僵直膝的人工全膝关节置换术

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1、僵直膝的人工全膝关节置换术TKAoftheStiffKnee北京积水潭医院矫形骨科郭晓忠膝关节日常活动度Kneeflexionrequiredfordailyactivities-67º行走forswingphaseofgait-83º爬楼梯toascendstairs-84º下楼梯todescendstairs-93º从椅子起来torisefromchair-106°系鞋带Tieshoes僵直膝STIFFKNEE:DEFINITIONLimited屈曲：Flexion(≤75°)伸直：Extension(≥15°flexiondef.)“PAIN”“LossofFunction

2、”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PriorArthrotomies胫骨高位截骨HTO胫骨平台骨折内固定ORIFTibialPlateauFracture髌骨重建PatellarRealignment韧带重建LigamentReconstruction股骨远端骨折内固定以前的关节手术PriorArthrotomies以前的手术切口PriorArthrotomies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-YQuadricepsTurndown最早由Coonse&Adams描

3、绘（1943）由Insall改良（1983）V-YQuadricepsTurndown优点Advantages很好的显露：AllowsExcellentExposure有利于股四头肌腱延长AllowsLengtheningofQuadricepsTendon保护髌腱和胫骨结节PreservesPatellaTendonandTibialTubercleAglietti:J.Arthroplasty4(1):1-5,1989Trousdale:Clin.Ortho.286:48-55,1993缺点Disadvantages术后可能减弱伸膝装置PostopExtensorLagMay

4、Occur可能影响股四头肌力量MayAffectQuadricepsStrength术后康复受影响ChangesPostopRehabAglietti:J.Arthroplasty4(1):1-5,1989Trousdale:Clin.Ortho.286:48-55,1993胫骨结节截骨TibialTubercleOsteotomy更好地显露PermitsExcellentExposure如果固定僵直允许更大活动IfRigidFixation-AllowsFWBandUnrestrictedROM优点Advantages避免伸膝装置减弱AvoidsExtensionLag避免股四

5、头肌腱减弱AvoidsQuadricepsWeakness避免屈曲的限制AvoidsLimitationsinFlexion没有康复的改变NoChangeinRehabWolf:JBJS71A:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:KneeSocietyInterimMeeting,NY1997缺点Disadvantages胫骨干骨折TibialShaftFracture胫骨结节撕脱骨折TibialTubercleAvulsionFracture伤口愈合问题WoundHealingProblemsWolf:J

6、BJS71A:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:KneeSocietyInterimMeeting,NY1997ExposureMedialArthrotomyTightQuadricepsSnipTightTTO北京积水潭医院矫形骨科郭晓忠谢谢！精品课件资料分享SL出品精品课件资料分享SL出品