僵直膝的人工全膝关节置换术TKAof the Stiff 课件.pptVIP

僵直膝的人工全膝关节置换术TKA of the Stiff Knee 北京积水潭医院矫形骨科 郭晓忠 膝关节日常活动度Knee flexion required for daily activities - 67o 行走for swing phase of gait - 83o 爬楼梯to ascend stairs - 84o 下楼梯to descend stairs - 93o 从椅子起来to rise from chair - 106°系鞋带Tie shoes 僵直膝STIFF KNEE: DEFINITION Limited 屈曲：Flexion ( ≤ 75° ) 伸直：Extension (≥ 15° flexion def.) “PAIN” “Loss of Function” 引起僵直膝的原因 陈旧的膝关节感染（结核） 严重的无菌性关节炎症（类风湿等免疫性疾病） 膝关节外伤（骨折）术后 以前的关节手术Prior Arthrotomies 胫骨高位截骨HTO 胫骨平台骨折内固定ORIF Tibial Plateau Fracture 髌骨重建Patellar Realignment 韧带重建Ligament Reconstruction 股骨远端骨折内固定 以前的关节手术Prior Arthrotomies 以前的手术切口Prior Arthrotomies 僵直膝手术中所见 膝关节皮肤及软组织扩张 V – Y 股四头肌腱延长术V - Y Quadriceps Turndown 最早由Coonse Adams 描绘（1943） 由 Insall 改良（1983） V - Y Quadriceps Turndown 优点Advantages 很好的显露：Allows Excellent Exposure 有利于股四头肌腱延长Allows Lengthening of Quadriceps Tendon 保护髌腱和胫骨结节Preserves Patella Tendon and Tibial Tubercle Aglietti: J. Arthroplasty 4(1): 1-5, 1989 Trousdale: Clin. Ortho. 286: 48-55, 1993 缺点Disadvantages 术后可能减弱伸膝装置Postop Extensor Lag May Occur 可能影响股四头肌力量May Affect Quadriceps Strength 术后康复受影响Changes Postop Rehab Aglietti: J. Arthroplasty 4(1): 1-5, 1989 Trousdale: Clin. Ortho. 286: 48-55, 1993 胫骨结节截骨Tibial Tubercle Osteotomy 更好地显露Permits Excellent Exposure 如果固定僵直允许更大活动If Rigid Fixation - Allows FWB and Unrestricted ROM 优点Advantages 避免伸膝装置减弱Avoids Extension Lag 避免股四头肌腱减弱Avoids Quadriceps Weakness 避免屈曲的限制Avoids Limitations in Flexion 没有康复的改变No Change in Rehab Wolf: JBJS 71 A:843 - 852, 1989 Whiteside: Clin. Ortho. 321:32 - 35, 1995 Barrack: Knee Society Interim Meeting, NY 1997 缺点Disadvantages 胫骨干骨折Tibial Shaft Fracture 胫骨结节撕脱骨折Tibial Tubercle Avulsion Fracture 伤口愈合问题Wound Healing Problems Wolf: JBJS 71 A:843 - 852, 1989 Whiteside: Clin. Ortho. 321:32 - 35, 1995 Barrack: Knee Society Interim Meeting, NY 1997 Exposure Medial Arthrotomy Tight Quadriceps Snip Tight TTO 北京积水潭医院矫形骨科 郭晓忠 谢谢！ 精品课件资料分享