1、Codman Valves for HydrocephalusCodman Valves for HydrocephaluThe Hakim Valve mechanismTechnology developed to provide long-term accuracy and reliability in valve performance.Hakim閥能保持長(zhǎng)期的精確性和穩(wěn)定性The Hakim Valve mechanismTechnOriginal Valve最初的閥門Original Valve最初的閥門Long valve sometimes a “pain in the nec

2、k”Long valve sometimes a “pain MicroValve顯微閥門MicroValve顯微閥門MicroValve + RickhamMicroValve + RickhamHakim shunt housing developmentHakim shunt housing developmenHakim ValvesHakim ValvesHakim ValveIs available asValve only單一閥門System (with separate catheters) 系統(tǒng)（帶單獨(dú)的導(dǎo)管）Unitised system合成系統(tǒng)Valve with pre

3、-attached distal catheter and separate ventricular catheter帶預(yù)置裝置的遠(yuǎn)端導(dǎo)管與閥門，以及獨(dú)立的腦室導(dǎo)管Hakim ValveIs available asHakim ValveLets talk about the valve mechanism 讓我們討論閥門機(jī)械裝置Hakim ValveLets talk about theMicroValve顯微閥門MicroValve顯微閥門MicroValve顯微閥門Ruby ball and collar紅寶石球Flat spring彈簧片Spring pillar彈簧柱Micro ad

4、justable fulcrum顯微調(diào)節(jié)支點(diǎn)MicroValve顯微閥門Ruby ball and coHakim precisionHakim precisionFlow through designFlow through designMicroValveAnti reflux valve防逆流閥Pre-chamber前腔To stop reverse flow防止倒流Injection inSampling outPumping注射取樣泵MicroValveAnti reflux valvePreHakim valve constructionHakim valve constructi

5、onAnti reflux mechanism防逆流裝置Anti reflux mechanism防逆流裝置No longer required不再需要Reflux pressure presses the ball down onto the collar closing the valve逆流壓力將球壓入軸環(huán)關(guān)閉閥門No longer required不再需要Reflux pMicroValve微型閥門Accurate to +/- 1mm H2O 精確度+/-1mm水柱Quoted and independently verified to +/-10mm H2OFlat pressur

6、e / flow curve水平壓力/流量曲線MicroValve微型閥門Accurate to +/- Pressure definition壓力定義areaatmospheric pressure大氣壓力hydrostatic pressure流體靜壓weightarea=area g h h Pressure definition壓力定義areaatFlow definition流量定義Flow流量 p壓力差Resistance阻力= pFlow definition流量定義Flow p壓力差Flow in a shunt is controlled by the pressure di

7、fferential分流管內(nèi)的流量是由壓力差控制的pFlow in a shunt is controlled Opening pressures (mm H20)050100150200250HAKIMPrecisionValveCORDISHAKIMP-SMEDICALP-SMEDICALP-SMEDICALOpening pressures開放壓力Opening pressures (mm H20)0Opening pressures開放壓力Means what it saysSo a wide band means you are not sure at what pressure t

8、hat valve will open給定的是一壓力范圍意味著你不能確定閥門究竟在哪個(gè)壓力下開放Customers feel it is an operating band顧客感覺是一壓力帶But there is no top and bottom沒有上下限Only a bottom只有基線This helps customers know what they are implanting - if performance is reliable Opening pressures開放壓力Means whaOpening pressuresMaybeBut the thrust of our

9、 argument is that they should think about it more爭(zhēng)論的焦點(diǎn)將是醫(yī)生必須考慮更多Their decisions affect the quality of the whole of a childs life醫(yī)生的決定影響一個(gè)孩子一生的生命質(zhì)量Is a 50% revision rate good enough? 50的翻修率夠好嗎？Next logical step in this argument is Programmability下一個(gè)討論焦點(diǎn)是閥門的可調(diào)性O(shè)pening pressuresMaybeOpening pressures (

10、mm H20)050100150200250HAKIMPrecisionValveCORDISHAKIMP-SMEDICALP-SMEDICALP-SMEDICALHOLTEROpening pressuresOpening pressures (mm H20)0Pressure responsive or Flow responsive?Some of our competitors confuse the doctors by suggesting one mechanism is superior to the other.我們的競(jìng)爭(zhēng)對(duì)手常誤導(dǎo)醫(yī)生，為了證明其閥門優(yōu)于其它“Ah but

