EN_TR_T08 Knee Prosthesis Surgical Technique.FH11

Transkript

T08
TOTAL KNEE SYSTEM
TOTAL DÝZ SÝSTEMÝ
TOTAL KNEE SYSTEM
TOTAL DÝZ SÝSTEMÝ
The key in
orthopaedic
sciences
SURGICAL TECHNIQUE
CERRAHÝ TEKNÝK
IMPLANTS & INSTRUMENTS
ÝMPLANTLAR VE EL ALETLERÝ
T08 Total Knee System
T08 Total Diz Sistemi
CONTENTS
Introduction
ÝÇÝNDEKÝLER
3
Giriþ
Tibial Stage
8
Tibial Safha
Use of Intra-Medullary Cutting Guide
8
Setting the Tibial Slope
9
Intra Medular Kesi Gaydýnýn Kullanýmý
Tibial Eðimin Ayarlanmasý
Setting the Level of the Cut
10
Use of the Extra-medullary Alignment Guide
12
Positioning of the Guide
12
Setting the Tibial Slope
13
Setting the Rotation
14
Setting the Level of the Cut
14
Realisation of the Tibial Cut
15
Choosing the Tibial Component
15
Assembly of the Standard and PS Mobile Test Inserts
17
Kesimin Seviyesinin Belirlenmesi
Extra Medular Kesi Gaydýnýn Kullanýmý
Gaydýn Pozisyonlanmasý
Tibial Slopeun Ayarlanmasý
Rotasyonun Belirlenmesi
Kesim Seviyesinin Belirlenmesi
Tibial Kesimin Gerçekleþtirilmesi
Tibial Komponentin Belirlenmesi
Standart ve PS Mobile Insertlerin Yerleþtirilmesi
Femoral Stage
Femoral Safha
Prepare the Sizing Guide
Ölçüm Gaydýnýn Hazýrlanmasý
18
18
SURGICAL TECHNIQUE / CERRAHÝ TEKNÝK
IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ
Positioning of the Guide
18
Placing the Guide
19
Fixing the Guide
20
Gaydýn Konumlandýrýlmasý
Gaydýn Yerleþtirilmesi
Gaydýn Sabitlenmesi
Patella Stage
Patellar Safha
22
Patella Resurfacing Technique
22
Inset Patella Technique
24
Inserting the Test Femoral Component
24
Tibial Baseplate
25
Instruments&Trays
26
Patellanýn Yeniden Yüzeylendirilmesi Tekniði
Inset Patella Tekniði
Test Femoral Komponentin Yerleþtirilmesi
Tibial Baseplate
El Aletleri&Tavalar
Introduction
Giriþ
T08 Total Knee System is designed and developed for use in cemented and
cementless application of Total Knee arthroplasty.
T08 Total Diz Sistemi Total Diz artroplastisinde sementli ve sementsiz kullaným için
dizayn edilmiþ ve geliþtirilmiþtir.
The unique femoral cutting guide combines various functionalities in one component.
This enables the surgeon to shape the femur fast and accurate with only one guide
positioning and fixing.
Benzersiz femur kesi kýlavuzu ile birden çok iþlevi tek bir yapýda toplamaktadýr. Bu
sayede cerrah; kýlavuzu bir kez konumlandýrma ile gerekli 5 kesiyi hýzlý ve hatasýz yaparak
femuru uygun yapýya getirebilmektedir.
T08 Total Knee system offers mobile and fixed insert options. This enables the surgeon
to make the appropriate choice for the case.
T08 Total diz sistemi, hem mobil hem de sabit insertli (Bað kesen/Koruyan) opsiyonlarýný
sunmaktadýr. Bu sayede Cerrah vakanýn gerektirdiði en doðru seçeneði tercih edebilmektedir
Material
Malzeme
T08 Total Knee System manufactured from:
-CoCrMo alloy according to ISO 5832-4 for Femoral Components
-Tibial Components;
-CoCrMo alloy according to ISO 5832-4 for Mobile System
-TiAlV alloy according to ISO 5832-3 for Fix System
-PE-UHMW (Ultra High Molecular Weight Polyethylene crosslinked according to ISO
5834-1/2 for Patella and inserts.
T08 Total Diz Sistemi:
-Femoral komponentler ISO 5832-4 standartýna uygun CoCrMo alaþýmýndan
-Tibial komponentler;
-Mobile yapý için kullanýlan komponent ISO 5832-4 standartýna uygun CoCrMo
alaþýmýndan
-Fix yapý için kullanýlan komponent ISO 5832-3 standartýna uygun TiAlV
alaþýmýndan
-Patella ve insertler ISO 5834-1/2 standartýna uygun Ultra Yüksek Moleküler Aðýrlýklý
Polietilen (PE-UHMW) çapraz baðlý malzemeden imal edilmiþtir.
