人工肩关节置换ppt课件

Reconstructions of the Reconstructions of the shoulder following shoulder following tumor resectiontumor resection Ways of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplasty Classification Hemiarthroplasty (humeral head replacements) Total shoulder arthroplasty (TSA glenohumeral replacements) Hemiarthroplasty TSA Unconstrained Hemi-constrained Constrained Ball-cotylaInverted type Categories of bone neoplasm Giant cell tumors(GCT) chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor . . . . . . . . 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 yes Malawer classification of shoulder girdle resections Type resection Intra-articular proximal humeral resection TypeA:abductors retained TypeB:abductors resected Magnetic resonance imaging (MRI) Margin of resection A margin of 3 to 4cm distal to the MRI extent of the tumor is sufficient and allows a type A resection Margin of resection Confined to bone Intramedullary Margin of resection Extraosseous extension that involves the deltoid, a typeB resection will be required Prosthesis Implantation Hemiarthroplasty TSA B Comparison Hemiarthroplasty TSA Simlper procedure Avoid loosening and instability Pain relief Activity Active range of motion Despite the increased technical difficulty ,longer operating time, and potential complications associated with the glenoid component, TSA appears to be our choice Choice Rotator cuff Rotator cuff 支点 Soft tissue reconstruction type A resection Deltoid （Supraspinatus） Rotator cuff 15% Dacron tape Enhance tendon anchor(ETA) Soft tissue reconstruction type B resection Obtain stability Mobilization (Dacron tape)elbowhand Rehabilitation Passive motion exercise Active exercises Active resistive strengthening exercises Compli