僵直膝的人工全膝关节置换术TKAoftheStiffKnee课件

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: DEFINITIONLimited 屈曲：Flexion ( 75 ) 伸直：Extension ( 15 flex

2、ion def.) “PAIN” “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

3、 - Y Quadriceps 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 TubercleAglietti: J. Arthroplasty 4(1): 1-5, 1989Trousdale: Clin. Ortho

4、. 286: 48-55, 1993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, 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 Rig

5、id Fixation - Allows 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 RehabWolf: JBJS 71 A:843 - 852, 1989Whiteside: Clin. Ortho. 321:32 - 35, 2019Barrack: Knee Society Interim Meeting, NY 2019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 ProblemsWolf: JBJS 71 A:843 - 852, 1989Whiteside: Clin. Ortho. 321:32 - 35, 2019Barrack: Knee Society Interim Meeting, NY 2019Exposur