3
FEMORAL COMPONENT
Standard
Posterior Stabilizer
Cemented
Cemented
Standart
Posterior Kýsýtlatyýcýlý
Sementli
Ref. Number
Ref. Numarasý
Co.Cr-alloy
Co.Cr-alaþým
Sementli
Size
Ref. Number
Style
Ebat
Ref. Numarasý
Tip
Co.Cr-alloy
Co.Cr-alaþým
Size
Style
Ebat
Tip
10281013000
10281013001
10281013002
10281013003
10281013004
10281013005
0
1
2
3
4
5
Right/Sað
Right/Sað
Right/Sað
Right/Sað
Right/Sað
Right/Sað
10281213000
10281213001
10281213002
10281213003
10281213004
10281213005
0
1
2
3
4
5
Right/Sað
Right/Sað
Right/Sað
Right/Sað
Right/Sað
Right/Sað
10281023000
10281023001
10281023002
10281023003
10281023004
10281023005
0
1
2
3
4
5
Left/Sol
Left/Sol
Left/Sol
Left/Sol
Left/Sol
Left/Sol
10281223000
10281223001
10281223002
10281223003
10281223004
10281223005
0
1
2
3
4
5
Left/Sol
Left/Sol
Left/Sol
Left/Sol
Left/Sol
Left/Sol
TIBIAL COMPONENT
Standard/Standart
Cemented/Sementli
Ref. Number
Ref. Numarasý
Ti alloy
Ti alaþým
10253612000
10253612001
10253612002
10253612003
10253612004
10253612005
Mobile Bearing
Cemented/Sementli
Ref. Number
Ref. Numarasý
Size
Co.Cr alloy
Ebat
Co.Cr alaþým
0
1
2
3
4
5
10282613000
10282613001
10282613002
10282613003
10282613004
10282613005
4
Size
Ebat
0
1
2
3
4
5
TIBIAL INSERT FIXED
Standard/Standart
Posterior Kýsýtlayýcýlý
Ref. Number
Size
Thickness
Ref. Number
Size
Thickness
10281517008
10281517010
10281517012
10281517015
10281517018
10281517108
10281517110
10281517112
10281517115
10281517118
10281517208
10281517210
10281517212
10281517215
10281517218
10281517308
10281517310
10281517312
10281517315
10281517318
10281517408
10281517410
10281517412
10281517415
10281517418
10281517508
10281517510
10281517512
10281517515
10281517518
0
0
0
0
0
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
10281557008
10281557010
10281557012
10281557015
10281557018
10281557108
10281557110
10281557112
10281557115
10281557118
10281557208
10281557210
10281557212
10281557215
10281557218
10281557308
10281557310
10281557312
10281557315
10281557318
10281557408
10281557410
10281557412
10281557415
10281557418
10281557508
10281557510
10281557512
10281557515
10281557518
0
0
0
0
0
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
Ref. Numarasý
Ebat
Kalýnlýk
Ref. Numarasý
5
Ebat
Kalýnlýk
TIBIAL INSERT MOBILE BEARING
Standard/Standart
Posterior Kýsýtlayýcýlý
Ref. Number
Size
Thickness
Ref. Number
Size
Thickness
10282517008
10282517010
10282517012
10282517015
10282517018
10282517208
10282517210
10282517212
10282517215
10282517218
10282517408
10282517410
10282517412
10282517415
10282517418
0
0
0
0
0
2
2
2
2
2
4
4
4
4
4
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
10282557008
10282557010
10282557012
10282557015
10282557018
10282557208
10282557210
10282557212
10282557215
10282557218
10282557408
10282557410
10282557412
10282557415
10282557418
0
0
0
0
0
2
2
2
2
2
4
4
4
4
4
8
10
12
15
18
8
10
12
15
18
8
10
12
15
18
Ref. Numarasý
Ebat
Kalýnlýk
Ref. Numarasý
Ebat
Kalýnlýk
PATELLA
Standard
Re-Surfacing
Ref. Number
Size
Ref. Number
Size
10281717000
10281717001
10281717002
0
1
2
10281737000
10281737001
10281737002
10281737003
0
1
2
3
Ref. Numarasý
Ebat
Ref. Numarasý
6
Ebat
TIBIAL STEM
Ref. Number
Ref. Numarasý
Co.Cr alloy
Size
10282913025
10282913050
25
50
Co.Cr alaþým
7
Ebat
TIBIAL STAGE
TIBIAL SAFHA
USE OF INTRA-MEDULLARY CUTTING GUIDE
ÝNTRA MEDULAR KESÝ GAYDININ KULLANIMI
Drill a hole using the Drill 10 mm (Ref:
10606511100) bit from attached to tibia of
anterior cruciate ligaments.
10 mm çapýndaki drill (Ref:
10606511100) ile anterior Cruciate Ligamentin
yapýþtýðý yerden delik açýn.
Additional Info/Ek Bilgi
After drilling the tibia, it is possible to make use of the bit already assembled on the
power tool drill to drill the femoral hole.
Tibiayý delerken kullanmýþ olduðunuz drilli femuru delerken de kullanmanýz mümkündür.
Introduce the intramedullary rod
(Ref:10608021055) and the tibial support
(Ref:10608511125) as deep as possible into
the tibia. Lower the support the reach contact
with the prespinal surface.
Tibial destek (Ref:10608511125) ile
intramedülar rodu (Ref:10608021055), tibianýn
içine mümkün olduðunca derin bir þekilde
yerleþtirin. Sonrasýnda tibial desteði prespinal
yüzeyle temas edecek þekilde çakýn.
Fasten the tibial resection guide on the
tibial guides peak point with using the fixation
screw.
Tibial kesi gaydýný tibial gaydýn üzerine,
en üst noktada olacak þekilde fiksasyon vidasý
ile sabitleyin.
Insert the telescopic rod into the tube
of tibial guide.
Teleskopik rodu tibial gaydýn tüpü içine
takýn.
