强生狂关节置换与假体设计

1、Author | PowerPoint title goes here | April XX, 2012CORAIL SYSTEM.Author | PowerPoint title goes here | April XX, 2012 CORAIL SYSTEM DESIGNERSARTRO GROUP FOUNTED IN 1981.Author | PowerPoint title goes here | April XX, 2012 1984 TITAN stem launched钛合金柄上市 1985 Clinical trails of TITAN / HA临床试验 1986 1s

2、t implantation of the CORAIL stem 第一个假体柄植入体内 1996 FDA approval FDA 通过 2005 Corail AMTHISTORICAL RECORD历史历史回顾回顾.Author | PowerPoint title goes here | April XX, 2012CORAIL DESIGN PRINCIPL设计原理设计原理SURFACE TREATMENT表面处理表面处理RANGE OF IMPLANTS假体尺寸假体尺寸SURGICAL TECHNIQUE外科技术外科技术CLINICAL RESULTS临床结果临床结果.Author

3、 | PowerPoint title goes here | April XX, 2012 RELIABLE PRIMARY STABILITY 可靠的初始稳定性 LONG TERM BIOLOGICAL FIXATION 长期的生物固定 PROXIMAL LOAD TRANSFER 近端负荷传导CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes h

4、ere | April XX, 2012FEMORAL HEADS 股骨头Alumina (Biolox Forte)氧化铝Tribological properties摩擦学属性Compatible with alumina or cobalt chrome liners 与氧化铝或钴铬内衬匹配CORAIL DESIGN PRINCIPLES设计设计原理原理.Author | PowerPoint title goes here | April XX, 2012Straight stem直柄Thin distal tip远端较细CORAIL DESIGN PRINCIPLES设计原理设计原理

5、.Author | PowerPoint title goes here | April XX, 2012135 neck angle 颈干角12/14 Morse taper锥度Progressive offset 偏心距逐渐扩大CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012 四边形横截面 轴向及旋转稳定性CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 20

6、12Double taper geometry gives stero-stability 双锥度设计提供 立体稳定性CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012Progressive horizontal macrostructure on the proximal stem柄的近端逐渐扩大的横行结构CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012

7、Horizontal proximal macrostructure近端横行结构 Size 9 = 11 grooves沟 Size 20 = 21 grooves沟CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012Vertical distal macrostructre 远端垂直结构CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012 Optional c

8、ollar for calcar loading 股骨距负荷-带领，不带领CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012HYDROXYAPATITE Bioactive coating 生物活性涂层CORAIL DESIGN PRINCIPLES设计原理设计原理.Author | PowerPoint title goes here | April XX, 2012BONE COMPOSITION骨组成骨组成 ORGANIC PHASE 有机期有机期 30% collag

9、en胶元, specific proteins特殊蛋白质 MINERAL PHASE 矿物质期矿物质期 60% carbonated apatite 碳酸磷灰石 WATER 水水 10%.Author | PowerPoint title goes here | April XX, 2012HYDROXYAPATITE羟基磷灰石羟基磷灰石Chemical Formula化学分子式 Ca10 (PO4)6 (OH)2Similar to the mineral phase of human bone与人类骨的矿物质期相似 Biocompatible, non resorbable生物相容，不可吸

10、收Osteo-conductive properties骨传导性.Author | PowerPoint title goes here | April XX, 2012 NON TOXIC无毒 NON INFLAMMATORY不引起炎症反应 NON ALLERGIC无过敏反应 NON CARCINOGENIC 不引起癌症HYDROXYAPATITE.Author | PowerPoint title goes here | April XX, 2012 Coating thickness涂层厚度 = 150m Coatings 200mrisk of delamination 脱层的危险HY

11、DROXYAPATITE.Author | PowerPoint title goes here | April XX, 2012ADVANTAGES优点 Increased bone ingrowth 增加骨内生 No fibrous tissue interposition 无纤维组织插入 Gap filling 孔隙充填HYDROXYAPATITE.Author | PowerPoint title goes here | April XX, 2012 New bone formation 新骨形成 HA coating HA涂层 Metal 金属HYDROXYAPATITENO FIB

12、ROUS TISSUE INTERPOSITION 无纤维组织插入无纤维组织插入.Author | PowerPoint title goes here | April XX, 2012HYDROXYAPATITE Why is Corail fully coated ? 为何全涂层？ Long term stability长期的稳定性 Biological seal against wear debris生物性封闭，以抵抗磨屑 No distal granulomas 没有远端肉芽肿.Author | PowerPoint title goes here | April XX, 2012LO

13、NG TERM STABILITY长期稳定性“The complete absence of femoral endosteal cortical osteolysis in spite of the abundance of particles is reassuring. The explanation may be that the extensive HA coating of the stem seals the whole interface and blocks the passage of particles.” 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

