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1、人工肩关节置换第1页，此课件共27页哦Ways of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplasty第2页，此课件共27页哦ClassificationHemiarthroplasty(humeral head replacements)Total shoulder arthroplas
2、ty(TSA glenohumeral replacements)第3页，此课件共27页哦HemiarthroplastyTSAUnconstrainedHemi-constrainedConstrainedBall-cotylaInverted type第4页，此课件共27页哦第5页，此课件共27页哦Categories of bone neoplasm Giant cell tumors(GCT)chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor .第6页，此课件共
3、27页哦Enneking 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，此课件共27页哦Malawer classification of shoulder girdle resections第8页，此课件共27页哦Type resection Intra-articular pr
4、oximal humeral resection TypeA:abductors retained TypeB:abductors resected第9页，此课件共27页哦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，此课件共27页哦Margin of resectionConfined to boneIntramedullary
5、第11页，此课件共27页哦Margin of resection Extraosseous extension that involves the deltoid,a typeB resection will be required第12页，此课件共27页哦Prosthesis ImplantationHemiarthroplastyTSAB第13页，此课件共27页哦ComparisonHemiarthroplastyTSASimlper procedureAvoid looseningand instabilityPain reliefActivityActive range of moti
6、on第14页，此课件共27页哦第15页，此课件共27页哦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，此课件共27页哦Rotator cuff第17页，此课件共27页哦Rotator cuff支点第18页，此课件共27页哦第19页，此课件共27页哦Soft tissue reconstructiontyp
7、e A resectionDeltoid（Supraspinatus）Rotator cuff第20页，此课件共27页哦15%第21页，此课件共27页哦Dacron tape第22页，此课件共27页哦Enhance tendon anchor(ETA)第23页，此课件共27页哦Soft tissue reconstructiontype B resectionObtain stability Mobilization(Dacron tape)elbowhand第24页，此课件共27页哦RehabilitationPassive motion exerciseActive exercisesActive resistive strengthening exercises第25页，此课件共27页哦ComplicationsRotator cuff tearingPostoperative glenohumeral instabilityPeriprosthetic humeral fracture第26页，此课件共27页哦Thanks第27页，此课件共27页哦