Insert the tibial guide with the into the
tibial support and firmly tighten the 3.5 screw
with the Screwdriver (Ref: 10604010065) to fix
the tibial support.
Tibial gaydý tibial desteðe takýn ve
yandaki vidayý 3.5 mm tornavidayla (Ref:
10604010065) sabitleyin.
8
Set the tibial slope at 0 degree by turning the frontal screw on the tibial guide.
Tibial gaydýn üzerindeki ön yüzdeki vidayý çevirerek tibial slopu 0 dereceye ayarlayýn.
Attention/Dikkat
Ensure that the screw located on to the tibial resection guide (Ref: 10612010101)
is directly facing the centre of the tibial plate (the junction of the internal third and two
external thirds of the tibial tuberosity)
Tibial kesi gaydýnýn (Ref: 10612010101) üzerindeki vidanýn direkt olarak tibial platein
merkezine doðru baktýðýna emin olun (Tibial tuberositinin internal 1/3ü ve eksternal 2/3ünün
kesiþme noktasý.)
SETTING THE TIBIAL SLOPE
TÝBÝAL EÐÝMÝN AYARLANMASI
Adjust the posterior slope between 0
and 10 degrees on the scale of the tibial
guide (Ref: 10608511151) by turning the frontal
thumbwhell switch of the guide anticlockwise.
Gaydýn ön tarafýndaki mekanizmayý
saat yönünün tersine döndürerek tibia gayd
(Ref: 10608511151) üzerindeki skalasýndan
posterior slopu 0 ile 10 derece arasýnda
ayarlayýn.
Attention/Dikkat
The tibial slope must be set before setting the height of cut.
Kesimin yüksekliðini belirlemeden önce tibial slopu belirleyiniz.
An excessive slope could damage the tibial insertion of the posterior cruciate
ligament.
Fazla verilen bir slop posterior baðýn tibial insersiyonuna zarar verebilir.
Extract the telescopic rod of the guide and ensure that the lower extremity end of
the rod is clearly matching the centre of the ankle.
Gaydýn teleskopik rodunu uzatýn ve rodun alt ucunun ayak bileði ekleminin merkezine
denk düþtüðüne emin olun.
9
SETTING THE LEVEL OF THE CUT
KESÝMÝN SEVÝYESÝNÝN BELÝRLENMESÝ
Place the tibial stylus (Ref: 10608511172)
on the tibial resection guide on the side where
tibial resection is expected to be greatest.
Place the tibial stylus 0 mm if measurement
is performed medially or place it 8 mm if
measurement is performed laterally.
Tibial stylusu (Ref: 10608511172) tibial
kesi gaydýnýn üzerine, tibial kesimin yapýlacaðý
yönden yerleþtirin. Tibial ölçüm medialden
yapýlacaksa stylus 0 a lateralden yapýlacaksa
8 mmye konumlandýrýlýr.
Ensure a sufficient cut of the controlateral compartment with the assistance of
the Blade Runner (Ref: 10608511173). ýf
necessary use the micrometer adjustment
screw to adjust the level of the cut.
Blade Runner (Ref: 10608511173)
yardýmýyla contro-lateral kompartýmanýn yeterli
bir seviyede kesileceðine emin olun. Gerektiði
hallerde mikrometrik ayarlama vidasýnýn
yardýmýyla yapýlacak kesimin seviyesini
ayarlayýn.
Drill the two inferior holes located on
each side of the fixation screw of the tibial
resection guide and inroduce two pins,
diameter 3.2 mm (Ref: 10606520570).
Tibial kesi gaydýnýn fiksasyon vidasýnýn
her iki tarafýnda bulunan alltaki iki deliði 3.2
mm drill ile delin ve çapý 3.2 mm lik iki çiviyi
buraya çakýn.
Release the tibial resection guide
fixation screw.
Tibial kesi gaydýnýn fiksasyon vidasýný
gevþetin.
10
Withdraw the intramedullary rod and remove the tibial guide and tibial support
together.
Ýntramedüller rodu çekerek çýkartýn, tibial gaydý ve tibia desteði birlikte çýkartýn.
Place the tibial resection guide in contact with the tibia, sliding it on the two pins.
Tibial kesi gaydýný tibiayla temas edecek þekilde, iki çivinin üzerinden kaydýrmak
suretiyle yaklaþtýrýn.
After drilling the tibial cutting guides
other fixing hole with the 3.2mm drill, fix the
tibial cutting guide with 3.2 mm nail (Ref:
10606520255).
Tibial kesi gaydý üzerindeki diðer
sabitleme deliðini 3.2 mm drill ile deldikten
sonra 3.2 mmlik çivinin (Ref: 10606520255)
yardýmýyla sabitleyin.
11
USE OF THE EXTRA-MEDULLARY ALIGNMENT GUIDE
EXTRA MEDULAR KESÝ GAYDININ KULLANIMI
Assembly of the upper part
Gaydýn üst kýsmýnýn kurulumu
Fasten the tibial resection guide on the tibial guides peak point with using the
fixation screw.
Tibial kesi gaydýný tibial gaydýn üzerine, en üst noktada olacak þekilde fiksasyon vidasý
ile sabitleyin.
Insert the tibial guide with the into the tibial support and firmly tighten the 3.5 screw
with the screwdriver to fix the tibial support.
Tibial gaydý tibial desteðe takýn ve yandaki vidayý 3.5 mm tornavidayla sabitleyin.
