膝关节基础精编PPT课件.pptxVIP

膝关节 膝关节的组成 股骨的远端 胫骨的近端 髌骨 关节囊 韧带 韧带 髌韧带 胫侧副韧带 腓侧副韧带 交叉韧带（前交叉韧带和后交叉韧带） 腘斜韧带 前交叉韧带 前交叉韧带的功能 限制胫骨前移 限制膝关节过伸 限制外旋和内旋 限制膝外展和内收 后交叉韧带的构造 后交叉韧带的功能 限制胫骨后移 限制膝过伸  限制小腿内旋 限制膝的内收和外展 膝关节的活动 屈：0－－140度。 旋转（在屈膝90度情况下）：向内30度，向外45度。 外展和内收（在屈膝30度情况下）：各10度。 日常活动中胫股关节活动 步态分析动力学 胫股关节 屈/伸 – 67度 (Marrison, 1970) 内/外旋 -- 13 度(Levens et al., 1948) 外展/内收 -- 11 度 (Kettelkamp et al., 1970) 前/后平移 -- 13 mm (Nahass et al., 1991) 膑股关节 平移 70 mm ( Goodfellow et al., 1976) 关节表面活动 旋转，滚动和滑动 膝关节作用力 胫股关节 (Marrison et al., 1970) 压缩力: 4 BW 内外剪力: 0.26 BW 前后剪力: 0.4 BW 膑股关节 压缩力: 0.5 BW (Reilly and Marten, 1972) 压缩力: 1.3 BW (Nisell 1985) 膝关节力线 mechanical axis anatomic axis 3° 6° Normal Anatomy Left Knee epicondylar axis AP axis Not drawn to scale. For illustration purposes only. mechanical axis anatomic axis 3° 6° bone cuts posterior cut externally rotated 3° relative to posterior condyles(perpendicularto AP axis) 3° Externally Rotated Cuts Rectangular Extension Gap Rectangular Flexion Gap epicondylar axis AP axis Not drawn to scale. For illustration purposes only. Traditional TKR Systems mechanical axis anatomic axis 6° bone cuts 3° epicondylar axis AP axis Not drawn to scale. For illustration purposes only. 3° Externally Rotated Cuts Rectangular Extension Gap Rectangular Flexion Gap Traditional TKR Systems rectangular extension gap rectangular flexion gap mechanical axis anatomic axis 6° bone cuts 3° polyethylene thickness equal in both medial and lateral compartments epicondylar axis AP axis Not drawn to scale. For illustration purposes only. 3° Externally Rotated Cuts Rectangular Extension Gap Rectangular Flexion Gap Traditional TKR Systems mechanical axis anatomic axis 6° bone cuts metal is added to fill gaps (equal condylar thickness) epicondylar axis AP axis Not drawn to scale. For illustration purposes only. 3° Externally Rotated Cuts Rectangular Extension Gap Rectangular Flexion Gap Traditional TKR Systems 0° joint line created 膝关节的活动模式 TKA适应症 退变性膝关节骨关节炎 类风湿性关节炎 非感染性关节炎引起的膝关节病损并伴有疼痛和功能障碍 创伤性