全踝关节置换术(PLUS适应症禁忌症及手术步骤学案.doc

TAR total ankle replacement TAA total ankle arthroplasty 全踝关节置换术（PLUS 适应症禁忌症及手术步骤） [原创 2010-11-30 12:59:59]?? 患者信息:M/66 术前诊断:OA ankle Rt. 治疗方案:TARA, Rt. 手术医师:professor Chu In Tak(St. Marys hospital) 手术日期: 2010-11-30 手术体会：chu教授做踝关节置换手术非常熟练，术中几乎不要截骨定位器。入路是标准的前入路，他建议从胫前肌腱内侧入路，骨膜分离用手术刀而非骨膜剥离器，他认为这样损伤小。先在流行的踝关节假体有11种，他所用的假体是法国的Hintegra Sensitive假体，而在教科书上大部分都是讲解利用PE假体，组件不同手术方式也有不同。 ?以上3图为术前X线表现 手术选择前正中切口 胫骨截骨定位器 截骨完成后 安装试模 安装试模后透视 胫骨假体组件标签 距骨假体组件标签 PE垫标签 术后拍片所见 术后到Catholic University图书馆查阅有关踝关节置换的内容，摘录如下： 假体组件Hintegra Sensitive Prosthesis tibial component(CoCr) talar component(CoCr) Fixation screws(Titanium alloy) intermediary sliding core(UHMW Polyethylene) ? 适应症Indications: systemic caused arthritis of the ankle(eg. rheumatoid arthritis,hemochromatosis); primary arthritis(eg. degenerative disease); secondary arthritis(eg. posttraumatic,infection,avascular necrosis); salvage for failed total ankle replacement; salvage for non-union and malunion of ankle arthrodesis. ? 禁忌症Contraindications: relative controindications: severe osteoporosis; immunosuppressive therapy; high demanding sport activities(eg.contact sports,jumping); patients with a poor soft tissue envelope; ? absolute contraindications: active infection; charcot neuroarthropathy; neurologic disease of the lower extremities; advanced peripheral vascular disease; absence of distal leg muscular function suspected or documented metal allery or intolerance; avascular necrosis of the talus/tiba of more than1/2; evere malalignment(if not surgically correctale); severe instability; diabetic syndrom ? 最常用的3种假体 although there are currently 11 different ankle implants being used throughout the world,attention in the united states has been focused on three second-generation ankle implant devices: Buechel Pappas total ankle repalcement(Endotec, South Orange,NJ,USA) Agility total ankle system (DePuy,Warsaw,IN,USA) scandinavian total ankle replacement(STAR? Waldemar-Link,Hamburg,Germany) ? 术前准备 preoper