Set the tibial slope at 0 degree by turning the frontal screw on the tibial guide.
Tibial gaydýn üzerindeki ön yüzdeki vidayý çevirerek tibial slopu 0 dereceye ayarlayýn.
Assembling of the lower part
Gaydýn alt kýsmýnýn kurulumu
Tibial
guide
attachment
(Ref:10608511152), tibial guide-malleolar
pincer (Ref:10608511153) and tibial guidemalleolar
pincer
attachment
(Ref:10608511154) are mounted reference 0
mm.
Tibial gayd uzatma parçasý
(Ref:10608511152), tibial gayd malleolar pincer
(Ref:10608511153) ve tibial gayd malleolar
pincer baðlantý parçasý (Ref:10608511154) 0
mm referans alýnarak monte edilir.
POSITIONING OF THE GUIDE
GAYDIN POZÝSYONLANMASI
Position the lower part of the guide
taking care that the malleolar pincer is exactly
facing the centre of the ankle joint.
Gaydýn alt kýsmýný malleolar pincer tam
olarak eklem baðýnýn merkezine bakacak
þekilde pozisyonlandýrýn.
12
Insert the tibial guide into the
extramedular guide. Let the upper and lower
part of the extramedular guide free to slide
into each other.
Tibial gaydý, ekstramedular gaydýn içine
yerleþtirin. Tibial aparatýn yukarý ve aþaðý
bölümlerini birbirinin içine doðru serbestçe
kayacak bir þekilde býrakýn.
Slightly hammer the first spike at the
centre of the tibia, leavng free the second
one. Approach the resection guide at a
distance of approximately 5 mm from the
tibila epiphysis by sliding the upper part of
the tibial guide on the tibial support.
Tibial destek kolundaki çiviyi tibial
platoya çakýn, ikincisini boþta býrakýn. Kesi
gaydýna , tibial epipihysisten yaklaþýk 5 mmlik
bir uzaklýktan tibial gaydýn üst kýsmýný tibial
desteðe kaydýrarak yaklaþýn.
SETTING THE TIBIAL SLOPE
TÝBÝAL SLOPUN AYARLANMASI
Additional info/Ek bilgi
Tibial slope will be set according to
patients anatomy by moving the lower part
of the extramedular guide.
Tibial slop, hastanýn anatomisine baðlý
olarak, ekstramedular gaydýn alt kýsmýnýn
hareket ettirilmesi sonucunda belirlenir.
Attention/Dikkat
The tibial slope must be set up before setting the level of cut.
Kesimin seviyesi belirlenmeden önce tibial slop belirlenmelidir.
Until the definitive correct position of the resection guide has not been defined the
upper and lower part of the tibial ancillary should remain free to slide into each other.
Kesi gaydýnýn nihai pozisyonlandýrýlmasý belirlenene dek tibial aparatýn yukarý ve
aþaðý bölümleri birbirine doðru rahatça kayabilecek þekilde serbest býrakýlmalýdýr.
An excessive slope choice could damage the tibial insertion of the posterior cruciate
ligament.
Haddinden fazla bir slop seçimi posterior cruciate ligamentin tibial insersiyonuna
zarar verebilir.
13
SETTING THE ROTATION
ROTASYONUN BELÝRLENMESÝ
The control of the rotation of the
resection guide can be done taking the
fixation screw as reference for the center of
the guide. the screw should face the center
of the tibia.Also check that the lower part is
correctly centred on the mid point of the
ankle joint. The long pin can now be
hammered and fixed in the tibial surface.
Kesi gaydýnýn rotasyonunun kontrolü
gaydýn ortasýndaki fiksasyon vidasý referans
alýnarak yapýlýr. Vida tibianýn merkezi yönüne
bakmalýdýr. Bunlara ilaveten aþaðý kýsmýn ayak
bileði ekleminin merkezine doðru ortalanarak
konumlandýrýldýðý da kontrol edilmelidir. Bu
noktadan sonra uzun çivi tibianýn yüzeyine
çakýlarak sabitlenebilir.
SETTING THE LEVEL OF THE CUT
KESÝM SEVÝYESÝNÝN BELÝRLENMESÝ
Place the tibial stylus (Ref: 10608511172)
on the tibial resection guide on the side where
tibial resection is expected to be greatest.
Place the tibial stylus 0 mm if measurement
is performed medially or place it 8 mm if
measurement is performed laterally.
Tibial stylusu (Ref: 10608511172) tibial
kesi gaydýnýn üzerine, tibial kesimin yapýlacaðý
yönden yerleþtirin. Tibial ölçüm medialden
yapýlacaksa stylus 0a lateralden yapýlacaksa
8 mmye konumlandýrýlýr.
Ensure a sufficient cut of the controlateral compartment with the assistance of
the Blade Runner. ýf necessary use the
micrometer adjustment screw to adjust the
level of the cut.
Blade Runner yardýmýyla contro-lateral
kompartýmanýn yeterli bir seviyede
kesileceðine emin olun. Gerektiði hallerde
mikrometrik ayarlama vidasýnýn yardýmýyla
yapýlacak kesimin seviyesini ayarlayýn.
Drill the two inferior holes located on each side of the fixation screw of the tibial
resection guide and inroduce two pins, diameter 3.2 mm (Ref: 10606520570).
