膝關(guān)節(jié)假體介紹oxford單髁

KennyYangOxford產(chǎn)品培訓(xùn)楊昆源UKAvs.TKAOxford牛津單髁——品牌價(jià)值擁有超過(guò)35年的臨床經(jīng)驗(yàn)，Oxford單髁是世界上最廣泛使用的且可靠的單髁系統(tǒng)1。一份多中心研究2

發(fā)現(xiàn)OxfordPKR的患者相對(duì)于TKR患者來(lái)說(shuō)，1.8倍的OxfordPKR患者報(bào)告稱(chēng)自己的膝關(guān)節(jié)感覺(jué)更自然，且患者滿(mǎn)意度2.7倍于全膝置換，體現(xiàn)在進(jìn)行日程生活的能力中。

一份調(diào)查3

顯示Oxford單髁患者比全膝置換的患者感到更幸福。

一份多中心研究展示了，PKA相對(duì)于TKA來(lái)說(shuō)發(fā)病率和并發(fā)癥更少4**已證實(shí)的5,安全可復(fù)制的器械1

相對(duì)于全膝，更好的功能6

和更自然的活動(dòng)度7

一流的持續(xù)教育項(xiàng)目OxfordPartialKneeHistory197419761982FirstpatentissuedregardingtheuniquedesignoftheOxfordPartialKnee(inventors:ProfessorJohnO‘ConnorandMrJohnGoodfellow)OxfordPartialKneereplacementindicationsarerefinedforthetreatmentofanteromedialosteoarthritisofthemedialcompartmentOn30thJuneat11:30amthefirstOxfordPartialKneeisimplantedbyMrJohnGoodfellowOxfordPartialKneeHistory198819982003OxfordPhase2:IntroductionofsecondgenerationOxfordPartialKneewhichpatentedthemethodofmillingthedistalendofthemedialcondylewithasphericalreamerOxfordCementlessPartialKneeislaunchedwithPPSandHAcoatingOxfordPhase3:ImproveddesignsuitableforminimallyinvasiveuseandOxfordInstructionalCoursesareintroduced6OxfordPartialKneeHistory20042009OxfordDomedLateralKneeisintroduced;therevolutionarydesignconceptmimicsthemovementofthelateralkneecompartmentLaunchoftheOxfordKneewithaTiNbNcoatingAseconddecadelife-tablesurvivalanalysisoftheOxfordpartmentalkneearthroplasty,Dr.Svard’s91%at20-yearsurvivorshipresultspublished52011LaunchofMicroplastyInstrumentation,designed

foreaseofuseand

reproducibleresults2011OxfordPartialKneeHistory20112012TheOxfordPartialKneecelebratesits35thanniversaryTheOxfordPartialKneeismadeavailablewithSignature*PersonalisedPatientCare,anindustryleadingimage-basedapproachtopre-operativeplanningusingpatient-specificpositioningguides2013LaunchoftheOxfordPatientSatisfactionCampaign2013WashingtonUniversityMulti-CentreStudyfindsthatOxfordPKRpatientsare2.7xmorelikelytobesatisfiedcomparedtoTKApatients28SystemDesign:雙柱股骨假體

雙柱股骨假體共有5種設(shè)計(jì)尺寸以匹配不同患者解剖形態(tài)

