德国人的膝关节置换

1、会计学1德国人的膝关节置换德国人的膝关节置换Why choose the Gemini SL ?为何选择Gemini SLWhat 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?第1页/共81页Advantages reflected in the surgical technique和外科技术有关的优势 approach 入路 tibial plate

2、au 胫骨平台 polyethylene plateau 聚乙烯垫片 femoral component and patella 股骨假体和髌骨第2页/共81页Approach 入路With Gemini SL Knee system MIS is possibleGemini SL系统同时可应用于微创第3页/共81页Approach 入路MISMinimal Invasiv Surgery微创Minimal Incision Surgery小切口! skin Incision is a secondary result when we preserve soft tissues muscle

3、 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第4页/共81页第5页/共81页第6页/共81页第7页/共81页第8页/共81页第9页/共81页第10页/共81页第11页/共81页第12页/共81页第13页/共81页第14页/共81页第15页/共81页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 patell

4、a“髌骨的平衡第16页/共81页第17页/共81页第18页/共81页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暴露小而无创第19页/共81页第20页/共81页第21页/共81页第22页/共81页第23页/共81页第24页/共81页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Pe

5、rfect coverage of the bone contact surface完美覆盖骨接触表面第25页/共81页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第26页/共81页tibial plateau第27页/共81页tibial plateau第28页/共81页polyethylene plateau 聚乙烯垫片Dished surface provides congruency

6、 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，磨损少第29页/共81页0 mm4 mm8 mmpolyethylene plateau 聚乙烯垫片In increasing flexion the femoral condyles glide backwards增加屈膝时的后滚第30页/共81页polyethy

7、lene 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第31页/共81页第32页/共81页polyethylen

8、e 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第33页/共81页polyethylene plateau聚乙烯垫片第34页/共81页polyethylene plateau第35页/共81页polyethylene plateau第36页/共81页第37页/共81页femoral component and patella股骨假体和髌骨too m

9、uch 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%第38页/共81页femoral component and patellareduction of patello-femoral pressure减少髌股压力 thin and high patellar glide 髌骨轨道又薄又长 anatomical shape

10、d patellar groove 髌骨滑车解剖型设计股骨假体和髌骨第39页/共81页femoral component and patellareduction 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第40页/共81页femoral component

11、and patellano 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 股骨假体和髌骨第41页/共81页第42页/共81页第43页/共81页第44页/共81页femoral component and patella股骨假体和髌骨Ballanced“ patella“平衡”髌骨第45页/共81页femoral component and patellapersonal opinion:个人观点an intact retropatellar surface (ca

12、rtilage 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”股骨假体和髌骨第46页/共81页第47页/共81页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

13、对线是手术技术精确的表现”第48页/共81页第49页/共81页第50页/共81页femoral component and patella第51页/共81页第52页/共81页第53页/共81页第54页/共81页第55页/共81页第56页/共81页第57页/共81页第58页/共81页第59页/共81页第60页/共81页第61页/共81页第62页/共81页第63页/共81页第64页/共81页第65页/共81页第66页/共81页第67页/共81页第68页/共81页第69页/共81页第70页/共81页第71页/共81页Conclusion结论Components can be used in vari

14、ous combinations 能应用于不同情况Minimal invasive technique is possible 使微创成为可能A wide intraoperative flexibility 术中灵活性Identical cuts used for rotating-hinge knee 同样的截骨还可应用旋转同样的截骨还可应用旋转铰链假体铰链假体Endo-Model and MEGASYSTEM-C第72页/共81页Why choose the Gemini SL ?为何选择Gemini SLWhat 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?第73页/共81页Approach 入路MISMinimal Invasiv Surgery微创Minimal Incision Surgery小切口! skin Incision is a secondary result when we preserve soft tissues muscle and tendon