Tibial kesi gaydýnýn fiksasyon vidasýnýn her iki tarafýnda bulunan alltaki iki deliði 3.2
mm drill ile delin ve çapý 3.2 mmlik iki çiviyi (Ref: 10606520570)buraya çakýn.
14
Release the tibial resection guides fixation screw.
Tibial kesi gaydýnýn fiksasyon vidasýný gevþetin.
Withdraw the extramedullary guide and remove the tibial guide and tibial support
together.
Ekstramedular gaydý çýkartýn, tibial gaydý ve tibia desteði birlikte çýkartýn.
Attention/Dikkat
While tibial guide and extramedullary guide is being removed ensure that tibial
resection guide is not moving.
Tibial gaydýn ve ekstramedular gaydýn sökülmesi sýrasýnda tibial kesi gaydýnýn yerinden
oynamamasýna dikkat edilmelidir.
Place the tibial resection guide in
contact with the tibia, sliding it on the two
pins.
Tibial kesi gaydýný tibiayla temas edecek
þekilde, iki çivinin üzerinden kaydýrmak suretiyle
yaklaþtýrýn.
After drilling the tibial cutting guides
other fixing hole with the 3.2mm drill, fix the
tibial cutting guide with 3.2 mm nail (Ref:
10606520255).
Tibial kesi gaydý üzerindeki diðer
sabitleme deliðini 3.2 mm drill ile deldikten
sonra 3.2 mmlik çivinin (Ref: 10606520255)
yardýmýyla sabitleyin.
REALISATION OF TIBIAL CUT
TÝBÝAL KESÝMÝN GERÇEKLEÞTÝRÝLMESÝ
Perform the tibial cut using the saw
blade.
Býçak aracýlýðýyla kesimi gerçekleþtirin.
Attention/Dikkat
Saw Blade to be used for cutting must
be 1.2 mm thickness. To use a thinner blade
makes imporer cutting.
Kesim esnasýnda kullanýlan býçaðýn
kalýnlýðý 1.2 mm olmalýdýr. Kesim için daha ince
bir býçak kullanýlmasý kesimde hataya sebep
olacaktýr.
CHOOSING THE TIBIAL COMPONENT
TÝBÝAL KOMPONENTÝN BELÝRLENMESÝ
Choose the size of tibial component using the trial baseplates.
Deneme baseplatelerini kullanarak tibial komponentin uygun boyunu seçin.
15
To strengthen the fit of the tibial trial
baseplate and avoid translation movements
during the preparation of the keel, put in
place two 2.7 pins (Ref: 10606520130) in the
holes of the trial tibial baseplate located
posteriorly. Then barrel is mounted on the trial
baseplate and drilling process is performed
with 10 mm drill.
Tibia deneme baseplateinin tam olarak
yerine oturmasýný saðlamak ve keel yuvalarýnýn
hazýrlanmasý sýrasýnda ortaya çýkacak
translasyon hareketini önlemek için deneme
tibial baseplateine posterior olarak
konumlandýrýlmýþ iki deliðe 2.7 mmlik iki adet
pini (Ref: 10606520130) yerleþtirin. Daha sonra
deneme baseplatei üzerine Barrel monte
edilerek 10 mm lik Drill ile delme iþlemi
gerçekleþtirilir.
Attention/Dikkat
If tbial stem is not used, perform drilling up to first line on the drill. If tibial stem is used,
perform drilling up to second line
Delme iþlemi tibial stem kullanýlmadýðý durumlarda drill üzerindeki ilk çizgiye kadar,
tibial stem kullanýlacaðý durumlarda ikinci çizgiye kadar yapýlmalýdýr.
After drilling, assemble the Slide
Hammer Attachment (Ref: 10608521033), the
Puncher (Ref: 106085210 . . )and the Slide
Hammer (Ref: 10608521032) together thus
create the frame of the keel.
Delme iþlemi yapýldýktan sonra Hareketli
Çakýcý-Çýkarýcý Ucu (Ref: 10608521033),
Puncher (Ref: 106085210 . . ) ve Hareketli
Çakýcý-Çýkarýcý (Ref: 10608521032) birbirine
monte edilerek keelin dýþ hatlarýný oluþturun.
When adding an tibial stem after using
the puncher itself, the test tibial stem of the
chosen length must be screwed to the end
of the puncher and the whole unit introduced
through the trial baseplate to prepare the
path for the tibial stem.
Puncherý kullanýldýktan sonra ilaveten
bir tibial stemin eklenmesi gerektiði hallerde
seçilen boyun testi punchera vidalanmalý ve
tüm aparat tial steme gerekli yolu açmak
için deneme baseplateinin içine
yerleþtirilmelidir.
16
Place a appropriate size trial insert and mount the test tibial component handle
to the baseplate
Uygun test inserti yerleþtirin ve Test Tibial Komponent Tutucuyu baseplatee monte
edin.
Assess tibial correction of the knee in
extension. Control the orthogonal aspect of
the tibial cut by introducing the centromedullary rod in one of the holes at the
extremity of the trial baseplate handle.
Ekstensiyon halindeki dize gereken tibial
düzeltme iþlemini yapýn. Deneme
baseplateinin tutacacaðýný ucunda bulunan
deliklerden birine merkezi-medüller rodu
yerleþtirmek suretiyle tibial kesimin orthogonal
görünümünü elde edebilirsiniz.
In order to pre-select the size of tibial insert, the resected part of the tibia may be
superimposed on the trial baseplate.