14、泛的HA涂层封闭了所有的交界面阻止了微粒的通道。 Rokkum et al JBJS Vol 81B, 1999HYDROXYAPATITE.Author | PowerPoint title goes here | April XX, 2012Prevention of thigh pain大腿痛的防止 No fibrous tissue distally远端没有纤维组织 No distal micromotion没有远端微动Minimise thigh pain最小化大腿痛New bone formationHYDROXYAPATITE.Author | PowerPoint title

15、goes here | April XX, 2012From Corail to Corail AMT.Author | PowerPoint title goes here | April XX, 2012Articul / eze Mini Taper: AMTThinner neck更薄的颈部设计=Improved range of motion更大的活动度.Author | PowerPoint title goes here | April XX, 2012 Polished taper 抛光的锥部 Better resistance to PE wear 减少PE磨损Articul

16、 / eze Mini Taper: AMT.Author | PowerPoint title goes here | April XX, 2012 AMT taperOld taperMini taper短小的锥部 12/14 Improved range of motion 更大的ROM No skirt effect无假裙现象Articul / eze Mini Taper: AMT.Author | PowerPoint title goes here | April XX, 2012Thinner neck更薄的颈部设计 Elliptico-trapezoidal shape 2

17、flat surfaces Frontal (向位): 12 mm Sagittal (矢向位): 9.15 mmArticul / eze Mini Taper: AMT.Author | PowerPoint title goes here | April XX, 2012 New impaction hole新打入孔新打入孔Articul / eze Mini Taper: AMT.Author | PowerPoint title goes here | April XX, 2012Standard range:KS Available sizes:(new) 8; 9; 10; 11

18、; 12; 13; 14; 15; 16; 18; 20 Without collar outside of France NSA: 135 Indications: Primary THR; Revision stage 1 and 2.Author | PowerPoint title goes here | April XX, 2012Articul / eze HeadsCobalt chrome-22.225 mm:+4medium+7 long.Author | PowerPoint title goes here | April XX, 2012Cobalt chrome: 28

19、 mm: +1.5 short neck+5medium (standard)+8.5 long+12 extra long Articul / eze Heads.Author | PowerPoint title goes here | April XX, 2012Articul / eze RangeCeramic: 28 mm, 36mm:+1.5 short neck +5 medium (Standard) +8.5 long 32 mm: +1short neck+5 medium (Standard)+9long.Author | PowerPoint title goes h

20、ere | April XX, 201297.7% Survivorship at 10 years89% of patients without thigh pain (大腿痛）0.8% stress shielding Gr. III应力遮挡JP Vidalain and the Artro Group International Corail Conference, 1998CORAIL Clinical results.Author | PowerPoint title goes here | April XX, 2012100% Survivorship in 100 cases a

21、fter 5 years0 % Thigh pain大腿痛0 % Stress shielding应力遮挡0 % migration移动Rokkum et al Journal of Arthroplasty Vol.14, 1999 CORAIL Clinical results.Author | PowerPoint title goes here | April XX, 2012NORWEGIAN HIP REGISTER 99.5% Survivorship in 1117 cases at 4.5 years Havelin L et al JBJS Vol. 77-B, 1995C

22、ORAIL Clinical results.Author | PowerPoint title goes here | April XX, 2012IN PATIENTS UNDER 50 years 99.1% Survivorship in 119 cases after 10 yearsVidalain JP et al European Hip Society, 1998CORAIL Clinical results.Author | PowerPoint title goes here | April XX, 2012IN PATIENTS UNDER 55 years 94.4%

23、 Survivorship in 1039 cases after 6 yearsHavelin L et al JBJS Vol.79-B, 1997CORAIL Clinical results.Author | PowerPoint title goes here | April XX, 201295.1% Survivorship in 5,130 cases at 15 yearsThe Norwegian Arthroplasty Register，1987-2004, 2005.迄今为止最成功生物型股骨假体迄今为止最成功生物型股骨假体Clinical Heritage Docum

24、ented.Author | PowerPoint title goes here | April XX, 2012FEATUREQUADI-LATERAL CROSS SECTION 横截面四边形横截面四边形BENEFITACCURATE ROTATIONAL STABILITY 精确的旋转稳定性精确的旋转稳定性CORAIL .Author | PowerPoint title goes here | April XX, 2012FEATUREMACROSTRUCTURE（横行，纵行）结构横行，纵行）结构BENEFITINCREASE THE SURFACE FOR BONE / IMPLA

25、NT CONTACT BY 15 % 增加骨与假体接触面积增加骨与假体接触面积15%CORAIL .Author | PowerPoint title goes here | April XX, 2012FEATUREHORIZONTAL MACROSTRUCTURE 横行结构横行结构PROGRESSIVE逐渐增大逐渐增大BENEFITTO PREVENT STEMSUBSIDENCE避免假体下沉避免假体下沉TO OPTIMISE PROXIMAL LOAD TRANSFER优化近端负荷传导优化近端负荷传导CORAIL .Author | PowerPoint title goes here