超小號(hào):20.3mm半徑小號(hào):22.0mm半徑

中號(hào):23.8mm半徑

大號(hào):25.7mm半徑

超大號(hào):27.5mm半徑

全匹配接觸的球面設(shè)計(jì)使整個(gè)活動(dòng)范圍的接觸應(yīng)力最小

內(nèi)部弧形幾何設(shè)計(jì)可達(dá)到最小骨去除89股骨假體大小

身高&性別

Small Medium LargeXLMale 160cm 170cm 185cm 5ft3in 5ft7in 6ft1inFemale165cm 175cm 5ft5in 5ft9cm10自然半月板的運(yùn)動(dòng)半月板在隨著膝關(guān)節(jié)運(yùn)動(dòng)時(shí)改變長(zhǎng)度及厚度，不變的是其接觸面積人工關(guān)節(jié)不能完全恢復(fù)半月板功能及特性，正球形接觸面可以最可能的接近自然解剖特性11非限制性活動(dòng)平臺(tái)12非限制性活動(dòng)平臺(tái)單髁13雙柱設(shè)計(jì)原理增加的假體前沿可以加上第二柱，同時(shí)可以允許假體屈曲放置，這樣可以增加關(guān)節(jié)接觸面積，減少高屈曲時(shí)的峰值壓力。*Theextrametalanteriorlyallowsforanadditional15°offlexion.TheMicroplastyinstrumentsodateplacingthefemoralcomponentin10degreesofflexion.=singlepeg=twinpeg增加屈曲度4,03(XS)–5,18(XL)(mm)14雙柱設(shè)計(jì)原理15接觸面積Reference2:DataonFile,TwinPegEvaluation,RiskAnalysis16日本的研究結(jié)果評(píng)價(jià)Oxford接觸面積基于3-D模型的計(jì)算mm2mm2Degreesofflexion17活動(dòng)墊片設(shè)計(jì)保留了與股骨部分在全方位活動(dòng)時(shí)的完全匹配性10ArCom?DCM聚乙烯增加抗磨損性能11,125個(gè)尺寸超小，小，中，大，超大7種厚度選擇3,4,5,6,7,8and9mm前后方抗旋設(shè)計(jì)，降低墊片旋轉(zhuǎn)脫位風(fēng)險(xiǎn)SystemDesign:解剖型活動(dòng)墊片18解剖型設(shè)計(jì)獲得最佳骨覆蓋137種尺寸可選，左右以2mm遞增SystemDesign:脛骨假體AA,A,B,C,D,E,F19球形研磨鉆和研磨桿簡(jiǎn)化了屈伸平衡的測(cè)量微創(chuàng)切口避免對(duì)四頭肌的破壞

獨(dú)特的股骨工具尺寸，精確到1mm的骨去除

Oxford單髁伴隨著Microplasty工具的設(shè)計(jì)，提供了簡(jiǎn)便、精確、高效，可復(fù)制:SystemDesign:Microplasty工具20公開(kāi)發(fā)表的文獻(xiàn)表明，幾乎50%的患者適合做單髁置換17.你能用Oxford單髁治療全膝患者嗎？患者選擇的標(biāo)準(zhǔn):前內(nèi)側(cè)骨關(guān)節(jié)炎(AMOA):ACL完好MCL功能正常外側(cè)全層軟骨可矯正的內(nèi)翻畸形固定屈曲畸形(FFD)小于15?確認(rèn)Oxford單髁適應(yīng)癥21確認(rèn)Oxford單髁適應(yīng)癥——AMOA

內(nèi)翻應(yīng)力位X光片內(nèi)側(cè)骨對(duì)骨前內(nèi)側(cè)骨性關(guān)節(jié)炎（AMOA）確認(rèn)Oxford單髁適應(yīng)癥——AMOA后側(cè)前側(cè)后側(cè)前側(cè)后側(cè)前側(cè)23

側(cè)位片股骨后方軟骨保留

脛骨磨損情況明顯在前內(nèi)側(cè)

脛骨磨損沒(méi)有擴(kuò)大到后方95%可預(yù)測(cè)18優(yōu)質(zhì)的側(cè)位X光片應(yīng)顯示兩側(cè)髁重疊確認(rèn)Oxford單髁適應(yīng)癥——ACL完好ACL+ACL+ACL-Gross(sublux)ACL-24最好用外翻應(yīng)力X片顯示

可矯正的關(guān)節(jié)畸形(GenuVarum)內(nèi)側(cè)間隙開(kāi)口正常確認(rèn)Oxford單髁適應(yīng)癥——MCL功能正常25最好用外翻應(yīng)力X片顯示邊緣骨贅不是禁忌癥

確認(rèn)Oxford單髁適應(yīng)癥——外側(cè)全層軟骨26確認(rèn)Oxford單髁適應(yīng)癥——可矯正的內(nèi)翻畸形

通過(guò)X光片和臨床評(píng)估確認(rèn)負(fù)重站立X光片

90°側(cè)位X-ray臨床評(píng)估

膝關(guān)節(jié)屈曲20?或以上,內(nèi)翻畸形可被矯正膝關(guān)節(jié)屈曲90?,內(nèi)翻畸形自然矯正可矯正的內(nèi)翻畸形可矯正的內(nèi)翻畸形可矯正的內(nèi)翻畸形30最好通過(guò)臨床評(píng)估確認(rèn)確認(rèn)Oxford單髁適應(yīng)癥——FFD小于15°31Wedge20o與垂線成10o夾角，與關(guān)節(jié)線平行施加外翻或內(nèi)翻應(yīng)力如何拍攝“應(yīng)力位X線片”20o與垂線成10o夾角，與關(guān)節(jié)線平行32極端病例保留的后側(cè)軟骨功能性完好的ACLPFJ完全磨損軟骨厚度完整33非禁忌癥