Tibial insert ün boyunu önceden belirleyebilmek için tibianýn kesilmiþ bölümünü
deneme baseplateiyle üstüste koyun.
ASSEMBLY OF THE STANDARD AND PS MOBILE TEST INSERTS
STANDART ve PS MOBIL BEARING TEST INSERTLERÝN YERLEÞTÝRÝLMESÝ
17
FEMORAL STAGE
FEMORAL SAFHA
PREPARE THE SIZING GUIDE
ÖLÇÜM GAYDININ HAZIRLANMASI
Fix the handle (Ref: 10608021051) on the femoral anterior sizing guide (Ref:
10608021050).
Tutma kolu (Ref: 10608021051) Femoral anterior ölçüm gaydýna (Ref: 10608021050)
takýlýr.
Introduce the Intramedular rod through the orientation hole and set the femoral
valgus (right or left side) with pulling the orientation pin (established from the pre-operative
planning). Place the posterior wedge 3 ° (Ref: 10608521023) on medial.
Intramedülar rodu oryantasyon deliði yardýmýyla yerleþtirin ve ameliyat öncesi
planlamada belirlenmiþ olan açý derecesinde oryantasyon mandalýný çekin, femoral
valgusu ayarlayýn ve býrakýn. 3 ° dýþ rotasyon kamasýný (Ref: 10608521023) mediale
konumlandýrýn.
Fix the anterior sizing stylus to the femoral anterior sizing guide (left or right bone
laterally)
Anterior ölçüm stylusunu femoral anterior ölçüm gaydýna takýn. (sað veya sol kemiðin
lateraline)
POSITIONING OF THE GUIDE
GAYDIN KONUMLANDIRILMASI
Flex the knee to 90 degree. Drill, using
the gauged 10 mm diameter drill in the axis
of the femur, immediately up front the femoral
insertion of the Posterior Cruciate Ligament.
Ameliyat edilecek dizi 90 derecelik bir
açýya getirin. 10 mm çapýndaki drill i
kullanarak femur eksenini hemen posterior
Cruciate Ligamentin önündeki femur
insersiyonundan delmeye baþlayýn.
18
PLACING THE GUIDE
GAYDIN YERLEÞTÝRÝLMESÝ
Fix the femoral anterior sizing guide to the femur with using intramedular rod. Measure
the bone size with stylus on the anterior side. Measuring of femoral anterior sizing guide
and measuring of scale on stylus must be matched. Verify the measuring with using femoral
anterir sizing guide control attachment. Then make sure there is a contact between guide
and posterior and distal edge of the condyles.
Femoral anterior ölçüm gaydý intramedular rod ile femur a takýlýr. Anteriordan stylus
ile ölçüm yapýlýr. Femoral anterior ölçüm gaydý üzerinde okunan ölçü ile Stylus üzerindeki
skalada bulunan ölçü birbiri ile eþleþmelidir. Kontrol sacý yardýmýyla ölçüm gaydýnýn yan
kýsmýnda bulunan referans kanallarýndan ölçüm doðrulamasý yapýlýr. Son aþama olarak
gaydýn, kondilin posterior ve distaline temas ettiðinden emin olunuz.
Hammer two Ø4.00 mm nails (Ref: 10606520670) into femur through the reference
holes on the femoral anterior sizing guide and remove the intramedular rod and femoral
anterior sizing guide.
Femoral anterior ölçüm gaydý üzerindeki referans deliklerinden femura 2 adet Ø4
(Ref: 10606520670) çivi çakýlýr ve ölçüm gaydý ve intramedular rod çýkarýlýr.
19
FIXING THE GUIDE
GAYDIN SABÝTLENMESÝ
Fix the femoral anterior sizing guide and determined size cutting guide onto the
nails. Then mount the Femoral Cutting Guide Attachment (Ref: 10608521012) on the
assembly. Fix the Femoral Cutting Guide Attachment on the peak point of the cortex with
the two 2.7 mm pins.
Femoral anterior ölçüm gaydý ile belirlenen ölçüdeki kesi gaydý referans çivilerinin
üzerinden takýlýr, sonra Femoral Kesi Gaydý Sabitleme Kolu (Ref: 10608521012) takýlýr.
Sabitleme kolu korteksin en tepe noktasýna 2 adet 2.7 mmlik çivi ile sabitlenir.
Check for the last time that posterior
and distal contact with the condyles is
ensured.
Son birkez , kondiller ile posterior ve
distal temasýn gerçekleþtiðini kontrol edip
temastan emin olun.
Fix the guide laterally and medially with
Ø3.2 mm nails in four places (During the fixing
process cutting block must be immobile).
Femoral kesi bloðu lateralden ve
medialden Ø 3.2 mm çiviler ile 4 yerden
sabitlenir. (Bu iþlem sýrasýnda kesi bloðu
kesinlikle hareket etmemelidir.)
Femoral cuts in the following order:
Kesi sýralamasý þu þekilde olmalýdýr:
1- Anterior
2- Posterior
3- Anterior Chamfer
4- Posterior Chamfer
5- Distal (8 mm)
1
2
Attention/Dikkat
After anterior and posterior cuts performed referans nails are removed and cutting
is continued.
Anterior ve Posterior kesiler yapýldýktan sonra referans çivileri sökülerek diðer kesilere
devam edilir.
20
3
4
Check that all cuts correctly performed. The implant will be ready for application.
Distal kesim tamamlandýðýnda femur implant uygulamaya hazýr olur.
