关节镜下前交叉韧带重建术.pptxVIP

关节镜下重建前交叉韧带ARTHROSCOPIC ACL SURGERY RECONSTRUCTION;ACL的解剖特点ANATOMY of ACL;ACL的解剖特点ANATOMY of ACL;ACL的解剖特点ANATOMY of ACL;ACL的解剖特点ANATOMY of ACL;ACL三束：前内束屈膝时紧张；后外束伸膝时紧张；中间束在膝关节屈伸运动中始终保持张力。;交叉韧带损伤症状Symptoms of an ACL Tear;体格检查 medical examination;体格检查 medical examination;体格检查 medical examination;MRI image;关节镜下观Arthroscopy Video ;重建材料 graft ;手术目的 purpose of surgery;麻醉Choices for Anesthesia;取材Graft Harvesting;取材Graft Harvesting;取材Graft Harvesting;取材Graft Harvesting;髌腱修整Graft fitting;髌腱修整Graft fitting;清理髁间窝 clean the notch;ACL定位器 the tibial drill guide;准确放置ACL定位器The tibial drill guide is positioned on the tibia;钻胫骨导针 The guide wire is drilled into the tibia;AB/AC平均为44％;在导针引导下制作胫骨骨道the tibial hole is drilled;在导针引导下制作胫骨骨道the tibial hole is drilled;股骨定位器与股骨导针the femoral drill guide;准确放置股骨定位器The guide is positioned on the back of the femur;股骨引导器引导下，钻股骨导针 The guide wire is drilled;制作股骨隧道 the femoral hole is drilled;制作股骨隧道 the femoral hole is drilled;拉进移植物The graft is placed through the tibia, through the knee joint, and into the femoral drill hole;界面螺钉固定移植物a screw is inserted into the femoral drill hole;界面螺钉固定移植物a screw is inserted into the femoral drill hole;界面螺钉固定移植物a screw is inserted into the femoral drill hole;上胫骨端界面螺钉A second screw is inserted into the tibia;上胫骨端界面螺钉A second screw is inserted into the tibia;用探钩检查，重建韧带张力良好，前抽屉试验阴性，膝关节屈伸正常。;缝合切口the incisions are closed;术后界面螺钉位置良好;Endobutton 技术重建ACLACL reconstruction with Endobutton ;Endobutton 技术重建ACLACL reconstruction with Endobutton ;术后康复训练rehabilitation training;术后康复训练rehabilitation training;手术中可能出现的问题;制作骨道注意问题;移植物固定注意问题;术后可出现的并发症;前交叉韧带双股重建;解剖基础;关节镜显示AM，PL;尸体标本显示AM，PL;伸直时AM，PL的股骨点垂直排列，两束平行。;屈曲90°时，AM，PL的股骨点平行，两束交叉;膝关节屈曲90 °时PL松弛，而伸直时PL紧张状态;理论基础;外科技术采用三切口入路：前外，前内和内侧辅助入路。AM和PL的分界可见一个骨嵴;移植物来源;辅助内侧入路钻PL股骨隧道;胫骨隧道：PL在55 ° AM在45 °在胫骨皮质上，PL入点位于AM入点的远端后内侧。PCL，外侧半月板根部和AM的止点构成三角，PL位于距其后角大约3-5MM，探针是单束重建的位置。;AM股骨隧道：在PL后侧边缘后方大约2MM，可以由胫骨隧??建立，直径一般7-8MM。;植入：先PL后AM;重建术后双束图;重建术后X片;Single