下肢对线和间隙平衡.pptxVIP

人工膝关节WorkShop--TKA1.膝关节置换适应症及基础解剖2.下肢对线与间隙平衡3.膝关节手术操作假骨练习4.总结：人工膝关节的发展兰天翔 Sky LanTKA手术下肢对线与间隙平衡Sky Lan全膝关节置换的核心：“一线两间隙”Limb Joint Alignment下肢和关节对线Varus 内翻 = Towards the Midline 朝向中线Valgus外翻 = Away from the Midline 远离中线 The tibia femur do not form astraight line but form an obtuseangle of 170° – 175° the averagebeing 173° which is the physiologicalValgus of the knee 胫骨与股骨不形成直线，而是170° – 175钝角、平均173° ，这是膝关节的生理外翻。The HKA Axis HKA 轴A line connecting the centre of the femoral head the centre of the knee and the centre of ankle 连接股骨头中心、膝关节中心及踝关节中心的线 This line runs inferiorly medial forming an angle of approx. 3° to the midline in normal stance 正常姿态时，该线向下内侧与中位线约呈三度 The joint line is perpendicular to the midline and therefore lies approx. 3° medially oblique to the HKA axis 关节线垂直与中位线，因此与HKA轴约呈三度、向内侧倾斜。Limb Joint Alignment下肢和关节对线Valgus deformityVarus deformity手术对线目的与要求假体关节线垂直与下肢力学轴!!!胫骨对线股骨对线股骨定位器根据术前X片提示， 设定合适的外翻角。股骨定位器固定到股骨髓内杆上下肢对线结果!——伸直位屈膝位股骨旋转对线获得相等的矩形伸屈位间隙获得屈膝位假体和力学轴正确关系胫骨旋转对线膝关节完全伸直位，以股骨试件为参照，用对线手柄旋转胫骨试件调整旋转对线。1，精确的假体对线2，良好的软组织平衡3，相等的伸屈位间隙4，正确的髌骨轨迹5，合适的假体型号6，可靠的骨水泥固定Thank You