HTO并发症与预防对策.pptxVIP

HTO并发症及如何避免的技巧;;Graph showing year-wise complication rates for medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation.;文献表一：病人选择上无明显差异（294例）。 ;;表三：闭式主要为神经损伤/筋膜室综合征，开式主要为平台骨折。;;表4：体重指数及内翻角度为主要危险因素;该文章显示： 40例中4例（10％）发现浅表感染（1例）。接受静脉注射抗生素治疗随后进行康复治疗。 37例中，平均14个月后拔除植入物（范围6-27个月）。 1例螺钉断裂TomoFix板在12个月后被移除。 1例术后术后2周发生浅表感染去除内固定。 1例全膝关节置换术被植入16个月后。;文献3：Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy;Result：;显示tomofix板应力发布广且载荷量大。;文献4：15年文献报道：;同样有文献报道:;Complications occurring from the medial opening wedge bone defect内侧骨缺损引起的并发症;Implant related complications内置物并发症;文献5：Complications and Short-Term Outcomes of MedialOpening Wedge High Tibial Osteotomy Using aLocking Plate for Medial Osteoarthritis of the Knee;文献6：Pseudoaneurysm of the Popliteal ArteryComplicating Medial Opening Wedge HighTibial Osteotomy;Vascular injury（血管损伤）;文献8：Case report ;文献9：Avoiding intraoperative complications in open-wedge high tibialvalgus osteotomy: technical advancement;外侧平台骨折;外侧平台骨折的分型及合理的合页区：;如图;外侧铰链错位;Fig. Precise opening of the osteotomy with a defined spacer on the medial side and exact geometry of the opening gap due the external fixator (which is under compression) holding the hinge together. The amount of opening can be calculated and verified directly on most modern image intensifiers。外固定支架可以固定合页铰链。;FIGURE (A) Intraoperative fluoroscopic image with Position HTO plate after osteotomy. (B) Radiograph after 2 months’ follow-up. A tibial plateau fracture was seen.;Radiographs of a fracture extending to the lateral tibial plateau during medial opening-wedge high tibial osteotomy which was a) stabilised by an additional 4.0 mm cannulated screw (arrow = frac-ture site) and b) healed at three months after the initial surgery (arrow = union of fracture).; 矫正力线的把握。;1.是否行ACLR 2.或者单纯HTO即可 3.或者可HTO中抬高slope减轻ACL负担。;有报道称，;Thromboembolic events（血栓）-外侧闭式截骨