PO4)6(OH)2 Similartothemineralphaseofhumanbone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2023/4/418NONTOXIC无毒NONINFLAMMATORY不引起炎症反应NONALLERGIC无过敏反应NONCARCINOGENIC不引起癌症HYDROXYAPATITE2023/4/419Coatingthickness涂层厚度=150µmCoatings<75µm

earlyresorbtion早期吸收Coatings>200µm riskofdelamination脱层的危险HYDROXYAPATITE2023/4/420ADVANTAGES优点

Increasedboneingrowth增加骨内生Nofibroustissueinterposition无纤维组织插入Gapfilling孔隙充填HYDROXYAPATITE2023/4/421Newboneformation新骨形成HAcoatingHA涂层Metal金属HYDROXYAPATITENOFIBROUSTISSUEINTERPOSITION无纤维组织插入2023/4/422HYDROXYAPATITEWhyisCorail®fullycoated?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

2023/4/423LONGTERMSTABILITY

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,1999HYDROXYAPATITE2023/4/424Preventionofthighpain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NewboneformationHYDROXYAPATITE2023/4/425FromCorailtoCorailAMT2023/4/426Articul/ezeMiniTaper:AMTThinnerneck更薄的颈部设计=Improvedrangeofmotion更大的活动度2023/4/427Polishedtaper

抛光的锥部BetterresistancetoPEwear减少PE磨损Articul/ezeMiniTaper:AMT2023/4/428

AMTtaperOldtaperMinitaper短小的锥部12/14Improvedrangeofmotion更大的ROMNoskirteffect无假裙现象Articul/ezeMiniTaper:AMT2023/4/429Thinnerneck更薄的颈部设计Elliptico-trapezoidalshape2flatsurfacesFrontal(向位):12mmSagittal(矢向位):9.15mmArticul/ezeMiniTaper:AMT2023/4/430

Newimpactionhole新打入孔Articul/ezeMiniTaper:AMT2023/4/431Standardrange:KSAvailablesizes:

(new)8;9;10;11;12;13;14;15;16;18;20WithoutcollaroutsideofFranceNSA:135˚Indications:PrimaryTHR;Revisionstage1and22023/4/432Articul/ezeHeadsCobaltchrome-22.225mm:+4 medium+7 long2023/4/433Cobaltchrome:28mm: +1.5 shortneck +5 medium(standard) +8.5 long +12 extralong

Articul/ezeHeads2023/4/434Articul/ezeRangeCeramic:28mm,36mm: +1.5 shortneck

+5 medium(Standard)

+8.5 long 32mm: +1 shortneck

+5 medium(Standard)

+9 long 2023/4/43597.7%Survivorshipat10years89%ofpatientswithoutthighpain(大腿痛）0.8%stressshieldingGr.III应力遮挡JPVidalainandtheArtroGroupInternationalCorailConference,1998CORAIL

Clinicalresults2023/4/436100%Survivorshipin100casesafter5years0%Thighpain大腿痛0%Stressshielding应力遮挡0%migration移动RokkumetalJournalofArthroplastyVol.14,1999

CORAIL

Clinicalresults2023/4/437NORWEGIANHIPREGISTER99.5%Survivorshipin1117casesat4.5years

HavelinLetalJBJSVol.77-B,1995CORAIL

Clinicalresults2023/4/438INPATIENTSUNDER50years99.1%Survivorshipin119casesafter10yearsVidalainJPetalEuropeanHipSociety,1998CORAIL

Clinicalresults2023/4/439INPATIENTSUNDER55years94.4%Survivorshipin1039casesafter6yearsHavelinLetalJBJSVol.79-B,1997CORAIL

Clinicalresults2023/4/44095.1%Survivorshipin5,130casesat15yearsTheNorwegianArthroplastyRegister，1987-2004,2005.迄今为止最成功生物型股骨假体ClinicalHeritageDocumented2023/4/441FEATUREQUADI-LATERALCROSSSECTION横截面四边形BENEFITACCURATEROTATIONALSTABILITY精确的旋转稳定性CORAIL2023/4/442FEATUREMACROSTRUCTURE（横行，纵行）结构BENEFITINCREASETHESURFACEFORBONE/IMPLANTCONTACTBY15%

增加骨与假体接触面积15%CORAIL2023/4/443FEATUREHORIZONTALMACROSTRUCTURE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CORAIL2023/4/444FEATUREVERTICALMACROSTRUCTURE

纵行结构BENEFITTOIMPROVEROTATIONALSTABILITY

改善旋转稳定性CORAIL2023/4/445FEATUREHYDROXYAPATITECOATINGHA涂层BENEFITGREATERSHEARSTRENGTHOFIMPLANT假体的剪力增大INCREASEDBONEONGROWTH增加骨表面增长CORAIL2023/4/446FEATUREHYDROXYAPATITECOATINGHA涂层BENEFITNOFIBROUSTISSUEINTERPOSITION没有纤维组织插入GAPFILLING空隙封闭CORAIL2023/4/447FEATUREFULLHACOATING完全的HA涂层BENEFITNOTHIGHPAIN没有大腿痛BARRIERTOTHEINGRESSOFWEARDEBRIS阻止磨屑进入CORAIL2023/4/448FEATURE21YEAREXPERIENCE21年经验BENEFITOVER130,000IMPLANTATIONS假体植入CLINICALRESULTSCORAIL2023/4/449FEATURESURGICALTECHNIQUE外科技术BENEFITEASY&REPRODUCIBLE容易，可重复性强NOCONTRA-INDICATIONS没有禁忌症CORAIL2023/4/450CORAIL®-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….2023/4/451Simpleandcomprehensiveinstrumentation简单易操作的工具CORAILSurgicaltechnique2023/4/452Simpleprocedure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CORAILSurgicaltechnique2023/4/453STEP1Neckresectionat45°45度颈部截骨Leveldeterminedduringpreopplanning术前计划决定截骨水平CORAIL

Surgicaltechnique2023/4/454STEP2Proximalcompactionbeforebroaching锉髓腔前近端松质骨压实Nodistalreaming远端不扩髓Cancellousboneispreserved保护松质骨CORAIL

Surgicaltechnique2023/4/455CanalFinder

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2023/4/456STEP3Progressivebroaching

untilcompletestability

isachieved进行性扩髓直到获得完全的稳定性CORAIL

Surgicaltechnique2023/4/457STEP4Calcarmilling锉平台CORAIL

Surgicaltechnique2023/4/458STEP5Trialreductionwithtrialnecksegment试模颈进行试模复位CORAIL

Surgicaltechnique2023/4/459STEP6Definitiveimplantinsertion确定的假体插入CORAIL

Surgicaltechnique2023/4/460STEP7Proximalbonecompactionintheremaininggapstoestablishacompletesealbetweenimplant&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

Surgicaltechnique2023/4/461STEP8Femoralheadimpaction股骨头打入CORAIL

Surgicaltechnique2023/4/462Anteversion

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2023/4/463Getting

TheCorrectImplantSize

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1~2mm2023/4/464Avoidearlyimpaction避免过早的打压