强生 狂关节置换与假体设计

CORAIL SYSTEM CORAIL SYSTEMDESIGNERSARTROGROUPFOUNTEDIN1981 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2005CorailAMT HISTORICALRECORD历史回顾 CORAIL DESIGNPRINCIPL设计原理 SURFACETREATMENT表面处理RANGEOFIMPLANTS假体尺寸SURGICALTECHNIQUE外科技术CLINICALRESULTS临床结果 RELIABLEPRIMARYSTABILITY可靠的初始稳定性LONGTERMBIOLOGICALFIXATION长期的生物固定PROXIMALLOADTRANSFER近端负荷传导 CORAIL DESIGNPRINCIPLES设计原理 CORAIL DESIGNPRINCIPLES设计原理 FEMORALHEADS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 CORAIL DESIGNPRINCIPLES设计原理 Straightstem直柄Thindistaltip远端较细 CORAIL DESIGNPRINCIPLES设计原理 135 neckangle颈干角12 14Morsetaper锥度Progressiveoffset偏心距逐渐扩大 CORAIL DESIGNPRINCIPLES设计原理 四边形横截面轴向及旋转稳定性 CORAIL DESIGNPRINCIPLES设计原理 Doubletapergeometrygivesstero stability双锥度设计提供立体稳定性 CORAIL DESIGNPRINCIPLES设计原理 Progressivehorizontalmacrostructureontheproximalstem柄的近端逐渐扩大的横行结构 CORAIL DESIGNPRINCIPLES设计原理 Horizontalproximalmacrostructure近端横行结构Size9 11grooves沟Size20 21grooves沟 CORAIL DESIGNPRINCIPLES设计原理 Verticaldistalmacrostructre远端垂直结构 CORAIL DESIGNPRINCIPLES设计原理 Optionalcollarforcalcarloading股骨距负荷 带领 不带领 CORAIL DESIGNPRINCIPLES设计原理 HYDROXYAPATITEBioactivecoating生物活性涂层 CORAIL DESIGNPRINCIPLES设计原理 BONECOMPOSITION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 HYDROXYAPATITE羟基磷灰石 ChemicalFormula化学分子式Ca10 PO4 6 OH 2Similartothemineralphaseofhumanbone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 NONTOXIC无毒NONINFLAMMATORY不引起炎症反应NONALLERGIC无过敏反应NONCARCINOGENIC不引起癌症 HYDROXYAPATITE Coatingthickness涂层厚度 150 mCoatings200 m riskofdelamination脱层的危险 HYDROXYAPATITE ADVANTAGES优点Increasedboneingrowth增加骨内生Nofibroustissueinterposition无纤维组织插入Gapfilling孔隙充填 HYDROXYAPATITE Newboneformation新骨形成HAcoatingHA涂层Metal金属 HYDROXYAPATITE NOFIBROUSTISSUEINTERPOSITION无纤维组织插入 HYDROXYAPATITE WhyisCorail 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 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 1999 HYDROXYAPATITE 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Newboneformation HYDROXYAPATITE FromCorailtoCorailAMT Articul ezeMiniTaper AMT Thinnerneck更薄的颈部设计 Improvedrangeofmotion更大的活动度 Polishedtaper抛光的锥部BetterresistancetoPEwear减少PE磨损 Articul ezeMiniTaper AMT Minitaper短小的锥部12 14Improvedrangeofmotion更大的ROMNoskirteffect无假裙现象 Articul ezeMiniTaper AMT Thinnerneck更薄的颈部设计Elliptico trapezoidalshape2flatsurfacesFrontal 向位 12mmSagittal 矢向位 9 15mm Articul ezeMiniTaper AMT Newimpactionhole新打入孔 Articul ezeMiniTaper AMT Standardrange KSAvailablesizes new 8 9 10 11 12 13 14 15 16 18 20WithoutcollaroutsideofFranceNSA 135 Indications PrimaryTHR Revisionstage1and2 Articul ezeHeads Cobaltchrome 22 225mm 4medium 7long Cobaltchrome 28mm 1 5shortneck 5medium standard 8 5long 12extralong Articul ezeHeads Articul ezeRange Ceramic 28mm 36mm 1 5shortneck 5medium Standard 8 5long32mm 1shortneck 5medium Standard 9long 97 7 Survivorshipat10years89 ofpatientswithoutthighpain 大腿痛 0 