11、yours is not a flow responsive system” “他們不是流量響應(yīng)系統(tǒng)”The truth is a little more simplePressure responsive or Flow rPressure responsive or Flow responsive?Flow occurs when there is a pressure differential當(dāng)有壓力差時(shí)才會(huì)產(chǎn)生液體流動(dòng)It is the case that flow can add to that pressure but a pressure responsive valve res

12、ponds to that pressure how ever it is generated事實(shí)上流速會(huì)增加壓力但壓力響應(yīng)系統(tǒng)只對(duì)應(yīng)產(chǎn)生時(shí)的壓力Pressure responsive or Flow rPressure responsive or Flow responsive?There is only one valve that can claim to be a flow responsive mechanism只有一種閥門稱得上是流量響應(yīng)閥門BUT但是Clinical studies have shown it makes no difference臨床試驗(yàn)證明并無多大區(qū)別Does

13、 that stop doctors pontificatingNot a chance!Pressure responsive or Flow rFlowHakim designed to react to pressure not flow Hakim設(shè)計(jì)反映的是壓力而非流量He wanted a pressure / flow curve that was a straight line他希望的壓力/流量曲線是一條直線This was an idea behind his original design這是設(shè)計(jì)者的初衷 Improved upon with the Precision隨著

14、精確性而不斷提高The achievement of his goal is confirmed by the UK MDA report這一結(jié)果得到了英國(guó)MDA的認(rèn)證FlowHakim designed to react toArtefactMetal in the valve will show on a scanMRI or CT 閥門的金屬會(huì)在CT或MRI有偽影The artefact is not usually in the area to be studied但通常并不影響研究“But it has metal in it!”Yes, thats because we find

15、it gives better and more predictable performance in the long term金屬能保證長(zhǎng)期的穩(wěn)定性和可預(yù)見性Silicone can calcify - 52% underdrainage?!硅橡膠會(huì)鈣化導(dǎo)致52引流不夠ArtefactMetal in the valve wilProgrammability可調(diào)性Shunt registry tells us 55% revisions are pressure related注冊(cè)證上顯示的是55的翻修率Patients needs change患者需要調(diào)整壓力Shunt misbehav

16、esHakim Programmable has 18 pressure Hakim可調(diào)壓閥共有18級(jí)調(diào)壓范圍From 30mm to 200mm H2O 從30mm水柱到200mm水柱Programmability可調(diào)性Shunt regisProgrammingProgrammingCombining high quality bio-compatible materials with expertise in micro-machining and micro-assembly.高質(zhì)量的生物相容性材料與專業(yè)的顯微 制造技術(shù)的完美結(jié)合Combining high quality bio-c

17、omHakim programmableHakim programmableProgramming the valveThe programmer head emits a series of magnetic pulses that control the angular position of the valve rotor調(diào)壓器發(fā)出的一系列磁脈沖控制轉(zhuǎn)軸的角度This allows the valve opening pressure to be adjusted non-invasively保證無侵襲地調(diào)整開放壓力12Programming the valveThe progrHow

18、does it work ?Rotor轉(zhuǎn)子Magnet磁鐵valve base plateStator固定片rotor axis轉(zhuǎn)軸10 magnets are integrated in the rotor轉(zhuǎn)子中共有10個(gè)磁極a cross shaped stator is integrated in the base plate十字形固定片固定在底座上 this system constitutes a stepping motor, that can be activated by an external magnetic field系統(tǒng)還包含一個(gè)步進(jìn)馬達(dá)，可被外部磁場(chǎng)激活How doe

19、s it work ?Rotor轉(zhuǎn)子MagneValve positioning for easy programmingValve positioning for easy proValve programmingValve programmingProgrammingProgrammingProgrammingProgrammingProgrammingProgrammingProgramming steps Programming steps Taking the radiological pictureTaking the radiological picturCheck X-RayC

