关节外科 初次髋关节置换的基本手术技巧学习2月份.pptVIP

初次髋关节置换的基本手术技巧（五大基本技巧） 新医大一附院关节外科 2014年2月 ⒈股骨髓腔入口的正确定位 Correct position of femoral canal entry hole 入口处必须紧贴梨状窝的前方 Entry hole should be just anterior piriform fosse 股骨假体柄正确的前倾 有赖于入口处的正确定位 Correct entry hole resulted In correct ante-version of stem 入口太靠前将导致股骨 假体柄的后倾 Too anterior entry hole resulted In retro-version of stem 梨状隐窝 Piriform fosse ⒉避免股骨假体柄的内翻位植入 Avoid varus placement of the stem 股骨髓腔的纵轴紧靠大转子的 内侧缘通过 Longitudinal axis of Intra-medullary to greater trochanter 股骨髓腔入口位置 必须尽可能靠外侧 Femoral entry hole must Be lateral enough 必须去除部分大转子以获 得股骨假体柄的正确力线 Part of greater trochanter must be removed to give correct stem alignment 大转子去除不充分将阻碍股骨 柄把持器的进入并导致内翻 Inadequate removal of greater Trochanter block the stem holder And resulted in varus 用锉刀进一步去除大转子 Further removal of greater Trochanter by rasp 骨的充分去除将 产生良好的力线 Good alignment with enough Bone removal Hand reaming –never power-ream ⒊采用手动扩髓法，禁止电动操作 采用手动扩髓以防止过热 引起的骨坏死，并可保留 骨内膜层的松质骨以利于 和骨水泥的相互交错嵌插 （骨水泥型假体）。 Hand reaming of femoral canal to prevent heat necrosis of bone ,and to retain the endosteal cancellous bone for cement inter-digitation(cemented Stem) ⒋股骨假体柄植入水平的调节 Adjust level of stem insertion 慢慢地植入骨水泥假体柄， 避免进入过深 Insert cemented stem slowly And don’t insert too deep 通过比较股骨头中心和大转子尖端之 间的位置关系来调节假体植入的深度 Adjust depth of insertion by relationship Between center of head and tip of greater trochanter ⒌必须探查真髋臼的位置 Must detect level of true floor 必须研磨至“真髋臼” Reaming must be down to acetabular “ true floor” 在X片上， “真髋臼”位于泪滴外侧Acetabular “ true floor” represented by lateral limb of tear drop in hip X-ray “真髋臼”与试样髋臼之间必须没有空隙 No gap should be presented between trial cup and acetabular “ true floor” 手术前 手术后 * * * *