5
Remove the nails.
Çivileri sökün.
Remove the cutting block.
Kesi bloðunu çýkartýn.
Saw Blade to be used for cutting must be 1.2 mm thickness. To use a thinner blade
makes imporer cutting
Kesim esnasýnda kullanýlan býçaðýn kalýnlýðý 1.2 mm olmalýdýr. Kesim için daha ince
bir býçak kullanýlmasý kesimde hataya sebep olacaktýr.
FEMUR
21
PATELLA STAGE
PATELLAR SAFHA
PATELLA RESURFACING TECHNIQUE
PATELLANIN YENÝDEN YÜZEYLENDÝRÝLMESÝ TEKNÝÐÝ
Lock the patella resection guide into the universal patella clamp. After carefully
releasing the periphery of the patella, position the resection guides at the appropriate
resection level, with the assistance pf the patellar stylus and firmly lock.
Patella kesi gaydýný patella kýskacýna kenetleyin. Dikkatli bir þekilde patellanýn
periferisini serbest býraktýktan sonra patellar stylusun yardýmýyla kesi gaydlarýný uygun kesim
seviyesinde konumlandýrýn ve kýskacý, saðlamca kilitleyin.
Perform the patellar cut through the slots of the resection guides.
Kesim gaydýnýn oluklarý içinde patellar kesimi gerçekleþtirin.
Open the patellear clamp, remove the
two resection guides and position the spike
jaw and drilling template.
Patella kýskacýný açýn, iki kesi gaydýný da
yerinden çýkartýn ve spike jaw ve delici þablonu
konumlandýrýn.
Apply the drilling template on the
resected surface of the patella and drill three
holes with the 5 mm diameter drill guide.
Delici þablonu patellanýn kesilmiþ olan
yüzeyine uygulayýn ve 5mm çaplý delici gayd
yardýmýyla üç adet delik açýn.
Remove the drill guide, select the
correct size of trial patella and put in place.
Four sizes are available (0,1,2,3).
Kesici gaydý yerinden çýkartýn, deneme
patellalarýnýn arasýndan doðru boyu seçin ve
yerine oturtun. (dört deðiþik ölçüsü mevcuttur
: 0,1,2,3)
22
INSET PATELLA TECHNIQUE
ÝNSET PATELLA TEKNÝÐÝ
Select the size of patella using the
different barrels (Ref: 106085305..).
Farklý ölçülerdeki barelleri (Ref:
106085305..) kullanarak patellanýn ebatýný
belirleyin.
Lock the corresponding guide of the
selected diameter on the patellar clamp
equipped with its spike jaws.
Sivri uçlarý olan patella kýskacýný uygun
çaptaki gayda kenetleyin.
Ensure that the reaming depth ring is
correctly adjusted. ýntroduce the reamer of
corresponding diameter into the guide and
ream until contact is made between the ring
of the reamer and the upper part of the
guide. If the reamer depth is inadequate, it
is possible to increase this by raising the reamer
ring.
Oyucu derinlik halkasýnýn doðru bir
þekilde ayarlandýðýna emin olun. Uygun
çaptaki oyucuyu gayda yerleþtirin ve oyucu
ile gaydýn üst kýsmý temas edene dek
uygulayýn. Eðer delinecek derinlik yetersiz ise
oyucu halkasý kaldýrýlarak derinlik arttýrabilir.
15
Place the trial patella, holding it with
the two jaws expressly designed to this
purpose mounted on the clamp.
Deneme patellasýný kýskacýn üzerine bu
amaçla yerleþtirilmiþ olan jawlardan tutarak
yerleþtirin.
23
Attention/Dikkat
The reaming power tool must be operated once the reamer has been completely
introduced into the guide. In order to reduce any risk of fracturing the patella, reaming
must be performed with caution at low speed, keeping the patellar clamp closed.
Oyucu motor, oyucu ancak gaydýn içine tamamen yerleþtirildikten sonra çalýþtýrýlmalýdýr.
Patellanýn kýrýlma riskini ortadan kaldýrmak için oyma iþlemi dikkatlice en düþük güçte;
patella kýskacý kapalý haldeyken yapýlmalýdýr.
INSERTÝNG THE TEST FEMORAL COMPONENT
TEST FEMORAL KOMPONENTÝN YERLEÞTÝRÝLMESÝ
Position the described test femoral component to the femoral component impactor
(Ref: 10608521105) . Hammer the test femoral component to the femur wit using slide
hammer.
Belirlenen test femoral komponenti Femoral Komponent Çakýcýya (Ref: 10608521105)
yerleþtirin. Hareketli çakýcý-çýkarýcýyý kullanarak test femoral komponenti femura çakýn.
Drill the peg holes on trial femoral component with Ø7 mm (Ref: 10606511070)drill.
Test femoral komponent üzerindeki deliklerden Ø7 mm (Ref: 10606511070) drill ile
peg deliklerini açýn.
24
Check correct alignment of the lower limb, introducing the intramedular rod into
the test tibial component handle.
Ýntramedular rodu test tibial komponent tutucu içerisinden geçirerek aks açýlarýný
kontrol edin.
TIBIAL BASEPLATE
May be position 25 or 50 mm extension.
If has been considered necessary, the
baseplate should be screwed.
25 ve 50mm uzatma takýlabilir. Gerekli
durumlarda tibial base plate vida ile
sabitlenebilir.
