人工肩关节置换精.ppt

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1、人工肩关节置换第1页，本讲稿共27页Ways of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplasty第2页，本讲稿共27页ClassificationHemiarthroplasty(humeral head replacements)Total shoulder arthroplasty

2、(TSA glenohumeral replacements)第3页，本讲稿共27页HemiarthroplastyTSAUnconstrainedHemi-constrainedConstrainedBall-cotylaInverted type第4页，本讲稿共27页第5页，本讲稿共27页Categories of bone neoplasm Giant cell tumors(GCT)chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor .第6页，本讲稿共27页En

3、neking stages benign tumor 1 indolent 2 active 3 aggressive malignant tumor stage grade location metastatic IA low in not IB low out not IIA high in not IIB high out not III any any yes第7页，本讲稿共27页Malawer classification of shoulder girdle resections第8页，本讲稿共27页Type resection Intra-articular proximal h

4、umeral resection TypeA:abductors retained TypeB:abductors resected第9页，本讲稿共27页Magnetic resonance imaging(MRI)Margin of resectionA margin of 3 to 4cm distal to the MRI extent of the tumor is sufficient and allows a type A resection第10页，本讲稿共27页Margin of resectionConfined to boneIntramedullary第11页，本讲稿共2

5、7页Margin of resection Extraosseous extension that involves the deltoid,a typeB resection will be required第12页，本讲稿共27页Prosthesis ImplantationHemiarthroplastyTSAB第13页，本讲稿共27页ComparisonHemiarthroplastyTSASimlper procedureAvoid looseningand instabilityPain reliefActivityActive range of motion第14页，本讲稿共27

6、页第15页，本讲稿共27页Despite the increased technical difficulty,longer operating time,and potential complications associated with the glenoid component,TSA appears to be our choiceChoice第16页，本讲稿共27页Rotator cuff第17页，本讲稿共27页Rotator cuff支点第18页，本讲稿共27页第19页，本讲稿共27页Soft tissue reconstructiontype A resectionDeltoi

7、d（Supraspinatus）Rotator cuff第20页，本讲稿共27页15%第21页，本讲稿共27页Dacron tape第22页，本讲稿共27页Enhance tendon anchor(ETA)第23页，本讲稿共27页Soft tissue reconstructiontype B resectionObtain stability Mobilization(Dacron tape)elbowhand第24页，本讲稿共27页RehabilitationPassive motion exerciseActive exercisesActive resistive strengthening exercises第25页，本讲稿共27页ComplicationsRotator cuff tearingPostoperative glenohumeral instabilityPeriprosthetic humeral fracture第26页，本讲稿共27页Thanks第27页，本讲稿共27页