全膝关置换术.ppt

辅助检查 OA的X线表现可有：关节间歇狭窄、关节软骨下骨质硬化、边缘骨质增生、关节鼠形成及软骨下囊性变。 Work-up take long films of both lower limbs (standing, patellae facing forward, feet together) trace all previous X-rays and find the previous operation records (for revision cases) consider knee aspiration and bone (Indium111) scan if sepsis is suspected (for revision cases) 术 前 准 备 拍摄双侧下肢全长X光片 (站立位、髌骨向前、双足并拢) 回顾所有以前拍摄过的X光片并找出以往手术记录 (对于翻修病例) 如果怀疑感染﹐可考虑行膝关节穿刺和铟111同位素骨扫描 (对于翻修病例) Operative supine position, apply foot positioner before draping (so that the knee can be locked in full flexion) thigh tourniquet is applied but is only inflated after draping (tourniquet only used for cementation after 2001) no bulking drape around foot and ankle surgical approach (Insall) with periosteum elevated from medial third of the patella is adopted patella is replaced routinely in rheumatoid arthritis, but not osteoarthritis intramedullary guide for femoral cuts and extramedullary guide for tibial cuts cut surfaces are cleansed with pulsatile lavage system before cementation (no need for cementless fixation) all three components are inserted with one pack of Endurance cement mixed in partial vacuum; if exposure is sub-optimal, cement the patellar button and tibial tray first, and then insert the femoral component with another pack of cement (cement gun after 2001) tourniquet is deflated after all components are inserted and before wound closure for hemostasis bulking dressing is applied afterwards for bilateral involvement with similar severity, both knees will be replaced under the same anaesthesia, one after the other - “one-stage, sequential” bilateral replacement 手 术 操 作 仰卧位﹐在铺巾前放置足固定挡板以使术中膝关节在完全屈曲位时能被固定 使用大腿空气止血带﹐并仅在消毒铺巾后才向止血带充气 (2001年后仅在注入骨水泥时才充气) 避免在足踝部铺过多的消毒巾 采用Insall手术入路﹐从髌骨内侧三分之一处剥离骨膜﹐将髌骨向外翻开以暴露整个膝关节节 类风湿性关节炎进行常规置换髌骨, 骨性关节炎则不需要 用髓内定位指导股骨远程切骨﹐髓外定位指导胫骨近端切骨 切骨表面在骨水泥处理前用脉冲灌洗系统冲洗 (非骨水泥固定则不需要) 用一包在半真空条件下混和搅拌的Endurance骨水泥来固定所有三部份假体﹔如果手术野暴露不佳﹐则先用一包骨水泥固定髌骨和胫骨假体﹐然后用另一包骨水泥固定股骨假体 (2001 年后采用骨水泥枪) 止血带在所有假体置入后、手术切口关闭前放松以利彻底止血