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,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,2024/11/17,1,僵直膝的人工全膝关节置换术TKA of the Stiff,膝关节日常活动度,Knee flexion required for daily activities,-67,行走,for swing phase of gait,-83,爬楼梯,to ascend stairs,-84,下楼梯,to descend stairs,-93,从椅子起来,to rise from chair,-106,系鞋带,Tie shoes,2,膝关节日常活动度Knee flexion required,僵直膝,STIFF KNEE:DEFINITION,Limited,屈曲：,Flexion(75),伸直：,Extension(15 flexion def.),“PAIN”,“Loss of Function”,3,僵直膝STIFF KNEE:DEFINITIONLimi,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,4,引起僵直膝的原因陈旧的膝关节感染（结核）4,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,5,以前的关节手术Prior Arthrotomies胫骨高位,以前的关节手术,Prior Arthrotomies,6,以前的关节手术Prior Arthrotomies6,以前的手术切口,Prior Arthrotomies,7,以前的手术切口Prior Arthrotomies7,僵直膝手术中所见,8,僵直膝手术中所见8,膝关节皮肤及软组织扩张,9,膝关节皮肤及软组织扩张9,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,）,10,V Y 股四头肌腱延长术V-Y Quadricep,V-Y Quadriceps Turndown,11,V-Y Quadriceps Turndown11,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.286:48-55,1993,12,优点Advantages很好的显露：Allows Excel,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.286:48-55,1993,13,缺点Disadvantages术后可能减弱伸膝装置Posto,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,14,胫骨结节截骨Tibial Tubercle Osteoto,15,15,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 1997,16,优点Advantages避免伸膝装置减弱Avoids Ext,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 1997,17,缺点Disadvantages胫骨干骨折Tibial Sha,Exposure,Medial Arthrotomy,Tight,Quadriceps Snip,Tight,TTO,18,ExposureMedial Arthrotomy18,北京积水潭医院矫形骨科,郭晓忠,谢谢！,19,北京积水潭医院矫形骨科谢谢！19,精品课件资料分享,SL,出品,2024/11/17,20,精品课件资料分享,精品课件资料分享,SL,出品,2024/11/17,21,精品课件资料分享,
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