8 stressshieldingGr III应力遮挡JPVidalainandtheArtroGroupInternationalCorailConference 1998 CORAIL Clinicalresults 100 Survivorshipin100casesafter5years0 Thighpain大腿痛0 Stressshielding应力遮挡0 migration移动RokkumetalJournalofArthroplastyVol 14 1999 CORAIL Clinicalresults NORWEGIANHIPREGISTER99 5 Survivorshipin1117casesat4 5yearsHavelinLetalJBJSVol 77 B 1995 CORAIL Clinicalresults INPATIENTSUNDER50years99 1 Survivorshipin119casesafter10yearsVidalainJPetalEuropeanHipSociety 1998 CORAIL Clinicalresults INPATIENTSUNDER55years94 4 Survivorshipin1039casesafter6yearsHavelinLetalJBJSVol 79 B 1997 CORAIL Clinicalresults 95 1 Survivorshipin5 130casesat15yearsTheNorwegianArthroplastyRegister 1987 2004 2005 迄今为止最成功生物型股骨假体 ClinicalHeritageDocumented FEATUREQUADI LATERALCROSSSECTION横截面四边形 BENEFITACCURATEROTATIONALSTABILITY精确的旋转稳定性 CORAIL FEATUREMACROSTRUCTURE 横行 纵行 结构 BENEFITINCREASETHESURFACEFORBONE IMPLANTCONTACTBY15 增加骨与假体接触面积15 CORAIL FEATUREHORIZONTALMACROSTRUCTURE横行结构PROGRESSIVE逐渐增大 BENEFITTOPREVENTSTEMSUBSIDENCE避免假体下沉TOOPTIMISEPROXIMALLOADTRANSFER优化近端负荷传导 CORAIL FEATUREVERTICALMACROSTRUCTURE纵行结构 BENEFITTOIMPROVEROTATIONALSTABILITY改善旋转稳定性 CORAIL FEATUREHYDROXYAPATITECOATINGHA涂层 BENEFITGREATERSHEARSTRENGTHOFIMPLANT假体的剪力增大INCREASEDBONEONGROWTH增加骨表面增长 CORAIL FEATUREHYDROXYAPATITECOATINGHA涂层 BENEFITNOFIBROUSTISSUEINTERPOSITION没有纤维组织插入GAPFILLING空隙封闭 CORAIL FEATUREFULLHACOATING完全的HA涂层 BENEFITNOTHIGHPAIN没有大腿痛BARRIERTOTHEINGRESSOFWEARDEBRIS阻止磨屑进入 CORAIL FEATURE21YEAREXPERIENCE21年经验 BENEFITOVER130 000IMPLANTATIONS假体植入CLINICALRESULTS CORAIL FEATURESURGICALTECHNIQUE外科技术 BENEFITEASY REPRODUCIBLE容易 可重复性强NOCONTRA INDICATIONS没有禁忌症 CORAIL 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 Simpleandcomprehensiveinstrumentation简单易操作的工具 CORAIL Surgicaltechnique Simpleprocedure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 CORAIL Surgicaltechnique STEP1Neckresectionat45 45度颈部截骨Leveldeterminedduringpreopplanning术前计划决定截骨水平 CORAIL Surgicaltechnique STEP2Proximalcompactionbeforebroaching锉髓腔前近端松质骨压实Nodistalreaming远端不扩髓Cancellousboneispreserved保护松质骨 CORAIL Surgicaltechnique 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 STEP3Progressivebroachinguntilcompletestabilityisachieved进行性扩髓直到获得完全的稳定性 CORAIL Surgicaltechnique STEP4Calcarmilling锉平台 CORAIL Surgicaltechnique STEP5Trialreductionwithtrialnecksegment试模颈进行试模复位 CORAIL Surgicaltechnique STEP6Definitiveimplantinsertion确定的假体插入 CORAIL Surgicaltechnique STEP7Proximalbonecompactionintheremaininggapstoestablishacompletesealbetweenimplant 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 Surgicaltechnique STEP8Femoralheadimpaction股骨头打入 CORAIL Surgicaltechnique Anteversion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 GettingTheCorrectImplantSize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 2mm Avoidearlyimpaction避免过早的打压 CorailInsertion假体植入 CorailInsertion假体植入 用手将假体沿准备好的髓腔方向