全膝关节置换术图解.doc

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1、A76-year-oldwomanpresentedwithbilateralkneepain,leftworsethanright.Pre-operativeradiographsoftheleftkneeshowsevere,end-stageosteoarthritis.Theradiographichallmarksofosteoarthritisare:jointspacenarrowing,sclerosisofthesubchondralbone,osteophyteformationandeventua

2、llycysticchangesintheadjacentboneStanding"alignmentviews"areusedtodeterminethepatient'sweightbearingandmechanicalaxis.ThetechnicalgoalsofTotalKneeArthroplastyincludere-establishingthepatientsmechanicalaxisandrestoringthejointline.Oftentimes,patientswillhavedevel

3、opedsevere"varus"deformity(bowedlegs)orlesscommonly,"valgusdeformity(knockkneed).Afterasterileprep,thelimbisdraped,landmarksareidentifiedandthemid-linekneeincisionisplannedunlesspatientshaveoldscarswhicharenotcompatiblewiththisstandardincisionThelegisexsanguinat

4、edandatourniquetisusedtomaintainhemostasisthroughoutthecase.Oncetheincisionismade,thequadricepstendon,thepatellaandthepatellartendonareidentified.Amedialpara-patellararthrotomyismadeandthesofttissuesareelevatedfromthetibia.Greatcaremustbetakennottostriptomuchmed

5、iallyorlaterallyasthismayresultindisruptionofthemedialcollateralligamentorthepatellartendon,respectfully.Botharedisastrouscomplications.Thepatellaandpatellartendonarereleasedfromtheunderlyingfatpadandothersofttissuessothepatellamaybeevertedlaterallytoexposethedi

6、stalfemurandproximaltibia.Afterthepatellaandtendonareeverted(underrakeinphoto),remainingcapsulartissuesarereleased.Thepatellar-femoralligamentabovetheclampisabouttobedivided.Onlyasinglecutismadetopreparethetibia.Anextramedullaryalignmentguideisplacedandsecuredwi

7、thpinsintheproximaltibia.ThisguideisusedtoresecttheproperamountofboneandcreatethepropersurfaceangulationforthenewtibialjointlineSeveralpinsareplacedtosecuretheguide.Oncetheguideissecure,thearthriticarticulatingsurfaceofthetibiaisresectedusinganoscillatingsawAfte

8、rthecutismadewiththeoscillatingsaw,thesectionoftibiaisremoved.TheresectedarthriticarticularsurfaceofproximaltibiaisshownAfterthetibialboneisresected,edgesandanyremain