PFJ損傷和膝前區(qū)疼痛

年齡以及較高的活動(dòng)水平

肥胖和軟骨鈣化癥

外側(cè)間室損傷Kozinn&Scott1

描述的固定墊片證據(jù)表明并不適用于Oxford2PKAKozinn,etal.JBJS19891Pandit,etalJBJS2011234髕股關(guān)節(jié)問(wèn)題若忽略PFJ不合適，那么文獻(xiàn)中將會(huì)很多因PFJ問(wèn)題的失敗然而并沒(méi)有:已發(fā)表的病例系列(1700例OxfordPKR,>5y年隨訪)565例翻修術(shù)，均不是因?yàn)镻FJ問(wèn)題SKAR瑞典膝關(guān)節(jié)置換手術(shù)登記(699例Oxford膝關(guān)節(jié))7

50例翻修，1

例因?yàn)镻FJ疼痛Beard,etal.JBJS20075Lewold,etal.JOA1995735術(shù)前疼痛部位100例AMOA患者用Oxford膝關(guān)節(jié)假體治療術(shù)前由獨(dú)立的理療醫(yī)師進(jìn)行評(píng)估以確定疼痛部位654%有前方痛Beard,etal.JBJS20076%ofPatients36年齡年輕不是禁忌

<60歲92%10年留存率8低磨損率Price,etal.JBJS(Br.)20058Liddle,etal.OsteoarthritisCartilage,20149ThereisnospecificagerangeindicationfortheOxfordPartialKnee.年老不是禁忌做特別好9尤其是不健康患者,低發(fā)病率&低死亡率<60&>60NSDSurvival%37高活動(dòng)水平Murrayetal.LondonKneeMeeting,201410高活動(dòng)群組(Tegner≥5)n=115Tegner5=重體力勞動(dòng),不平路面上慢跑12年留存率97.3%(95%CI:92-99).活動(dòng)并不影響結(jié)果非禁忌癥，可推薦患者不遵醫(yī)囑4或者更低的評(píng)分是推薦的30%5到8

重體力勞動(dòng)，自行車(chē)運(yùn)動(dòng)，非平地長(zhǎng)跑

網(wǎng)球，滑雪

網(wǎng)球運(yùn)動(dòng)比賽，跑步足球比賽，壁球38肥胖體重與磨損率之間沒(méi)有相互關(guān)系1病態(tài)肥胖2

良好的短期結(jié)果，與固定平臺(tái)假體有所區(qū)別Argenson,J.AndO’Connor,J.PolyethyleneWearInMeniscalKneeReplacement:AOnetoNine–YearRetrievalAnalysisoftheOxfordKnee.TheJournalofBoneandJointSurgery.74-B.228–32.1992.Berend,K.etal.Mobile-bearingpartmentalKneeArthroplasty(UKA).OrthoSuperSite.1May2008.39軟骨鈣化癥定義為在以下情況下可見(jiàn)鈣化X光片上術(shù)中失敗率沒(méi)有增加Woods,etal.Knee,19951210yearFUOKS48/48PostOp40Oxford適應(yīng)癥vsKozinn&Scott1024例OUKR268%有

K&S禁忌癥12年存活Kozinn&Scott禁忌癥不適用于Oxford單髁

K&Scontraindicated

K&S“Ideal”P(pán)andit,etal.JBJS,2011241采用Kozinn&Scott標(biāo)準(zhǔn)的影響患者選擇的因素局限于

Kozinn&Scott標(biāo)準(zhǔn)1只有5%膝關(guān)節(jié)置換適合做UKR(6%Sternetal16;2%Ritteretal17)Oxford標(biāo)準(zhǔn)(K&S不適用)約50%適合做Oxford膝關(guān)節(jié)置換15,18

大樣本數(shù)據(jù)–好的結(jié)果Kozinnetal.JBJS,19891,Yoshidaetal.JOA,201314,Stern,etal.CORR,199315,Ritter,etal.JBJS,200416,Willis-Owen.TheKnee,20091742K&S禁忌癥適用于固定平臺(tái)?固定平臺(tái)的PFJ問(wèn)題在術(shù)后10年后普遍19,20,21PFJ損傷禁忌癥21撞擊,運(yùn)動(dòng)力學(xué)固定平臺(tái)在如下情況中磨損增加

