德国人的膝关节置换

General remarks总评,design and instruments of knee replacement systems are getting more and more similar“不同膝关节置换系统的设计和器械越来越相似”,the better the systems get, the more accurate the surgical technique has to be“系统越好,外科技术的精确性也应该越高”,many problems after TKR are more related to a wrong implantation technique than to material or design problems“TKR后的许多问题更多的是由于错误的植入技术造成, 而不是材料或设计的问题,Why choose the Gemini SL ?为何选择Gemini SL,What are the special advantages united in this system in comparison to others ?相对于其他系统,该系统有什么特殊优点?,Which surgical problems can be avoided ?能避免什么样的技术失误?,Advantages reflected in the surgical technique和外科技术有关的优势,approach 入路 tibial plateau 胫骨平台 polyethylene plateau 聚乙烯垫片 femoral component and patella 股骨假体和髌骨,Approach 入路,With Gemini SL Knee system MIS is possibleGemini SL系统同时可应用于微创,Approach 入路,MIS,Minimal Invasiv Surgery微创,Minimal Incision Surgery小切口, skin Incision is a secondary result when we preserve soft tissues muscle and tendons ! “皮肤的小切口是我们保护了软组织、肌肉和肌腱的表现而已,approach,no contractile elements included没有包括的收缩因素 good ventral coverage 良好的腹侧固定 incision of the different layers not one upon another 只切开同侧ballanced patella“髌骨的平衡,Approach 入路,unilateral tibial resection guide on the medial tibial head单侧胫骨截骨导向器放在胫骨平台内侧,small and atraumatic exposure暴露小而无创,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,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,tibial plateau,tibial plateau,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,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,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,polyethylene plateau聚乙烯垫片,Restriction 限制,combination of a smaler tibial baseplate to a femoralComponent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,polyethylene plateau聚乙烯垫片,polyethylene plateau,polyethylene plateau,femoral component and patella股骨假体和髌骨,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%,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,股骨假体和髌骨,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,股骨假体和髌骨,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,股骨假体和髌骨,femoral component and patella股骨假体和髌骨,Ballanced“ patella“平衡”髌骨,femoral component and patella,personal opinion:个人观点an intact retropatellar surface (cartilage or sclerotic zone) reduces knee pain after TKR“原封未动的髌骨后表面（软骨或硬化区）降低TKR后的膝关节痛opened cancellous bone pain on palpation/pressure“开放的松质骨触痛或压痛”,股骨假体和髌骨,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”,femoral component and patella,Conclusion结论,Components can be used in various