人工膝关节置换的要点分析张国强.ppt

关节线 研究显示， 应用PS假体进行翻修时，关节线应位于其正常解剖水平的8mm以内即可获得良好的关节功能。 合适的股骨假体尺寸和胫骨聚乙烯衬垫厚度 ，翻修病例中常需要应用结构骨移植或者假体加强块来进一步调整关节线 Figgie III HE, Goldberg VM, Heiple KG, et al. The influence of tibial-patellofemoral location on function of the knee in patients with posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 1986;68:1035 关节线 恢复关节线的正常解剖水平对维持膝关节的运动学和稳定性至关重要。 Stiehl JB, Abbott BD. Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Arthroplasty 1995; 10:785. 大致位置：腓骨小头上一横指、髌骨下缘以下一横指 精确位置：股骨内上髁以下3.08 cm ，外上髁以下2.53 cm 如果PCL止点存留：关节线位于3mm之内 关节线水平的确定 假体选择 CR 翻修病例的PCL常有破坏、甚至缺如，临床效果常不理想。 PS 侧副韧带功能良好，股骨远端和胫骨近端骨缺损不重，关节线水平那个 髁限制性假体 侧副韧带功能不良，明显的屈伸间隙不平衡。 全限制性假体 假体的限制性，股骨和胫骨加强块，延长杆 * Remember - any constraining features of the bearing can result in torsional and shear forces being transmitted to the fixation interfaces. * * Gawlinski,Karl * * * 膝关节翻修技术 入 路 便于延长，扩大显露，应对术中突发情况 对于术前僵硬的病例，延长显露，松解关节内的粘连，扩大松解内侧副韧带深层周围的粘连，包括后内侧关节囊，后交叉韧带止点。这样便于外旋胫骨，降低伸膝装置的张力。保护伸膝装置尤为重要。 禁止部分松解髌韧带止点，否则会出现晚期髌韧带的撕脱。 内侧髌旁入路 (Redrawn from Insall JN: Surgical techniques and instrumentation in total knee arthroplasty. In Insall JN, ed: Surgery of the knee, 2nd ed, New York, 1993, Churchill Livingstone.) 入 路 Insall rectus snip modification of quadriceps turndown procedure Coonse and Adams, 1943. Coonse?K,?Adams?JD:? A new operative approach to the knee joint.?? Surg Gynecol Obstet? ?1943;?77:344. Scott and Siliski, 1985. Scott?RD,?Siliski?JM:? The use of a modified V-Y quadricepsplasty during total knee replacement to gain exposure and improve flexion in the ankylosed knee.?? Orthopedics? ?1985;?8:45. 入 路 Coonse-Adams最先描述的V-Y 股四头肌成形术 Scott and Siliski 修正的 V-Y 股四头肌成形术 胫骨粗隆截骨术 (Redrawn from Morrey BF: Reconstructive surgery of the joints, New York, 1996, Churchill Livingstone. By permission of Mayo Foundation.) 入 路 胫骨粗隆截骨松弛伸膝装置，改善显露. 初步软组织松解 One must determine if preoperative deformities are fixed or flexible. If deformities are flexible and e