25
Instruments & Trays/El Aletleri & Tavalar
Tibia instrument tray 1
Tibia el aletleri tava 1
Femur instrument tray 1
Femur instrument tray 2
Femur el aletleri tava 1
Femur el aletleri tava 2
26
Pens
Çivi Tutucu Pense
Screw Driver
Tornavida / 3,5
Drill Adaptor
Drill Tutucu Adaptör
Drill Bit
Drill / Ø3,2
Drill Bit
Drill / Ø5
Drill Bit
Drill / Ø7
Drill Bit
Drill / Ø10
Nail
Çivi / Ø2,7X40
Nail
Çivi / Ø3,2X55
Nail
Çivi / Ø3,2X70
Nail
Çivi / Ø4,0X70
Impactor Bar
Çakýcý Pimi
Universal Femoral Component Impactor
10607150005
Üniversal Femoral Komponent Çakýcý
Femoral Anterior Sizing Guide
Femoral Anterior Çivi Ölçüm Gaydý
27
10608021051
Femoral Anterior Sizing Guide Handle
10608021053
Femoral Anterior Sizing Guide Control Attachment
Femoral Anterior Ölçüm Kaydý Tutma Kolu
Femoral Anterior Ölçüm Kaydý Kontrol Sacý
Intramedular Rod for Tibia
Intramedular Rod / Tibia
Posterior stabilisation Shaft Peg for Test Tibial Insert
Test Tibia Ýnsert Posterior Stabilizasyon Parçasý
Test Tibial Component
Test Tibial Komponent
0
1
2
3
4
5
Test Tibial Component Handle
Test Tibial Komponent Tutucu
Barrel
Barrel
Tibial Support
Tibial Destek Parçasý
Tibial Guide
Tibial Gayd
Tibial Guide Attachment
Tibial Gayd - Uzatma Parçasý
Tibial Guide - Malleoler Pincer
Tibial Gayd - Malleoler Pincer
Tibial Guide - Malleoler Pincer Attachment
Tibial Gayd - Maleoler Pincer Baðlantý Parçasý
Telescope
Teleskop
28
Tibial Stylus
Tibial Stylus
Blade Runner
Blade Runner
Tibial Component Impactor
Tibial Komponent Çakýcý
Test Tibial Stem
Test Tbial Stem
25
50
Notching Intsrument
Yuva Açýcý
Distal Wedge
Distal Wedge
Anterior Chamfer Wedge
Anterior Chamfer Wedge
Femoral Cutting Guide Attachment
Femoral Kesi Gaydý Sabitleme Kolu
Posterior Wedge
Posterior Kama / 3°
Slide Hammer
Hareketli Çakýcý - Çýkarýcý
Slide Hammer Attachment
Hareketli Çakýcý - Çýkarýcý Ucu
Puncher
Puncher
0-1
2-3
4-5
Femoral Component Impactor
Femoral Komponent Çakýcý
29
Patellar Clamp
Patella Tutucu
Spike Jaw
Patella Sivri Uçlu Çene
Patella Recection Guide
Patella Kesi Gaydý
Right / Sað
Left / Sol
Pressurizing Jaws
Patella Bastýrýcý Çene
Dirilling Template
Patella Delik Þablonu
Barrel
Barrel
0
1
2
Patella Reamer
Patella Oyucu
0
1
2
Patella Stylus
Patella Stylus
Calliper Gauge
Kumpas
Test Tibial Insert / 0
Test Tibia Insert / 0
30
Posterior stabilisation Shaft for Test
Femoral Component
T08 Test Femoral Komponent Posterior
Stabilizasyon Þaftý
Test Femoral Component
TTest Femoral Komponent
Right / Sað 0
Right / Sað 1
Right / Sað 2
Right / Sað 3
Right / Sað 4
Right / Sað 5
Left / Sol 0
Left / Sol 1
Left / Sol 2
Left / Sol 3
Left / Sol 4
Left / Sol 5
Test Patella Component
Test Patella Komponent
0
1
2
31
Test Re-Surfacing Patella Component
Test Re-Surfacing Patella Komponent
0
1
2
3
Femoral Cutting Guide
Femoral Kesi Gaydý
0
1
2
3
4
5
90° Resection Guide
90° Tibial Kesi Gaydý
10608610008
10608610010
10608610012
10608610015
10608610018
Mobile Bearing Test Tibial Insert / 0
MB Test Tibia Insert / 0
10608610208
10608610210
10608610212
10608610215
10608610218
10608610408
10608610410
10608610412
10608610415
10608610418
Mobile Bearing Punch Handle
MB Test Tibial Komponent Çakýcý - Çýkarýcý Ucu
Mobile Bearing Test Tibial Component
MB Test Tibial Komponent
0
1
2
3
4
5
32
Revision 03 / Printed in TURKEY - 09/11 - TIPSAN Design
The products being manufactured by TIPSAN A.S. has been certified from SZUTEST (Strojírensk
Zkuební Ústav) for EC certificate (CE 1015) according to Annex II. 3 and II.4 of Council Directive
93/42/EEC concerning medical devices
Kemalpasa Cd. 7404/1 Sk. No: 3 Pinarbasi - IZMIR - TURKEY
Tel: +90 232 479 56 54 Fax: +90 232 479 58 27
[email protected] www.tipsan.com.tr

EN_TR_T08 Knee Prosthesis Surgical Technique.FH11

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