人工关节置换概述ppt课件

人工关节置换概述,1,主 要 内 容,一、相关知识 （1）概念 （2）适应证 （3）禁忌症 二、病例介绍 （1）术前准备 （2）手术配合,2,全髋关节置换术（THA） 全膝关节置换术（TKA）,是用人工生物材料置换髋、膝关节中已被破损的骨和软骨，恢复关节活动功能。 THA手术始于20世纪20年代，从髋臼杯成形术股骨头置换术（短柄、长柄、双动头）全髋关节置换 TKA手术始于20世纪60年代 20世纪骨矫形中最成功的手术之一,3,髋关节的解剖,4,膝关节的解剖,5,关节置换适应症,1.原发性或继发性骨性关节炎者（ 股骨髁、胫骨平台创伤后骨折畸形愈合）2.创伤性疾病并发症（股骨头坏死、骨折不愈合）3.原发或者继发性肿瘤4.自身免疫性疾病累计关节（RA、血友病、AS）5.先天性疾患（DDH、Perthes病）6.感染性疾病（关节结核、化脓性感染）,6,关节置换禁忌症,有全身或局部的活动性感染 主要运动肌瘫痪，屈伸功能丧失 骨组织严重缺损难以稳定假体 衰竭，无法耐受手术相对禁忌症：如老年痴呆、帕金森等,7,TKA手术适应症,A.屈曲挛缩畸形,8,TKA手术适应症,B.膝内翻畸形,9,TKA手术适应症,C.膝外翻畸形,10,TKA手术适应症,D.屈曲挛缩内翻畸形,11,TKA手术适应症,E.屈曲挛缩外翻畸形,12,TKA手术适应症,类风湿性关节炎（RA）,13,TKA手术适应症,强直性脊柱炎（AS）,14,TKA手术适应症,创伤性关节炎,15,TKA手术适应症,膝关节结核强直后,16,TKA手术适应症,骨肿瘤切除术后,17,人工关节髋臼杯及内衬,18,人工关节股骨假体,19,人工膝关节的类型-单髁关节,20,人工膝关节的类型-全膝关节,不保留后交叉,保留后交叉,21,麻醉方式,*麻醉方式：多用连续硬膜外麻醉，类风湿病人穿刺失败可用椎板钻孔插管或全麻。,22,术前准备,1.术前一天访视患者，查看病历了解病人身体状况和讲解术前准备。2.术前查看手术用物的完好，建立静脉通道、配合麻师打麻醉、和器械护士清点手术台上物品。,23,术前准备,*用物准备（洗手）：剖腹探查包、小面盆、手术衣、布类、大腹单、骨科包、骨科特殊器械、电刀笔、21#刀片、1#、4#、7#号线、吸引管、骨科引流装置。,24,全膝关节置换术的流程,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,tibial plateau 胫骨平台,Shaped in accordance with the anatomy of the tibial head 解剖设计和胫骨平台良好匹配,Perfect coverage of the bone contact surface 完美覆盖骨接触表面,44,tibial plateau 胫骨平台,You avoid oversizing and any compromising of the popliteus muscle or dorsal capsule 避免过多处理或产生掴肌或背侧关节囊的任何妥协,45,tibial plateau,46,tibial plateau,47,polyethylene plateau 聚乙烯垫片,Dished surface provides congruency of the articulating planes 深盘状表面提供关节接触面的匹配,It stabilizes the knee joint even in absence of the PCL 即使在PCL缺如的情况下也能稳定膝关节,Large area of load transmission, less wear 大的应力传导面，磨损少,48,0 mm,4 mm,8 mm,polyethylene plateau 聚乙烯垫片,In increasing flexion the femoral condyles glide backwards 增加屈膝时的后滚,49,polyethylene plateau 聚乙烯垫片,surgeons manual: you can combine any size of femoral component with any size of tibial baseplate“ 医生手册：“可以将任何型号的股骨假体和任何 型号的胫骨托进行匹配,uniform mechanism of fixation of the polyethylene, which must have the size of the femoral component 聚乙烯垫片的统一固定机制，需要和股骨假体型号进行匹配,50,51,polyethylene plateau聚乙烯垫片,Restriction 限制,combination of a smaler tibial baseplate to a femoral Component 胫骨托的型号不要小于股骨假体,polyethylene plateau is oversized ! 等于或大于没有问题,52,polyethylene plateau聚乙烯垫片,53,polyethylene plateau,54,polyethylene plateau,55,56,too much patello-femoral pressure or an incomplete tracking (snapping“) of the patella causes anterior knee pain 太大的髌骨压力或不完全髌骨轨道 (snapping“)会导致膝前痛 10 % after TKR TKR后10%,57,femoral component and patella,reduction of patello-femoral pressure 减少髌股压力,thin and high patellar glide髌骨轨道又薄又长anatomical shaped patellar groove髌骨滑车解剖型设计,58,femoral component and patella,reduction of patello-femoral pressure 减少髌-股压力,less invasive, ballanced“ approach is possible微创，“平衡的”入路成为可能backward translation in flexion reduces pressure to the patellar joint屈膝时的后滚同样降低髌股关节压力,59,femoral component and patella,no or less resection-arthroplasty of the patella 不需要或少的髌骨成型,resection of exophytic bone 截骨或植骨,60,61,62,63,femoral component and patella 股骨假体和髌骨,Ballanced“ patella “平衡”髌骨,64,65,Surgeons manual: most important steps 外科医生手册：最关键的步骤,instruments with a good alignement allow an accurate surgical technique !“ “ “器械良好的对线是手术技术精确的表现”,66,67,68,femoral component and patella,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,人工全髋关节置换术,视频,90,人工关节置换术后并发症,感染 松动 脱位 术后疼痛 术后关节僵硬 假体周围骨折 金属过敏 炎性假瘤,91,谢谢聆听！,92,