膝关节置换原理.pptx

Department of Orthopaedics,Shanghai Sixth Peoples Hospital膝关节置换原理膝关节置换原理膝关节置换原理膝关节置换原理上海交通大学附属第六人民医院上海交通大学附属第六人民医院Department of Orthopaedics,Shanghai Sixth Peoples HospitalDepartment of Orthopaedics,Shanghai Sixth Peoples Hospital技技术术目目标标是是一一致致的的一条直线Department of Orthopaedics,Shanghai Sixth Peoples Hospital矩形矩形伸直间隙屈曲间隙伸直间隙屈曲间隙间隙的宽度植入假间隙的宽度植入假体的厚度体的厚度（20mm）二个间隙Department of Orthopaedics,Shanghai Sixth Peoples Hospital&尽可能的让内外侧副韧带起主要稳定结构尽可能的让内外侧副韧带起主要稳定结构&尽可能的让屈曲间隙平行髁上线尽可能的让屈曲间隙平行髁上线髁上线间隙力线Department of Orthopaedics,Shanghai Sixth Peoples Hospital获得两个获得两个20mm垂直机械轴的矩形间隙垂直机械轴的矩形间隙力线力线20cmDepartment of Orthopaedics,Shanghai Sixth Peoples HospitalDepartment of Orthopaedics,Shanghai Sixth Peoples HospitalDepartment of Orthopaedics,Shanghai Sixth Peoples HospitalDepartment of Orthopaedics,Shanghai Sixth Peoples HospitalDepartment of Orthopaedics,Shanghai Sixth Peoples Hospital胫骨近端截骨胫骨近端截骨胫骨近端截骨胫骨近端截骨&截骨位置截骨位置在冠状位垂直机械轴在冠状位垂直机械轴矢状位适当的后倾矢状位适当的后倾&截骨厚度截骨厚度胫骨假体厚度胫骨假体厚度内翻膝：外侧内翻膝：外侧10mm外翻膝：内侧外翻膝：内侧7mm&截骨方向截骨方向沿胫骨近端前后轴方向沿胫骨近端前后轴方向Department of Orthopaedics,Shanghai Sixth Peoples Hospital胫骨近端截骨完成后，需要反复确认截骨准确Department of Orthopaedics,Shanghai Sixth Peoples Hospital股骨远端截骨股骨远端截骨股骨远端截骨股骨远端截骨&截骨位置截骨位置截骨面垂直机械轴截骨面垂直机械轴外翻角为机械轴和解剖轴的外翻角为机械轴和解剖轴的夹角夹角&截骨厚度截骨厚度9-10mm（股骨假体远端厚度）（股骨假体远端厚度）5Department of Orthopaedics,Shanghai Sixth Peoples Hospital股骨远端截骨股骨远端截骨股骨远端截骨股骨远端截骨Department of Orthopaedics,Shanghai Sixth Peoples Hospital股骨后髁线和髁上线的夹角为3度Department of Orthopaedics,Shanghai Sixth Peoples Hospital外旋外旋外旋外旋3 3度？度？度？度？Department of Orthopaedics,Shanghai Sixth Peoples Hospital参考线参考线参考线参考线Department of Orthopaedics,Shanghai Sixth Peoples Hospital股骨远端切骨影响伸膝的软组织平衡而股股骨远端切骨影响伸膝的软组织平衡而股股骨远端切骨影响伸膝的软组织平衡而股股骨远端切骨影响伸膝的软组织平衡而股骨后髁的切骨影响屈膝位的软组织平衡骨后髁的切骨影响屈膝位的软组织平衡骨后髁的切骨影响屈膝位的软组织平衡骨后髁的切骨影响屈膝位的软组织平衡Department of Orthopaedics,Shanghai Sixth Peoples Hospital截骨板的选择截骨板的选择截骨板的选择截骨板的选择&当截骨板尺寸和股骨远端不匹配时，是当截骨板尺寸和股骨远端不匹配时，是选择大一号的截骨板还是选择小一号的选择大一号的截骨板还是选择小一号的截骨板？截骨板？Department of Orthopaedics,Shanghai Sixth Peoples Hospital前参考和后参考前参考和后参考前参考和后参考前参考和后参考&前参考前参考以股骨前侧皮质为参考点来测以股骨前侧皮质为参考点来测量股骨在矢状面上的大小量股骨在矢状面上的大小&后参考后参考以股骨后髁为参考点来测量股以股骨后髁为参考点来测量股骨在矢状面上的大小骨在矢状面上的大小Department of Orthopaedics,Shanghai Sixth Peoples HospitalTF=6#5#7#前参考后参考TF=6#5#TF=6#7#屈曲间隙TF=6#5#TF=6#7#髌股间隙Department of Orthopaedics,Shanghai Sixth Peoples Hospital软组织平衡的目标软组织平衡的目标软组织平衡的目标软组织平衡的目标&间隙是矩形间隙是矩形&伸直间隙伸直间隙=屈曲间隙屈曲间隙Department of Orthopaedics,Shanghai Sixth Peoples HospitalPS TKRPS TKR只要简单的考只要简单的考虑伸屈间隙软虑伸屈间隙软组织平衡组织平衡使内外侧副韧使内外侧副韧带在膝关节伸带在膝关节伸直和屈曲时都直和屈曲时都能够保持主要能够保持主要稳定结构稳定结构Department of Orthopaedics,Shanghai Sixth Peoples Hospital内翻畸形内翻畸形内翻畸形内翻畸形&MCL特性特性深层深层浅层浅层前部前部后部后部Department of Orthopaedics,Shanghai Sixth Peoples Hospital内翻畸形内翻畸形内翻畸形内翻畸形&影响伸直影响伸直后关节囊后关节囊MCL后部后部&影响屈曲影响屈曲MCL前部前部Department of Orthopaedics,Shanghai Sixth Peoples Hospital膝关节伸直好膝关节屈曲紧MCL前部 Department of Orthopaedics,Shanghai Sixth Peoples Hospital膝关节伸直紧膝关节屈曲好后关节囊MCL后部Department of Orthopaedics,Shanghai Sixth Peoples Hospital外翻畸形外翻畸形外翻畸形外翻畸形&特性特性伸直伸直外侧副韧带外侧副韧带后关节囊后关节囊,ITB,腘肌腱腘肌腱屈曲屈曲外侧副韧带外侧副韧带腘肌腱腘肌腱Department of Orthopaedics,Shanghai Sixth Peoples Hospital膝关节伸直好膝关节屈曲紧 松解腘肌腱松解外侧副韧带Department of Orthopaedics,Shanghai Sixth Peoples Hospital 膝关节伸直紧膝关节屈曲好 髂胫束.后关节囊 Department of Orthopaedics,Shanghai Sixth Peoples HospitalFlexion-Extension Flexion-Extension 算法算法算法算法&伸直、屈曲间隙都紧伸直、屈曲间隙都紧薄内衬薄内衬胫骨加截胫骨加截Department of Orthopaedics,Shanghai Sixth Peoples Hospital Flexion-Extension Flexion-Extension 算法算法算法算法&伸直间隙好伸直间隙好,屈曲间隙紧屈曲间隙紧使用小一号的股骨假体使用小一号的股骨假体Department of Orthopaedics,Shanghai Sixth Peoples HospitalFlexion-Extension Flexion-Extension 算法算法算法算法&伸直间隙小伸直间隙小,屈曲间隙好屈曲间隙好股骨远端加截股骨远端加截Department of Orthopaedics,Shanghai Sixth Peoples HospitalThanksThanks