26、| April XX, 2012FEATUREVERTICAL MACROSTRUCTURE 纵行结构纵行结构BENEFITTO IMPROVE ROTATIONAL STABILITY 改善旋转稳定性改善旋转稳定性CORAIL .Author | PowerPoint title goes here | April XX, 2012FEATUREHYDROXYAPATITE COATING HA涂层涂层BENEFITGREATER SHEAR STRENGTH OF IMPLANT假体的剪力增大假体的剪力增大INCREASED BONE ONGROWTH增加骨表面增长增加骨表面增长CORAI

27、L .Author | PowerPoint title goes here | April XX, 2012FEATUREHYDROXYAPATITE COATING HA涂层涂层BENEFITNO FIBROUS TISSUE INTERPOSITION没有纤维组织插入没有纤维组织插入GAP FILLING空隙封闭空隙封闭CORAIL .Author | PowerPoint title goes here | April XX, 2012FEATUREFULL HA COATING完全的完全的HA涂层涂层BENEFITNO THIGH PAIN没有大腿痛没有大腿痛BARRIER TO T

28、HE INGRESS OF WEAR DEBRIS阻止磨屑进入阻止磨屑进入CORAIL .Author | PowerPoint title goes here | April XX, 2012FEATURE21 YEAR EXPERIENCE21年经验年经验BENEFITOVER 130,000 IMPLANTATIONS假体植入假体植入CLINICAL RESULTSCORAIL .Author | PowerPoint title goes here | April XX, 2012FEATURESURGICAL TECHNIQUE外科技术外科技术BENEFITEASY & RE

29、PRODUCIBLE容易，可重复性强容易，可重复性强NO CONTRA-INDICATIONS没有禁忌症没有禁忌症CORAIL .Author | PowerPoint title goes here | April XX, 2012CORAIL - Positioning 产品定位产品定位Key selling points宣传要点 Superior Design 上乘的设计 Proximal Loading and Fully HA Coated近端负重及HA全涂层 21 Years of Clinical Heritage21年的临床验证 130 000 implantations Ea

30、sy Surgical Technique手术技术简单 Stems for all surgeons 满足各种需求 Perfect fit for MI适合于MI手术 .Author | PowerPoint title goes here | April XX, 2012 Simple and comprehensive instrumentation 简单易操作的工具CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012 Simple procedure简单的手术步骤 One step b

31、roaching (non agressive)一步扩髓腔（不锋利） No prior reaming of the canal不先进行扩髓 Preserving cancellous bone保护松质骨 Living bony mantle respected and compacted 有活力的松质骨得到重视并压实CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012STEP 1 Neck resection at 45 45度颈部截骨 Level determined during pr

32、eop planning 术前计划决定截骨水平CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012STEP 2 Proximal compaction before broaching 锉髓腔前近端松质骨压实 No distal reaming 远端不扩髓 Cancellous bone is preserved 保护松质骨CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012Canal F

33、inder股骨探髓股骨探髓Canal probe establish a direct pathway to the medullary canal髓腔探棒找到正确髓腔位置靠后外侧，紧贴梨状窝进靠后外侧，紧贴梨状窝进入，找到正确髓腔位置，入，找到正确髓腔位置，中立位进入，避免内翻中立位进入，避免内翻.Author | PowerPoint title goes here | April XX, 2012STEP 3 Progressive broaching until complete stability is achieved 进行性扩髓直到获得完全的稳定性CORAIL Surgical

34、technique.Author | PowerPoint title goes here | April XX, 2012STEP 4 Calcar milling 锉平台CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012STEP 5 Trial reduction with trial neck segment 试模颈进行试模复位CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012S

35、TEP 6 Definitive implant insertion 确定的假体插入CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012STEP 7 Proximal bone compaction in the remaining gaps to establish a complete seal between implant & 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 Surgical technique.Author | PowerP

36、oint title goes here | April XX, 2012STEP 8 Femoral head impaction 股骨头打入CORAIL Surgical technique.Author | PowerPoint title goes here | April XX, 2012Anteversion 前倾前倾Anteversion by first broach control前倾角由第一把髓腔锉来控制髓腔锉尽量靠后靠外，髓腔锉尽量靠后靠外，避免假体内翻避免假体内翻.Author | PowerPoint title goes here | April XX, 2012Getting The Correct Implant Size获得正确的假体尺寸获得正确的假体尺寸When the last broach is rotationally stable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建议最后锉打击至截骨面下12mm.Author | PowerPoint title goes here | April XX, 2012Avoid early impaction避免过早的打压避免过早的打压Corail Insertion 假体植入假体植入.Author | PowerPoint ti