狂关节置换与假体设计课件.ppt

狂关节置换与假体设计医学课件;; 1984 TITAN stem launched钛合金柄上市 1985 Clinical trails of TITAN / HA临床试验 1986 1st implantation of the CORAIL? stem 第一个假体柄植入体内 1996 FDA approval FDA 通过 2005 Corail AMT;; 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;FEMORAL 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;Straight stem 直柄 Thin distal tip 远端较细; 135° neck angle 颈干角 12/14 Morse taper锥度 Progressive offset 偏心距逐渐扩大; 四边形横截面 轴向及旋转稳定性 ;Double taper geometry gives stero-stability 双锥度设计提供 立体稳定性;Progressive horizontal macrostructure on the proximal stem 柄的近端逐渐扩大的横行结构; Horizontal proximal macrostructure 近端横行结构 Size 9 = 11 grooves沟 Size 20 = 21 grooves沟;Vertical distal macrostructre 远端垂直结构;Optional collar for calcar loading 股骨距负荷-带领，不带领;HYDROXYAPATITE Bioactive coating 生物活性涂层;BONE COMPOSITION骨组成;HYDROXYAPATITE羟基磷灰石;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;Coating thickness涂层厚度 = 150μm Coatings 75μm ? early resorbtion 早期吸收 Coatings 200μm ? risk of delamination 脱层的危险;ADVANTAGES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; New bone formation 新骨形成 HA coating HA涂层 Metal 金属;HYDROXYAPATITE;LONG 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, 1999;Prevention 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 formation ; From Corail to Corail AMT ;Articul / eze Mini T