弧形墊理念與技術(shù)實踐

弧形墊理念與技術(shù)實踐施樂輝Mid-Tier

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distributetothirdparties.如何實現(xiàn)人工膝關(guān)節(jié)的穩(wěn)定性？后穩(wěn)定型假體的優(yōu)與劣弧形襯墊的基本原理弧形襯墊的優(yōu)勢與特點推廣策略小結(jié)關(guān)于膝關(guān)節(jié)假體分類保留ACL/PCL:單髁保留PCL：CR不保留PCL：髁間截骨：PS：切除PCL髁間不截骨：弧形墊片Post-BoxPost-Cam

PS型假體的優(yōu)點PS型假體的髁間截骨目前假體流行趨勢PS為主：手術(shù)操作簡單髁間截骨量大100_4557.JPG髁間截骨丟失骨質(zhì)造成應(yīng)力集中點，骨折易發(fā)截骨量隨假體設(shè)計而異Lombardi

Jr

AV,

Mallory

TH,

Waterman

RA,

et

al.

Intercondylar

distal

femoral

fracture:

an

unreported

complication

of

posterior-stabilized

totalkneearthroplasty.

J

Arthroplasty

1995;10:643-649.纖維疤痕組織屈膝90度屈膝70度Garino

J,Lotke

P.

Sacrificing

the

Posterior

Cruciate

Ligament

with

or

without

substitution

in

Total

knee

Arthroplasty.

In

Fu

F(

ed

).

Knee

Surgery.Baltimore.

Williams

&

Wilkins.1994:

1321-1329.DepuyPFCPS型股骨髁有較高的髕骨撞擊發(fā)生率，以至于目前需作重大改良。PS

Component

smooth

box

transitionReach股骨髁（舊PFC髁）2010年改進后上市的PFC當(dāng)從坐位站起時，膝關(guān)節(jié)所需承受的應(yīng)力是體重的8~10倍。Bartel

DL,

Rawlinson

JJ,Burstein

AH,

et

al.

Stresses

inPolyethylene

Components

of

Contemporary

Total

Knee

Replacements.

Clin

Orthop1995:

76-82.后穩(wěn)定型假體立柱磨損及撞擊PS假體不足過伸立柱撞擊高屈髕骨撞擊保留髁間骨量的選擇——CR接近生理保留本體感覺保留膝關(guān)節(jié)“后滾”能力提高股四頭肌力PCL保留型假體利用PCL的前后穩(wěn)定性引導(dǎo)股骨髁的滑動和后移墊片平坦—良好的活動度保護膝關(guān)節(jié)的本體感覺手術(shù)技術(shù)要求高PCL保留型假體當(dāng)PCL功能不全時，股骨髁的后滾變成了反向扣鎖，股骨假體的前緣與脛骨假體的前緣發(fā)生接觸墊片平坦—降低接觸面積，增加磨損手術(shù)技術(shù)要求高，后關(guān)節(jié)囊松解困難那么，年輕患者保存骨量減小撞擊及磨損畸形較重關(guān)節(jié)PCL功能不全?；⌒螇|的關(guān)節(jié)活動度明顯優(yōu)于普通襯墊Scott

WN,

Rubinstein

M,

Scuderi

G.

Results

After

Knee

Replacement

with

APosterior

Cruciate-substituting

Prosthesis.

J

Bone

Joint

Surg

Am.

1998;70:1163-1169.弧形襯墊的術(shù)后ROM、上下樓梯能力、疼痛評分、膝關(guān)節(jié)功能評分、穩(wěn)定性、關(guān)節(jié)周圍疼痛、假體力線、影像學(xué)檢查（正側(cè)位）等治療結(jié)果與經(jīng)典PS型相同Laskin

RS,

Maruyama

Y,

Villaneuva

M,

et

al.

Deep-Dish

Congruent

TibialComponent

Use

in

Total

knee

Arthroplasty:

A

Randomized

Prospective

Study.Clin

Orthop

Relat

Res.

2000;

380:

36-44.弧形襯墊假體長期隨訪（21年）結(jié)果優(yōu)異Font-Rodriguez

DE,

Scuderi

GR,

Insall

JN.

Survivorship

of

Cemented

TotalKnee

Arthroplasty.

Clin

Orthop

1997:

79-88.H：水平脫出距離V：垂直脫出距離Font-Rodriguez

DE,

Scuderi

GR,

InsallJN.

Survivorship

of

Cemented

Total

Knee

Arthroplasty.

ClinOrthop

1997:

79-88.一般情況下切除PCL，尤其PCL功能不全時。Scott

RD,

VolatileTB.

Twelve

years’

experience

with

posterior

cruciate-retaining

total

knee

arthroplasty.

ClinOrthop

1986;100.使用弧形襯墊置換，切除PCL或是保留PCL，其關(guān)節(jié)活動度（ROM）膝關(guān)節(jié)術(shù)后評分（KneeSocietyscores、WOMACscores）等結(jié)果并無明顯差別。確保軟組織平衡才是預(yù)防假體脫位的關(guān)鍵。如患者存在內(nèi)/外翻畸形，或屈曲攣縮畸形超過15~20度，應(yīng)切除PCL。如保留PCL，應(yīng)確保韌帶充分松解。在PCL緊張的情況下使用弧形墊，會導(dǎo)致假體后滾幅度加大，反而加速聚乙烯磨損。避免了股骨髁骨折的風(fēng)險Paletta

G,

Laskin

R.Total

Condylar

knee

Replacement

inRheumatoid

Arthritis.

JBone

Joint

Surg.

1996;

77A:

42-49.無聚乙烯襯墊中柱斷裂風(fēng)險Sathappan

SS,

Wasserman

B,

Jaffe

WL,

et

al.

Midterm

Results

of

PrimaryTotal

Knee

Arthroplasty

Using

a

Dished

PolyethyleneInsert

with

a

Recessed

or

Resected

Posterior

Cruciate

Ligament.

J

Arthroplasty.

2006;

21:1012-1016.有效避免髕骨撞擊綜合征Hozack

WJ,

Rothman

RH,

Booth

Jr

RE,

Balderstrom

PA:

The

patellar

clunk

syndrome:

a

complication

of

posterior

stabilized

totalknee

arthroplasty.

Clin

Orthop.

1989;

241:203.保留髁間骨質(zhì)Lombardi

Jr

AV,

Mallory

TH,

Waterman

RA,

Eberle

RW:

Intercondylar

distalfemoral

fracture:

an

unreportedcomplication

of

posterior-stabilized

total

knee

arthroplasty.

J

Arthroplasty

.1995;

10:643.Richard

S

Laskin,

MD.Robert