年輕,活動(dòng)和肥胖K&S可能適用于固定平臺(tái)1Hernigou,etal-JBJS(Am),200218,Berger,etal-CORR,200619,Argenson,etalJBJS(AM),201320,Kozinn,ScottJBJS(AM)1989143適應(yīng)癥

標(biāo)準(zhǔn)

前內(nèi)側(cè)OA骨對(duì)骨ACL功能正常MCL功能正常外側(cè)間室有全層軟骨非禁忌癥

PFJ軟骨丟失

膝前區(qū)疼痛

軟骨鈣化癥

肥胖

年齡

活動(dòng)水平Whatwouldyourpatientschoose?Oxford

PartialKneeThere’smoretoconsiderthanjustsurvivorship

whendecidingbetweenPKAandTKA.Survivorshipcomparisonat10years1Likelytobesatisfied2StudybyresearchersatWashingtonUniversityinSt.Louis,Missouri,US.PortionsofthisstudyfundedbyBiomet.Determinedbasedonadjustedoddsratiocalculation.AOANJR(AustralianOrthopaedicNationalJointRegistry)45華盛頓大學(xué)多中心研究結(jié)果：OxfordPKR患者:滿(mǎn)意度2.7倍于全膝置換，體現(xiàn)于進(jìn)行日常活動(dòng)的能力

21.8倍于全膝患者，更愿意報(bào)告膝關(guān)節(jié)感覺(jué)自然2TKAFBPKAOXFORD膝關(guān)節(jié)感覺(jué)‘自然’1.000.801.817進(jìn)行日常生活的能力1.000.532.69746生存率Oxford單髁的長(zhǎng)期臨床表現(xiàn)是取決于全球臨床文獻(xiàn)42。Oxford單髁的長(zhǎng)期生存率比得上競(jìng)爭(zhēng)的全膝關(guān)節(jié)假體19-22

。這是僅有的一個(gè)能與全膝置換的臨床相比的單髁膝關(guān)節(jié)置換。19-2247競(jìng)品分析——StrykerTriathlon48競(jìng)品分析——StrykerTriathlon49競(jìng)品分析——LinkEndo50競(jìng)品分析——LinkEndo51競(jìng)品分析——Smith&Nephew52競(jìng)品分析——Smith&Nephew53競(jìng)品分析——Depuy54競(jìng)品分析——Depuy55非競(jìng)品分析——Zimmer56非競(jìng)品分析——Zimmer57培訓(xùn)機(jī)會(huì)——Oxford高級(jí)培訓(xùn)班Oxford高級(jí)培訓(xùn)課程是繼承了英國(guó)牛津的十年成功經(jīng)驗(yàn)，在世界各地舉辦。其內(nèi)容包括：課程演講：適應(yīng)癥和禁忌癥；設(shè)計(jì)原理；手術(shù)技術(shù)和手術(shù)原則；臨床結(jié)果等。手術(shù)直播；以及讓醫(yī)生使用Microplasty工具進(jìn)行假骨操作。58培訓(xùn)機(jī)會(huì)——Oxford大師班Oxford大師班為Oxford使用者提供了一個(gè)極好的機(jī)會(huì)以提高技術(shù)。通過(guò)圓桌討論，手術(shù)技巧，術(shù)中問(wèn)題及關(guān)于患者效果的分享。醫(yī)生通過(guò)大師班能學(xué)到最好的預(yù)防并發(fā)癥的經(jīng)驗(yàn)，且能與其他Oxford單髁使用者討論患者選擇的因素等。59參考文獻(xiàn)*SignatureisacollaborativepartnershipwithMaterialiseNV**NotallpartialkneesinthisstudywereOxfordkneesDataonfileStudybyresearchersatWashingtonUniversityinSt.Louis,Missouri,US.PortionsofstudyfundedbyBiomet.Determinedbasedonadjustedoddsratiocalculation.BiometOxfordvs.TKASatisfactionSurvey.March,2012.Brown,NM,etal.TotalKneeArthroplastyHasHigherPostoperativeMorbidityThanpartmentalKnee

Arthroplasty:AMulticenterAnalysis.TheJournalofArthroplasty.Sep;27(8Suppl):86-90:2012PriceAJ,SvardU.:AseconddecadelifetablesurvivalanalysisoftheOxfordpartmentalkneearthroplasty.ClinOrthopRelatRes.2011Jan;469(1):174-9.Lygre,SHLetal.PainandFunctioninPatientsAfterPrimarypartmentalandTotalKneeArthroplasty.

