1、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膝关节日常活动度Knee flexion required for daily activitiesn n - 67 行走for swing phase of gaitn n - 83 爬楼梯to ascend stairsn n - 84 下楼梯to descend stairsn n - 93 从椅子起来to rise from chairn n - 106系鞋带Tie shoes僵直膝STIFF KNEE: DEFINITIONLimited 屈曲：Flexion ( 75 ) 伸直：Exte
2、nsion ( 15 flexion def.) “PAIN” “Loss of Function”引起僵直膝的原因n n陈旧的膝关节感染（结核）n n严重的无菌性关节炎症（类风湿等免疫性疾病）n n膝关节外伤（骨折）术后以前的关节手术Prior Arthrotomiesn n胫骨高位截骨HTOn n胫骨平台骨折内固定ORIF Tibial Plateau Fracturen n髌骨重建Patellar Realignmentn n韧带重建Ligament Reconstructionn n股骨远端骨折内固定以前的关节手术Prior Arthrotomies以前的手术切口Prior Arthr
3、otomies僵直膝手术中所见膝关节皮肤及软组织扩张V Y 股四头肌腱延长术V - Y Quadriceps Turndownn n最早由Coonse & Adams 描绘（1943）n n由 Insall 改良（1983）V - Y Quadriceps Turndown优点Advantagesn n很好的显露：Allows Excellent Exposuren n有利于股四头肌腱延长Allows Lengthening of Quadriceps Tendonn n保护髌腱和胫骨结节Preserves Patella Tendon and Tibial TubercleAglietti:
4、 J. Arthroplasty 4(1): 1-5, 1989Trousdale: Clin. Ortho. 286: 48-55, 1993缺点Disadvantagesn n术后可能减弱伸膝装置Postop Extensor Lag May Occurn n可能影响股四头肌力量May Affect Quadriceps Strengthn n术后康复受影响Changes Postop RehabAglietti: J. Arthroplasty 4(1): 1-5, 1989Trousdale: Clin. Ortho. 286: 48-55, 1993胫骨结节截骨Tibial Tube
5、rcle 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Advantagesn n避免伸膝装置减弱Avoids Extension Lagn n避免股四头肌腱减弱Avoids Quadriceps Weaknessn n避免屈曲的限制A
6、voids Limitations in Flexionn n没有康复的改变No Change in RehabWolf: JBJS 71 A:843 - 852, 1989Whiteside: Clin. Ortho. 321:32 - 35, 1995Barrack: Knee Society Interim Meeting, NY 1997缺点Disadvantagesn n胫骨干骨折Tibial Shaft Fracturen n胫骨结节撕脱骨折Tibial Tubercle Avulsion Fracturen n伤口愈合问题Wound Healing ProblemsWolf: JBJS 71 A:843 - 852, 1989Whiteside: Clin. Ortho. 321:32 - 35, 1995Barrack: Knee Society Interim Meeting, NY 1997ExposureMedial Arthrotomy TightQuadriceps Snip TightTTO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 SL出品精品课件资料分享 SL出品
