股骨柄假体的设计和临床应用选择ppt课件.pptx

髋关节假体的设计和临床 MD PhD 股骨柄临床成功的重要因素 非骨水泥股骨柄材料 钛合金 钛铝钒 钛铝铌 钴铬钼合金不锈钢 非骨水泥股骨柄经典设计 方型柄圆形柄锥形柄解剖柄组配柄 方形柄 圆形柄 锥形柄 解剖柄 组配柄 非骨水泥股骨柄植入后的稳定 非骨水泥股骨柄初期稳定的部位 非骨水泥股骨柄远期稳定的实现 粗糙表面上的骨长上 多孔表面上的骨长入 采用多种不同的工艺 在非骨水泥柄表面形成具有一定厚度的多孔涂层 以利骨长入多孔内而获得柄远期稳定 对表面多孔涂层的要求 孔隙率对骨长入的影响 孔隙大小对骨长入的影响 孔隙大小对术后抗剪力强度的影响 各种不同多孔表面的骨接触百分比 多孔涂层比较 VPS VPS VPS原理 涂层形成过程 多孔表面上的骨长入 非骨水泥柄的选择中的其他考虑 假体选择的正确 髓腔评价型号选择的准确 术前计划并发症的预见 应力遮挡 大腿疼痛 颈干角 颈距 颈长 颈高 肢体长度 股骨柄的发展 1950 1960 1970 1980 1990 2000 骨水泥柄 非骨水泥柄 对非骨水泥柄热情下降骨水泥柄回潮 非骨水泥柄回潮 骨水泥柄的两种基本设计理念 骨水泥柄的两种基本设计 骨水泥柄的两种基本设计 骨水泥柄设计的两种思想 骨水泥柄中的 法国悖论 髓腔锉与植入柄同号尽可能植入较大号柄可去除较多的松质骨无需均匀的骨水泥层柄可直接与骨质接触 A Neck stemangleisreduced B Neckisattachedatmoremedialpositiononstem Large diameterheadwithtrapezoidalneck A hasgreaterrangeofmotionandlessimpingementthansmallerdiameterheadandskirtedmodularneck B DefinitionPMstem Proximallongitudinalgroovesandsurfacetexturingpromotemechanicalinterlockwithcement Integralproximalanddistalpolymethylmethacrylatespacersensureneutralpositioningincanalandadequatethicknessofcementmantle CourtesyofStrykerOrthopaedics Kalamazoo Mich OmnifitEONstem StrykerOrthopaedics Kalamazoo Mich Normalizedproximaltexturingconvertsshearforcestocompressiveforces A Standardoffset B Enhancedoffset SpectronEFstem Rounded rectangularshapeandlongitudinalgrooveimproverotationalstability A Highoffset B Standardoffset CourtesyofSmith Nephew Memphis Tenn CPThipstem Zimmer Warsaw Ind Collarless polished tapereddesignallowscontrolledsubsidenceandmaintainscompressivestresseswithincementmantle Basiccementlessstemshapes StrykerOrthopaedics Kalamazoo Mich A MeridianTMZFstraightstemissymmetricalandfitseitherfemur B CitationTMZFanatomicalstemdesignincorporatesproximalposteriorbowandantevertedfemoralneck Synergyporousstem Smith Nephew Memphis Tenn Taperedstraightstemdesign Proximalflutesprovideadditionalrotationalstability A Standardoffset B Highoffset Shownwithoxidizedzirconiaheads APRstem Zimmer Warsaw Ind Collaredanatomicaldesign Standard A andlargebody B componentsprovidevariableproximalfitforgivendistalstemsize Taperlocstem Plasma sprayedtitaniumporoussurface Collarless flat wedge shapedgeometryisavailablewithtwofemoraloffsets CourtesyofBiomet Warsaw Ind VerSysstem Collaredtitaniumalloystemwithtitaniumfibermetalcircumferentialporoussurface Trapezoidalproximalgeometryanddistalflutespromoterotationalstability CourtesyofZimmer Warsaw Ind S ROMmodularstem A Multipleproximalsleevesizescanbecombinedwithgivendiameterstem Stemcanberotatedinrelationtosleevetocorrectrotationaldeformityoffemur Distalflutesimproverotationalstability B Long curvedstem Distalpartofstemisslottedincoronalplanetodiminishbendingstiffness CourtesyofJohnson Johnson DePuy Warsaw Ind Extensivelyporous coatedstems A AMLstemforprimaryandrevisionarthroplastieswhenisthmusisintact B ExtensivelycoatedSolutionlongstemusedforrevisionswhenproximalbonelossissevere C Calcarreplacementlongstem CourtesyofJohnson Johnson DePuy Warsaw Ind Noncircumferentialporouscoating Despiteexcellentingrowthintoporouspad debrismaymigratetodistalaspectofstemthroughadjacentsmoothchannels arrow Alloclassicstem Zimmer Warsaw Ind Conicalstraightstemwithrectangularcrosssection Titaniumalloywithgrit blast nonporoussurface Corailstem Johnson Johnson DePuy Warsaw Ind Titaniumalloystemwithextensivehydroxyapatitecoating Proximalridgesanddistalgroovesprovideadditionalstability Specializedfemoralcomponentsforreplacementofvariablelengthofproximalfemur OrthogenesisLimbPreservationSystem Modularsegmentalreplacementstemforreplacementoflargesegmentofproximalfemur Stemcanbecombinedwithtotalkneereplacementtoreplaceentirefemur CourtesyofJohnson Johnson DePuy Warsaw Ind EnduranceCDHstem Straightsmall diameterstemdesignisidealforuseinpatientswithdevelopmental congenital hipdysplasiaorsmallstature CourtesyofJohnson Johnson DePuy Warsaw Ind Acetabularcomponentdesignedforcementfixation Texturedsurfaceandpolymethylmethacrylatespacersoptimizecementmantleandcement prosthesisinterface CourtesyofSmith Nephew Memphis Tenn Contourantiprotrusiocage Smith Nephew Memphis Tenn hastitaniumsupportringfixedtoiliumandischiumwithscrews Alternatively inferiorfincanbeimpactedintoischiumwithoutscrews Universalacetabularcomponent Biomet Warsaw Ind Titaniumplasmaspraycoatingwithdomeandrimscrewfixationoptions Interfitacetabularcomponent Hemisphericaldesignwithgradualtransitiontoenlargementinperipheralrimforimprovedinitialstabilityandperipheralstresstransfer CourtesyofSmith Nephew Memphis Tenn Arrayoflineroptionsavailablewithcontemporarymodularacetabularsystem standardflatliner A posteriorlipwithoutanteversion B 4 mmlateralizedflat C anteverted20degrees D CourtesyofSmith Nephew Memphis Tenn Constrainedacetabularliners A Tripolardesignwithsmallbipolarshellcapturedwithinouterliner StrykerOrthopaedics Kalamazoo Mich B Peripherallockingringdesign Johnson Johnson DePuy Warsaw Ind Specializedacetabularcomponents A Oblongcomponentusedforsuperiorsegmentaldeficiencies B Deepprousedforprotru