髖關(guān)節(jié)假體的設(shè)計(jì)

和

臨床應(yīng)用選擇應(yīng)明MD,

PhD

12024/8/4股骨柄臨床成功的重要因素設(shè)計(jì)理念表面處理假體材料22024/8/4非骨水泥股骨柄材料

鈦合金(鈦鋁釩,鈦鋁鈮)鈷鉻鉬合金不銹鋼32024/8/4非骨水泥股骨柄經(jīng)典設(shè)計(jì)方型柄圓形柄錐形柄解剖柄組配柄42024/8/4方形柄52024/8/4圓形柄62024/8/4錐形柄72024/8/4解剖柄82024/8/4組配柄92024/8/4非骨水泥股骨柄植入后的穩(wěn)定初期穩(wěn)定柄局部與髓腔的緊密匹配和卡壓遠(yuǎn)期穩(wěn)定骨長(zhǎng)上或骨長(zhǎng)入102024/8/4非骨水泥股骨柄初期穩(wěn)定的部位112024/8/4非骨水泥股骨柄遠(yuǎn)期穩(wěn)定的實(shí)現(xiàn)骨長(zhǎng)上粗糙表面骨長(zhǎng)入多孔表面122024/8/4粗糙表面上的骨長(zhǎng)上132024/8/4多孔表面上的骨長(zhǎng)入采用多種不同的工藝，在非骨水泥柄表面形成具有一定厚度的多孔涂層，以利骨長(zhǎng)入多孔內(nèi)而獲得柄遠(yuǎn)期穩(wěn)定142024/8/4152024/8/4對(duì)表面多孔涂層的要求162024/8/4孔隙率對(duì)骨長(zhǎng)入的影響172024/8/4孔隙大小對(duì)骨長(zhǎng)入的影響孔隙大小(um)骨長(zhǎng)入情況50結(jié)締組織形成，無骨長(zhǎng)入100有礦化骨組織侵入，有可能血管化200骨組織生長(zhǎng)明顯300明確加速骨組織的生長(zhǎng)400骨組織進(jìn)入孔隙深部仍有可能500骨組織生長(zhǎng)速度受限，進(jìn)入深部受限182024/8/4孔隙大小對(duì)術(shù)后抗剪力強(qiáng)度的影響192024/8/4各種不同多孔表面的骨接觸百分比鈦多孔表面植入后1個(gè)月植入后6個(gè)月鈦絲21.8±2.5%43.2±4.5%鈦珠34.0±4.2%33.3±2.9%等離子噴涂32.5±3.8%41.9±5.2%202024/8/4多孔涂層比較212024/8/4VPS222024/8/4VPS232024/8/4VPS原理242024/8/4涂層形成過程252024/8/4多孔表面上的骨長(zhǎng)入262024/8/4非骨水泥柄的選擇中的其他考慮假體選擇的正確——髓腔評(píng)價(jià)型號(hào)選擇的準(zhǔn)確——術(shù)前計(jì)劃并發(fā)癥的預(yù)見（應(yīng)力遮擋、大腿疼痛）頸干角/頸距/頸長(zhǎng)/頸高/肢體長(zhǎng)度272024/8/4股骨柄的發(fā)展195019601970198019902000骨水泥柄非骨水泥柄對(duì)非骨水泥柄熱情下降骨水泥柄回潮非骨水泥柄回潮282024/8/4骨水泥柄的兩種基本設(shè)計(jì)理念承載錐型主要關(guān)注載荷分散組合柱型主要關(guān)注柄的形狀292024/8/4骨水泥柄的兩種基本設(shè)計(jì)302024/8/4骨水泥柄的兩種基本設(shè)計(jì)承載錐型組合柱型柄體材料CoCr，SSCoCr,

SS,

Ti合金柄體形狀錐形為主截面方、橢圓頸領(lǐng)通常無通常有表面處理高拋光毛糙、粗糙骨水泥層的要求較低較高植入后下沉顯著(0.9-1.4mm)甚小(0.1-0.5mm)312024/8/4骨水泥柄設(shè)計(jì)的兩種思想承載錐型組合柱型骨水泥層是不可能完美的，股骨柄與骨水泥層之間的綁定也無法完美。因此通過允許柄的下沉達(dá)到二次穩(wěn)定，使骨水泥在柄與骨骼之間形成良好的充填，使應(yīng)力更好地從柄傳遞到骨水泥層再到骨骼應(yīng)盡一切可能獲得骨水泥層的完美，增加骨水泥層與柄之間的邦定，這是植入柄遠(yuǎn)期穩(wěn)定的基礎(chǔ)。因此應(yīng)盡量限制柄的任何下沉或微動(dòng)。增加頸領(lǐng)、表面粗糙化處理等均是出于這一目的。322024/8/4骨水泥柄中的“法國(guó)悖論”髓腔銼與植入柄同號(hào)盡可能植入較大號(hào)柄可去除較多的松質(zhì)骨無需均勻的骨水泥層柄可直接與骨質(zhì)接觸332024/8/4342024/8/4352024/8/4A,Neck-stemangleisreduced.B,Neckisattachedatmoremedialpositiononstem.362024/8/4372024/8/4382024/8/4Large-diameterheadwithtrapezoidalneck(A)hasgreaterrangeofmotionandlessimpingementthansmallerdiameterheadandskirtedmodularneck(B).392024/8/4DefinitionPMstem.Proximallongitudinalgroovesandsurfacetexturingpromotemechanicalinterlockwithcement.Integralproximalanddistalpolymethylmethacrylatespacersensureneutralpositioningincanalandadequatethicknessofcementmantle.

