《僵直膝的人工全膝关节置换术TKAof the Stiff Knee》由会员分享，可在线阅读，更多相关《僵直膝的人工全膝关节置换术TKAof the Stiff Knee（21页珍藏版）》请在金锄头文库上搜索。
1、僵直膝的人工全膝关节置换术僵直膝的人工全膝关节置换术 TKA of TKA of the Stiff Kneethe Stiff Knee北京积水潭医院矫形骨科北京积水潭医院矫形骨科 郭晓忠郭晓忠膝关节日常活动度膝关节日常活动度 Knee flexion required for daily activitiesKnee flexion required for daily activitiesn n- 67- 67 行走行走for swing phase of gaitfor swing phase of gaitn n- 83 - 83 爬楼梯爬楼梯to ascend stairsto a
2、scend stairsn n- 84 - 84 下楼梯下楼梯to descend stairsto descend stairsn n- 93 - 93 从椅子起来从椅子起来to rise from chairto rise from chairn n- 106 - 106系鞋带系鞋带Tie shoesTie shoes僵直膝僵直膝 STIFF KNEE: DEFINITIONSTIFF KNEE: DEFINITIONLimited Limited 屈曲：屈曲：Flexion ( 75 )Flexion ( 75 )伸直：伸直：Extension ( 15 flexion Extensio
3、n ( 15 flexion def.)def.)“PAIN”“Loss of Function”引起僵直膝的原因引起僵直膝的原因n n陈旧的膝关节感染（结核）陈旧的膝关节感染（结核）n n严重的无菌性关节炎症（类风湿等严重的无菌性关节炎症（类风湿等 免疫性疾病）免疫性疾病）n n膝关节外伤（骨折）术后膝关节外伤（骨折）术后以前的关节手术以前的关节手术 Prior ArthrotomiesPrior Arthrotomiesn n胫骨高位截骨胫骨高位截骨HTOHTOn n胫骨平台骨折内固定胫骨平台骨折内固定ORIF Tibial ORIF Tibial Plateau FracturePlat
4、eau Fracturen n髌骨重建髌骨重建Patellar RealignmentPatellar Realignmentn n韧带重建韧带重建Ligament ReconstructionLigament Reconstructionn n股骨远端骨折内固定股骨远端骨折内固定以前的关节手术以前的关节手术 Prior ArthrotomiesPrior Arthrotomies以前的手术切口以前的手术切口 Prior ArthrotomiesPrior Arthrotomies僵直膝手术中所见僵直膝手术中所见膝关节皮肤及软组织扩张膝关节皮肤及软组织扩张V V Y Y 股四头肌腱延长术股四头
5、肌腱延长术 V - Y Quadriceps TurndownV - Y Quadriceps Turndownn n最早由最早由Coonse & Coonse & Adams Adams 描绘（描绘（19431943）n n由由 Insall Insall 改良（改良（19831983）V - Y Quadriceps TurndownV - Y Quadriceps Turndown优点优点AdvantagesAdvantagesn n很好的显露：很好的显露：Allows Excellent ExposureAllows Excellent Exposuren n有利于股四头肌腱延长有利于
6、股四头肌腱延长Allows Lengthening Allows Lengthening of Quadriceps Tendonof Quadriceps Tendonn n保护髌腱和胫骨结节保护髌腱和胫骨结节Preserves Patella Preserves Patella Tendon and Tibial TubercleTendon and Tibial TubercleAglietti: J. Arthroplasty 4(1): 1-5, 1989 Trousdale: Clin. Ortho. 286: 48-55, 1993缺点缺点DisadvantagesDisadva
7、ntagesn n术后可能减弱伸膝装置术后可能减弱伸膝装置Postop Extensor Postop Extensor Lag May OccurLag May Occurn n可能影响股四头肌力量可能影响股四头肌力量May Affect May Affect Quadriceps StrengthQuadriceps Strengthn n术后康复受影响术后康复受影响Changes Postop RehabChanges Postop RehabAglietti: J. Arthroplasty 4(1): 1-5, 1989 Trousdale: Clin. Ortho. 286: 48
8、-55, 1993胫骨结节截骨胫骨结节截骨 Tibial Tubercle OsteotomyTibial Tubercle Osteotomyn n更好地显露更好地显露Permits Permits Excellent ExposureExcellent Exposuren n如果固定僵直允许更大如果固定僵直允许更大 活动活动If Rigid Fixation - If Rigid Fixation - Allows FWB and Allows FWB and Unrestricted ROMUnrestricted ROM优点优点AdvantagesAdvantagesn n避免伸膝装置
9、减弱避免伸膝装置减弱Avoids Extension LagAvoids Extension Lagn n避免股四头肌腱减弱避免股四头肌腱减弱Avoids Quadriceps Avoids Quadriceps WeaknessWeaknessn n避免屈曲的限制避免屈曲的限制Avoids Limitations in Avoids Limitations in FlexionFlexionn n没有康复的改变没有康复的改变No Change in RehabNo Change in RehabWolf: JBJS 71 A:843 - 852, 1989 Whiteside: Clin.
10、Ortho. 321:32 - 35, 1995 Barrack: Knee Society Interim Meeting, NY 1997缺点缺点DisadvantagesDisadvantagesn n胫骨干骨折胫骨干骨折Tibial Shaft FractureTibial Shaft Fracturen n胫骨结节撕脱骨折胫骨结节撕脱骨折Tibial Tubercle Avulsion Tibial Tubercle Avulsion FractureFracturen n伤口愈合问题伤口愈合问题Wound Healing ProblemsWound Healing Problems
11、Wolf: JBJS 71 A:843 - 852, 1989 Whiteside: Clin. Ortho. 321:32 - 35, 1995 Barrack: Knee Society Interim Meeting, NY 1997ExposureExposureMedial ArthrotomyMedial ArthrotomyTight TightQuadriceps SnipQuadriceps SnipTight TightTTOTTO北京积水潭医院矫形骨科北京积水潭医院矫形骨科 郭晓忠郭晓忠谢谢！谢谢！精品课件资料分享精品课件资料分享SLSL出品出品精品课件资料分享精品课件资料分享SLSL出品出品
