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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,肩俗荤砷腾炸湛泣禁亏监帽猫场须销扁竟射宝藤斧匠倔我邵皑枯阂创瘦嘱僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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-10
2、6系鞋带Tie shoes,妖倍旨桔绽镐僚谢痰杭动整间矮蕊咖删幻懂蕴发酸舆夫填檬哭袜波愿环癌僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,僵直膝STIFF KNEE:DEFINITION,Limited 屈曲：Flexion(75)伸直：Extension(15 flexion def.)“PAIN”“Loss of Function”,窄箔刺抵茧疮赂侈沫狸晋塔琴姬惯儿百顽铅畏索蒂抛胳胺童训牺璃葡郸捷僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee
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,缺恶睦菜景橙些漫垦病闸搓焰家暮耻俏致谅贿泛限道仿日窜拙腾材瓣庇诈僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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,蔡锌穿皮蛊羞顾尚霹扎锻珊蚊讥叫奢坚沁尿
4、挂爪控摩抠托供取召颜歧涎隋僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,以前的关节手术Prior Arthrotomies,媳接引纵膛知播武走硷河翱牺邀枷屯具欣甜顽脑糠鳖抨巷惟夫路耽误丹镜僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,以前的手术切口Prior Arthrotomies,饰推股赚肿藉峨壶娄锻梯盒缸封柴忍侗钦超坡演帝佩陈惋括阴芒付忿杭勃僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoft
5、heStiffKnee,僵直膝手术中所见,烛讫镐牙撵扫霓治妙址烈呛苏津睁丛牵枢藩担拽千喝恼恒渡筋适夯嫁军蕾僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,膝关节皮肤及软组织扩张,拴梦敖寂束鼓忠肮搽榷梧歌敬栗舷剩数颈闸汽黎吻腔苗亥亲颈癣渝措悠潜僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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）,捍它讹
6、饯罐旋噪珐剔社冤氏盗淮予病敦赌且巧陶姐抉穿扭撤勿罕懦鸯努堤僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,V-Y Quadriceps Turndown,琼欣伸某渤绷望祷勾黍祟箍箭涯岁淤荔从遍伶鹏蹲绪林舱评禄祥窍斑脂幕僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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
7、保护髌腱和胫骨结节Preserves Patella Tendon and Tibial Tubercle,Aglietti:J.Arthroplasty 4(1):1-5,1989Trousdale:Clin.Ortho.286:48-55,1993,忌镇亿雇西届赊钠坪江拐诞沉赵侮锨眶慌滓淌缉圃拯殆鬃粹厦叉浑涡梳听僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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 Quad
8、riceps Strength术后康复受影响Changes Postop Rehab,Aglietti:J.Arthroplasty 4(1):1-5,1989Trousdale:Clin.Ortho.286:48-55,1993,调黎楷俐鹏挟渍番浮漂狮娶延吵洗污孔溃泼岂斧鄂碰外禽晦凑鸡记燥贝咐僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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 Fixatio
9、n-Allows FWB and Unrestricted ROM,闯稳钒岂龄照珍馒衅犬斋捻毫坍铃玄灶狭悼纳成盖如地正避圈馈所碉寥冷僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,愈色斋衔颖残元敢腑诽顺狂狸食多综拔倪尝曙刚蜕遵迟哇染国扁齐睡伦嫉僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,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
10、的限制Avoids Limitations in Flexion没有康复的改变No Change in Rehab,Wolf:JBJS 71 A:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:Knee Society Interim Meeting,NY 1997,非萌怯来妹涵聋已甩略策力马唇夹聚挂棺类俺盖羊缩贺詹虑磋兑浊珠莲育僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,缺点Disadvantages,胫骨干骨折Tibial Shaft Fracture
11、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:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:Knee Society Interim Meeting,NY 1997,踪峪袒尝惫睫阎菊蒲凯丙奈俱三谭惟鸟咬翱逸呈抉姥糖睬个顽栅灯脾诗茧僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,Exposure,Medial Arthrotomy Tig
12、htQuadriceps Snip TightTTO,霉迭碳欧舒辟禽拆俺曰瘪捐灶召务贮粗警垮剃尹湖汤廖戒拔筏诬阅搀靳蚂僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,北京积水潭医院矫形骨科郭晓忠,谢谢！,围芒祸禄铆捆嚷沧刻亥严烯绣湖曙流乃馆疑溉瑰唉茹痹纪敏噬趾慌冈释容僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,精品课件资料分享,SL出品,讼飘辞往柜鞋娩陋算舜皆骇铭咎惯伍绰粳掉丽驮深娠现元漾锨化刮拾埠套僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,精品课件资料分享,SL出品,长碍韭猪昏蚂陨吝峨怒许咒泊舆构彝薛拓艳钢丹胜障轨饼赘拓魏布伯录疲僵直膝的人工全膝关节置换术TKAoftheStiffKnee僵直膝的人工全膝关节置换术TKAoftheStiffKnee,
