1、,CORAIL SYSTEM,CORAIL SYSTEM DESIGNERS ARTRO GROUP FOUNTED IN 1981,1984 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,HISTORICAL RECORD 历史回顾,CORAIL DESIGN PRINCIPL 设计原理,SURFACE TREATMENT 表面处理RA
2、NGE OF IMPLANTS 假体尺寸SURGICAL TECHNIQUE 外科技术CLINICAL RESULTS 临床结果,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,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Com
3、patible with alumina or cobalt chrome liners 与氧化铝或钴铬内衬匹配,CORAIL DESIGN PRINCIPLES 设计原理,Straight stem 直柄Thin distal tip 远端较细,CORAIL DESIGN PRINCIPLES 设计原理,135 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,四边形横截面 轴向及旋转稳定性,CORAIL DESIGN PRINCIPLES 设计原理,Double
4、taper geometry givesstero-stability 双锥度设计提供立体稳定性,CORAIL DESIGN PRINCIPLES 设计原理,Progressive 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,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,Verti
5、cal distal macrostructre 远端垂直结构,CORAIL DESIGN PRINCIPLES 设计原理,Optional collar for calcar loading 股骨距负荷-带领，不带领,CORAIL DESIGN PRINCIPLES 设计原理,HYDROXYAPATITE Bioactive coating 生物活性涂层,CORAIL DESIGN PRINCIPLES 设计原理,BONE COMPOSITION骨组成,ORGANIC PHASE 有机期 30%collagen胶元, specific proteins特殊蛋白质MINERAL PHASE 矿
6、物质期 60%carbonated apatite 碳酸磷灰石WATER 水 10%,HYDROXYAPATITE 羟基磷灰石,Chemical Formula 化学分子式Ca10 (PO4)6 (OH)2 Similar 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，不可吸收Osteo-conductive properties 骨传导性,NON TOXIC无毒NON INFLAMMATORY不引起炎症反应NON ALLERGIC无过敏反应NON CARCINOGENIC 不
7、引起癌症,HYDROXYAPATITE,Coating thickness涂层厚度 = 150mCoatings 200m risk of delamination脱层的危险,HYDROXYAPATITE,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,HYDROXYAPATITE,New bone formation新骨形成HA coating HA涂层Metal金属,HYDROXYAPATITE,NO FIBROUS TISSUE INTERP
8、OSITION无纤维组织插入,HYDROXYAPATITE,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,LONG TERM STABILITY 长期稳定性 “The complete absence of femoral endosteal cortical osteolysis in spite of the abundance of particles is
9、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 alJBJS Vol 81B, 1999,HYDROXYAPATITE,Prevention of thigh pain大腿痛的防止No fibrous tissue distally 远
10、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,HYDROXYAPATITE,From Corail to Corail AMT,Articul / eze Mini Taper: AMT,Thinner neck更薄的颈部设计 = Improved range of motion 更大的活动度,Polished taper抛光的锥部 Better resistance to PE wear 减少PE磨损,Articul / eze Mini Taper: AMT,Mini tap
11、er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,Thinner neck更薄的颈部设计 Elliptico-trapezoidal shape 2 flat surfaces Frontal (向位): 12 mm Sagittal (矢向位): 9.15 mm,Articul / eze Mini Taper: AMT,New impaction hole新打入孔,Articul / eze Mini Taper: AMT,Standard rang
12、e:,KS Available sizes:(new) 8; 9; 10; 11; 12; 13; 14; 15; 16; 18; 20 Without collar outside of France NSA: 135 Indications: Primary THR; Revision stage 1 and 2,Articul / eze Heads,Cobalt chrome-22.225 mm:+4 medium +7 long,Cobalt chrome: 28 mm: +1.5 short neck+5 medium (standard)+8.5 long+12 extra lo
13、ng,Articul / eze Heads,Articul / eze Range,Ceramic: 28 mm, 36mm: +1.5 short neck +5 medium (Standard) +8.5 long 32 mm: +1 short neck +5 medium (Standard) +9 long,97.7% Survivorship at 10 years 89% of patients without thigh pain (大腿痛） 0.8% stress shielding Gr. III 应力遮挡JP Vidalain and the Artro Group
14、International Corail Conference, 1998,CORAIL Clinical results,100% Survivorship in 100 cases after 5 years 0 % 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,NORWEGIAN HIP REGISTER99.5% Survivorship in 1117 cases at 4.5
