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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,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,僵直膝STIFF KNEE:DEFINITION,Limited 屈曲：Flexion(75)伸直：Extension(15 flexion def.)“PA
2、IN”“Loss of Function”,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,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,以前的关节手术Prior Arthrotomies,以前的手术切口Prior Arthrotomies,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 Qu
3、adriceps Turndown,最早由Coonse&Adams 描绘（1943）由 Insall 改良（1983）,V-Y Quadriceps Turndown,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):1-5,1989Trousdale:Clin.Ortho.286:48-55,1
4、993,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):1-5,1989Trousdale:Clin.Ortho.286:48-55,1993,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
5、FWB and Unrestricted ROM,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:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:Knee Society Interim Meeting,NY 1997,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:843-852,1989Whiteside:Clin.Ortho.321:32-35,1995Barrack:Knee Society Interim Meeting,NY 1997,Exposure,Medial Arthrotomy TightQuadriceps Snip TightTTO,北京积水潭医院矫形骨科郭晓忠,谢谢！,精品课件资料分享,SL出品,精品课件资料分享,SL出品,
