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2022-9-281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 shoes2僵直膝STIFF KNEE:DEFINITIONLimited 屈曲：Flexion(75)伸直：Extension(15 flexion de
2、f.)“PAIN”“Loss of Function”3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 Arthrotomies6以前的手术切口Prior Arthrotomies7僵直膝手术中所见8膝关节皮肤及软组织扩张9V Y 股四头肌腱延长术V-
3、Y Quadriceps Turndown最早由Coonse&Adams 描绘（1943）由 Insall 改良（1983）10V-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 TubercleAglietti:J.Arthroplasty 4(1):1-5,1989Trousdale:Clin.Ortho.286:48-5
4、5,199312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 RehabAglietti:J.Arthroplasty 4(1):1-5,1989Trousdale:Clin.Ortho.286:48-55,199313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-All
5、ows FWB and Unrestricted ROM1415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 RehabWolf:JBJS 71 A:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:Knee Society Interim Meeting,NY 199716缺点Disadvantages胫骨干骨折Tibi
6、al Shaft Fracture胫骨结节撕脱骨折Tibial Tubercle Avulsion Fracture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 199717ExposureMedial Arthrotomy TightQuadriceps Snip TightTTO1819精品课件资料分享 SL出品2022-9-2820精品课件资料分享 SL出品2022-9-2821