15、 years Havelin L et al JBJS Vol. 77-B, 1995,CORAIL Clinical results,IN PATIENTS UNDER 50 years99.1% Survivorship in 119 cases after 10 yearsVidalain JP et al European Hip Society, 1998,CORAIL Clinical results,IN PATIENTS UNDER 55 years94.4% Survivorship in 1039 cases after 6 yearsHavelin L et al JBJ
16、S Vol.79-B, 1997,CORAIL Clinical results,95.1% 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,Clinical Heritage Documented,FEATUREQUADI-LATERALCROSS SECTION横截面四边形,BENEFITACCURATEROTATIONAL STABILITY精确的旋转稳定性,CORAIL,FEATUREMACROSTRUCTURE （横行，
17、纵行）结构,BENEFITINCREASE THE SURFACEFOR BONE / IMPLANTCONTACT BY 15 %增加骨与假体接触面积15%,CORAIL,FEATUREHORIZONTALMACROSTRUCTURE横行结构PROGRESSIVE 逐渐增大,BENEFITTO PREVENT STEM SUBSIDENCE 避免假体下沉 TO OPTIMISE PROXIMAL LOAD TRANSFER 优化近端负荷传导,CORAIL,FEATUREVERTICAL MACROSTRUCTURE纵行结构,BENEFITTO IMPROVEROTATIONAL STABIL
18、ITY改善旋转稳定性,CORAIL,FEATUREHYDROXYAPATITECOATINGHA涂层,BENEFITGREATER SHEAR STRENGTH OF IMPLANT 假体的剪力增大 INCREASED BONE ONGROWTH 增加骨表面增长,CORAIL,FEATUREHYDROXYAPATITECOATINGHA涂层,BENEFITNO FIBROUS TISSUE INTERPOSITION 没有纤维组织插入 GAP FILLING 空隙封闭,CORAIL,FEATUREFULL HA COATING 完全的HA涂层,BENEFITNO THIGH PAIN 没有大腿
19、痛 BARRIER TO THE INGRESS OF WEAR DEBRIS 阻止磨屑进入,CORAIL,FEATURE21 YEAR EXPERIENCE 21年经验,BENEFITOVER 130,000 IMPLANTATIONS 假体植入CLINICAL RESULTS,CORAIL,FEATURESURGICAL TECHNIQUE 外科技术,BENEFITEASY & REPRODUCIBLE 容易，可重复性强NO CONTRA-INDICATIONS 没有禁忌症,CORAIL,CORAIL - Positioning 产品定位,Key selling points宣传要点 Su
20、perior 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 Easy 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 .,Simple and comprehensive instrumentation简单易操作的工具,CORAIL Surgical technique,Simple pro
21、cedure简单的手术步骤 One step broaching (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,STEP 1Neck resection at 4545度颈部截骨Level determined during preop planning 术前计划决定截骨水平,CORA
22、IL Surgical technique,STEP 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,Canal Finder 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，紧贴梨状窝进入，找到正确髓腔位置，中立位进入，避免内翻,STEP 3Progress
23、ive broaching until complete stability is achieved 进行性扩髓直到获得完全的稳定性,CORAIL Surgical technique,STEP 4Calcar milling 锉平台,CORAIL Surgical technique,STEP 5Trial reduction with trial neck segment 试模颈进行试模复位,CORAIL Surgical technique,STEP 6Definitive implant insertion 确定的假体插入,CORAIL Surgical technique,STEP
24、7Proximal 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,STEP 8Femoral head impaction 股骨头打入,CORAIL Surgical technique,Anteversion 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，避免假体内翻,G
25、etting The Correct Implant Size 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12mm,Avoid early impaction避免过早的打压,Corail Insertion 假体植入,Corail Insertion 假体植入,用手将假体沿准备好的髓腔方向推入，避免假体和髓腔错误对线,Sepcial Case 特殊病例,Young Male patients 年轻男性病人,Challenge（挑战）：usually you will find
26、 it is difficult to put the stem in. 通常比较难以将柄植入Reason（原因）： This is because young male patients have higher chance for narrower canal (especially in the conjunction of metaphysis and diaphysis of the femur). 这是由于很多年轻男性病人髓腔比较狭窄（特别是在股骨干骺端连接处）Tips (小技巧）： ream a little bit at the distal part of the narro
27、w canal to make sure we can choose a right Corail implant that can fully fit in proximal part of the femur. 在远端髓腔狭窄处用细钻钻一下，确保我们可以选择一个完全匹配股骨近端的正确的假体 We can use the Srom 6/7mm canal reamer to help us during the operation. 我们可以使用S-Rom 工具中的6/7mm的髓腔钻,CORAIL,CASE REVIEW,PRE-OP,9 YEARS,2 WEEKS,Postoperation Ideal X-ray 术后好的X光片,Remained Cancellous Bone保留的松质骨,CORAIL,CASE REVIEW,PRE-OP,8 YEARS,3 MONTHS,Thank You !,