20、heck X-RayProgrammabilityProgrammabilityCathetersVentricular catheter腦室導(dǎo)管CathetersVentricular catheter腦CathetersDistal catheters遠(yuǎn)端導(dǎo)管CathetersDistal catheters遠(yuǎn)端導(dǎo)管Shunts - componentsVentricular catheter腦室導(dǎo)管Valve閥門Peritoneal cathete腹膜導(dǎo)管Accessories附件Shunts - componentsVentricularShunt implantationVentri

21、cular catheter connection腦室導(dǎo)管連接Introducing distal catheter引導(dǎo)遠(yuǎn)端導(dǎo)管Shunt implantationVentricular catheters: Standard標(biāo)準(zhǔn) Dotted點(diǎn)列式Right angle右角型Right angle with reservoir帶儲(chǔ)液囊右角型with spring帶彈簧型“flanged”凸緣式Ventricular catheters: StandarShunt reservoirsRickham reservoirSalomon reservoirOther ACCU-FLO reserv

22、oirsShunt reservoirsRickham reservPre-chamber functions1. Aspirate and sample of CSF腦脊液取樣2. Flushing obstructed ventricular catheter沖洗堵塞的腦室導(dǎo)管3. Flushing obstructed valve沖洗堵塞的閥門Pre-chamber functions1. AspirShunt implantationShunt implantationValves accessories - distal catheters passers附件遠(yuǎn)端導(dǎo)管引導(dǎo)器Reusa

23、ble DisposableValves accessories - distal caSystem componentsAtrialCatheters心室導(dǎo)管System componentsAtrialSystem components系統(tǒng)組成A system is completeVentricular catheter with connector and stylet帶連接器和穿刺針的腦室導(dǎo)管Valve閥門Distal catheter遠(yuǎn)端導(dǎo)管Introducer導(dǎo)引器Instructions說明書System components系統(tǒng)組成A systemSystemsStandar

24、d valve標(biāo)準(zhǔn)閥門Unitised standard valve合成標(biāo)準(zhǔn)閥門Unitised MicroValve合成微型閥門Unitised MicroValve with Rickham 帶Rickham儲(chǔ)液囊的合成微型閥門Standard valve only單獨(dú)的標(biāo)準(zhǔn)閥門MicroValve valve only單獨(dú)的微型閥門MicroValve with Rickham valve only單獨(dú)的帶Rickham儲(chǔ)液囊的微型閥門SystemsStandard valve標(biāo)準(zhǔn)閥門Pressures availableVery Low 10mmLow40mmMedium70mmMed

25、ium high100mmHigh130mmProgrammable30mm to 200mmAll measured in mm H2O所有壓力都以水柱表示Pressures availableVery LowThats the Original valveand the MicroValve那就是初始閥門和顯微閥門Thats the Original valveandNew Hakim Product shapes新的Hakim產(chǎn)品形式New Hakim Product shapes新的HakNew Valve Housings新的閥門構(gòu)架New housing design新穎的結(jié)構(gòu)設(shè)計(jì)

26、 - In line - Burr holeSelf sealing reservoir自封性儲(chǔ)液囊Pumping Chamber泵Swiss technology瑞士技術(shù)New Valve Housings新的閥門構(gòu)架New h2 New ShapesRight angle / Burr holeIn-Line2 New ShapesRight angle / Burr2 New FormatsRight angle / Burr holewith integratedSiphonGuardIn-Line2 New FormatsRight angle / BurRight Angle /

27、Burr HoleRight Angle / Burr HolePrecision / ProgrammablePrecision / ProgrammableNew Marketing Support PackageNew Marketing Support Package分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件New Detail Aid in 3 LanguagesNew Detail Aid in 3 Languages分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Co

28、dman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件分流系統(tǒng)Codman教材課件Clinical ProofPaperPatientsAgesDatePublicationRomner583Prem 891999NeurofocusYamashita1793 days 881999J. NeurosurgeryRohde605 days141998Acta NeurochurgicaCarmel3771999NeurofocusBlack131994NeurosurgeryReinprecht907 weeks851995Acta NeurochurgicaBelliard501996NeurochirurgieClinical ProofPaperPatientsClinical Proof For the best patient management of hydrocephalus, the ability to re-programme the valve pressure has been found to significantly be