JBJSAm.2010;92:2890-2897.Cobb,J,etal.FunctionalAssessmentofkneearthroplastyusinganinstrumentedtreadmill.ImperialCollegeofLondon.March8,2012.Presentation.Kim,K.etal.AProspectiveAnalysisofOxfordPhase3partmentalKneeArthroplasty.Orthopedics30(5Suppl):15-18,2007.DataonfileGoodfellow,J.etal.TheMechanicsoftheKneeandProsthesisDesign.TheJournalofBoneandJointSurgery(Br).60(3):358-69,1978.Bankston,A.etal.ComparisonofPolyethyleneWearinMachinedVersusMoldedPolyethylene.ClinicalOrthopaedicsandRelatedResearch.317:37-43,1995.Clarke.Ietal.HipSimulatorWearTestingArComvs.ExtrudedBarPolyethylene.Presentation7thAnnualConferenceonTechniques&ScienceforSuccessfulJointArthroplasty.1995.Incavo,S.etal.TibialPlateauCoverageinTotalKneeArthroplasty.ClinicalOrthopaedicsandRelatedResearch.299:81-5,1994.FocusonFixation:PorusPlasmaSpray&OsteoCoatHA.BiometbrochureFormNo.Y-BMT-777Pandit,Hetal.CementedandCementlessFixationofpartmentalKneeReplacement:ARandomisedControlledTrial.Robertsson,O,etal.Useofpartmentalinsteadofpartmentalprosthesesforpartmentalarthrosisinthekneeisacosteffectivealternative.ActaOrthopScand.(1999);70(2):170-175.Willis-OwenCetal.UnicondylarkneearthroplastyintheUKNationalHealthService:Ananalysisofcandidacy,eandcostefficiacy.TheKnee16473-478.2009Keys,G.TheRadiographicClassificationofMedialGonarthrosis.CorrelationwithOperationMethodsin200Knees.ActaOrtopScand.63:497-501,1992.Murray,Detal.TheOxfordMedialpartmentalArthroplasty.ATenYearSurvivalStudy.TheJournalofBoneandJointSurgery.80-B(6):983-89,1998.Ritter,Metal.Flat-on-Flat,Nonconstrained,Compression-moldedPolyethyleneTotalKneeReplacement.ClinicalOrthopaedicsandRelatedResearch,321:79-85,1995.60參考文獻(xiàn)Duffy,G.etal.CementedTotalKneeArthroplastyusingaModernProsthesisinYoungPatientswithOsteoarthritis.TheJournalofArthroplasty.22(6Suppl1):67-70,2007.Laskin,R.TheGenesisTotalKneeProsthesis.ClinicalOrthopaedicsandRelatedResearch.388:95-102,2001.Malkani,A.etal.TotalKneeArthroplastywiththeKinematicCondylarProsthesis.TheJournalofBoneandJointSurgery77(3):423-31,1995Brassard,M.etal.DoesModularityAffectClinicalSuccess?AComparisonwithaMinimum10-yearFollowup.ClinicalOrthopaedicsandRelatedResearch.388:26-32,2001.Svard,U.andPrice,A.OxfordMedialpartmentalKneeArthroplasty.ASurvivialAnalysisofanIndependentSeries.JournalofBoneandJointSurgeryBr.83:191-194,2001.Price,Aetal.LongtermClinicalResultsoftheMedialOxfordpartmentalKneeArthroplasty.ClinicalOrthopaedicsandRelatedResearch.435:171-180.2005Keys,Getal.AnalysisofFirstFortyOxfordMedialpartmentalKneeReplacementsfromasmallDistrictHospitalintheUK.Knee11:375-377,2004.Rajasekhar,Cetal.partmentalKneeArthroplasty.2-to12-yearResultsinaCommunityHospital.JournalofBoneandJointSurgeryBr.86:983-985,2004.Baker,etalCenterandSurgeonVolumeInfluencetheRevisionRateFollowingUKA,JBJS2013andtheNewZealandNationalJointRegistryLiddle,ADetal.OptimalusageofpartmentalKneeReplacement.Astudyof41,986patientsfromtheNationalJointRegistryforEnglandandWales.ISARAnnualMeeting2013Murray,D.etal.TheOxfordMedialpartmentalArthroplasty.ATen-YearSurvivalStudy.JournalofBoneandJointSurgery.80:983–989.1998.Ritter,M.etal.Flat-on-Flat,Nonconstrained,Compression-MoldedPolyethylen