(CourtesyofStrykerOrthopaedics,Kalamazoo,Mich.)

402024/8/4OmnifitEONstem(StrykerOrthopaedics,Kalamazoo,Mich).Normalizedproximaltexturingconvertsshearforcestocompressiveforces.A,Standardoffset.B,Enhancedoffset.412024/8/4SpectronEFstem.Rounded,rectangularshapeandlongitudinalgrooveimproverotationalstability.A,Highoffset.B,Standardoffset.

(CourtesyofSmith&Nephew,Memphis,Tenn.)

422024/8/4CPThipstem(Zimmer,Warsaw,Ind).Collarless,polished,tapereddesignallowscontrolledsubsidenceandmaintainscompressivestresseswithincementmantle.432024/8/4Basiccementlessstemshapes(StrykerOrthopaedics,Kalamazoo,Mich).A,MeridianTMZFstraightstemissymmetricalandfitseitherfemur.B,CitationTMZFanatomicalstemdesignincorporatesproximalposteriorbowandantevertedfemoralneck.442024/8/4Synergyporousstem(Smith&Nephew,Memphis,Tenn).Taperedstraightstemdesign.Proximalflutesprovideadditionalrotationalstability.A,Standardoffset.B,Highoffset.Shownwithoxidizedzirconiaheads.452024/8/4APRstem(Zimmer,Warsaw,Ind).Collaredanatomicaldesign.Standard(A)andlargebody(B)componentsprovidevariableproximalfitforgivendistalstemsize.462024/8/4Taperlocstem.Plasma-sprayedtitaniumporoussurface.Collarless,flat,wedge-shapedgeometryisavailablewithtwofemoraloffsets.

(CourtesyofBiomet,Warsaw,Ind.)

472024/8/4VerSysstem.Collaredtitaniumalloystemwithtitaniumfibermetalcircumferentialporoussurface.Trapezoidalproximalgeometryanddistalflutespromoterotationalstability.

(CourtesyofZimmer,Warsaw,Ind.)

482024/8/4S-ROMmodularstem.A,Multipleproximalsleevesizescanbecombinedwithgivendiameterstem.Stemcanberotatedinrelationtosleevetocorrectrotationaldeformityoffemur.Distalflutesimproverotationalstability.B,Long,curvedstem.Distalpartofstemisslottedincoronalplanetodiminishbendingstiffness.

(CourtesyofJohnson&Johnson,DePuy,Warsaw,Ind.)

492024/8/4Extensivelyporous-coatedstems.A,AMLstemforprimaryandrevisionarthroplastieswhenisthmusisintact.B,ExtensivelycoatedSolutionlongstemusedforrevisionswhenproximalbonelossissevere.C,Calcarreplacementlongstem.

(CourtesyofJohnson&Johnson,DePuy,Warsaw,Ind.)

502024/8/4Noncircumferentialporouscoating.Despiteexcellentingrowthintoporouspad,debrismaymigratetodistalaspectofstemthroughadjacentsmoothchannels(arrow).512024/8/4Alloclassicstem(Zimmer,Warsaw,Ind).Conicalstraightstemwithrectangularcrosssection.Titaniumalloywithgrit-blast,nonporoussurface.522024/8/4Corailstem(Johnson&Johnson,DePuy,Warsaw,Ind).Titaniumalloystemwithextensivehydroxyapatitecoating.Proximalridgesanddistalgroovesprovideadditionalstability.532024/8/4Specializedfemoralcomponentsforreplacementofvariablelengthofproximalfemur.OrthogenesisLimbPreservationSystem.Modularsegmentalreplacementstemforreplacementoflargesegmentofproximalfemur.Stemcanbecombinedwithtotalkneereplacementtoreplaceentirefemur.

(CourtesyofJohnson&Johnson,DePuy,Warsaw,Ind.)

542024/8/4EnduranceCDHstem.Straightsmall-diameterstemdesignisidealforuseinpatientswithdevelopmental(congenital)hipdysplasiaorsmallstature.

(CourtesyofJohnson&Johnson,DePuy,Warsaw,Ind.)

552024/8/4Acetabularcomponentdesignedforcementfixation.Texturedsurfaceandpolymethylmethacrylatespacersoptimizecementmantleandcement-prosthesisinterface.

(CourtesyofSmith&Nephew,Memphis,Tenn.)

562024/8/4Contourantiprotrusiocage(Smith&Nephew,Memphis,Tenn)hastitaniumsupportringfixedtoiliumandischiumwithscrews.Alternatively,inferiorfincanbeimpactedintoischiumwithoutscrews.572024/8/4Universalacetabularcomponent(Biomet,Warsaw,Ind).Titaniumplasmaspraycoatingwithdomeandrimscrewfixationoptions.582024/8/4592024/8/4Interfitacetabularcomponent.Hemisphericaldesignwithgradualtransitiontoenlargementinperipheralrimforimprovedinitialstabilityandperipheralstresstransfer.

(CourtesyofSmith&Nephew,Memphis,Tenn.)

602024/8/4Arrayoflineroptionsavailablewithcontemporarymodularacetabularsystem:standardflatliner(A);posteriorlipwithoutanteversion(B);4-mmlateralizedflat(C);anteverted20degrees(D