牟翔-关节置换的康复1.ppt

关节的作用 人工关节置换的目的 关节疾病 髋关节置换术后康复 防止关节脱位 术前肌力训练 术后体位 运 动 功 能 训 练 术后1-3周 深呼吸、咳嗽 踝泵运动 股四头肌和臀肌的等长收缩 避免脱位 术后4-6周 深呼吸、咳嗽 踝泵运动 股四头肌和臀肌的等长收缩 避免脱位 膝关节置换术后康复 上下楼梯，要求健腿先上，患腿先下 正确的侧卧位，健侧在下，两腿间夹枕 不要弯腰拾物 不要跷二郎腿 人工关节置换的新进展 微创全髋关节置换 材料:金属-金属/陶瓷-陶瓷全髋 导航下人工关节置换 传统和微创手术 现代陶瓷和金属假体 不同摩擦界面磨损率对比 大直径股骨头THA 导航技术 * * 人工全膝关节置换术后的康复及功能锻练是一项系统而艰巨的任务。做得好，可起到锦上添花的作用，做得不好，可能前功尽弃。周密而系统的术前术后的病人教育、康复及功能锻练计划，是取得最佳手术疗效的基本前提。 Manufacturers continually strive to improve the wear performance of polyethylene. In the laboratory, highly crosslinked polyethylenes have demonstrated significant improvements, reducing wear 90%. Alternative bearings such as metal-on-metal and ceramic-on-ceramic decrease wear by another order of magnitude. This graphic shows the differences in linear wear for different wear couples:CoCr/poly, CoCr/Crossfire?, metal-on-metal and ceramic-on ceramic. Ceramic-on-ceramic wear is much lower than even metal-on-metal bearings. Alumina/alumina shows less than 1 micron/year of wear compared to CoCr/Polyethylene which shows 200 microns/year, CoCr/Crossfire? Polyethylene shows 20 microns/year, and Metal/Metal shows 4.2 microns/year. In laboratory testing, alumina/alumina bearing wear 2000 times less than metal/polyethylene couples.5 1. Wilmann G, Ceramics for Total Hip Replacement - What a Surgeon Should Know, Orthopedics, No. 2, February 1998. 2. Howmedica Osteonics White Paper, Literature No. LSA23. 3. Schmalzried T, et al, Long-Duration Metal-on-Metal Total Hip Arthroplasties with Low Wear of the Articulating Surfaces, Journal of Arthroplasty, Vol. 11, No. 3, 1996. 4. Saikko V and Pfaff HG, Wear of Alumina on Alumina Total replacement Hip joints Studied with a Hip Simulator, 2nd Symposium on Ceramic Wear Couple, 1997. 5. Taylor SK, Serekian P, Manley M, “Wear Performance for a Contemporary Alumina:Alumina Bearing Couple under Hip Joint Simulation,” Trans. 44th Ann. Mtg. ORS, 51, 1998. * * * TKA适应证 骨性关节炎 类风湿性关节炎 创伤性关节炎 严重的髌股关节炎 静息的感染性关节炎 OA RA （oste