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1、膝關(guān)節(jié)置換圖解（1）??A76-year-oldwomanpresentedwithbilateralkneepain,leftworsethanright.Pre-operativeradiographsoftheleftkneeshowsevere,end-stageosteoarthritis.Theradiographichallmarksofosteoarthritisare:jointspacenarrowing,sclerosisofthesubchondralbone,osteophyteformationandeventuallycysticchange
2、sintheadjacentbone患者，女，76歲，主訴雙膝疼痛，左側(cè)為重。術(shù)前X線（左側(cè)）示：骨性關(guān)節(jié)炎，關(guān)節(jié)間隙變窄，軟骨硬化，骨贅形成以及軟骨下骨囊性改變。??Standing"alignmentviews"areusedtodeterminethepatient'sweightbearingandmechanicalaxis.ThetechnicalgoalsofTotalKneeArthroplastyincludere-establishingthepatientsmechanicalaxisandrestoringthejointline.Oftentim
3、es,patientswillhavedevelopedsevere"varus"deformity(bowedlegs)orlesscommonly,"valgusdeformity(knockkneed).站立位通常用于決定患者負(fù)重和力線，TKA技術(shù)目標(biāo)包括重建患者下肢機(jī)械軸線和恢復(fù)關(guān)節(jié)功能。通常，患者都有嚴(yán)重內(nèi)翻或外翻（少見）。?Afterasterileprep,thelimbisdraped,landmarksareidentifiedandthemid-linekneeincisionisplannedunlesspatientshaveoldscarswhi
4、charenotcompatiblewiththisstandardincision經(jīng)過一系列準(zhǔn)備以后，下肢鋪單貼膜，標(biāo)記前正中切口皮緣，除非患者有疤痕不宜采用標(biāo)準(zhǔn)切口。??Thelegisexsanguinatedandatourniquetisusedtomaintainhemostasisthroughoutthecase.用下肢驅(qū)血帶驅(qū)血，保持整個(gè)手術(shù)過程清晰。??Oncetheincisionismade,thequadricepstendon,thepatellaandthepatellartendonareidentified.Amedialpara-pat
5、ellararthrotomyismadeandthesofttissuesareelevatedfromthetibia.Greatcaremustbetakennottostriptomuchmediallyorlaterallyasthismayresultindisruptionofthemedialcollateralligamentorthepatellartendon,respectfully.Botharedisastrouscomplications.切開皮膚，顯露股四頭肌腱，髕骨，髕腱。從髕骨內(nèi)側(cè)緣（保留0.5cm軟組織以利用縫合）切開軟組織致脛骨，注
6、意不要向內(nèi)側(cè)或外側(cè)剝離過多，以防損傷內(nèi)側(cè)副韌帶或髕韌帶，以免引起嚴(yán)重并發(fā)癥。??Thepatellaandpatellartendonarereleasedfromtheunderlyingfatpadandothersofttissuessothepatellamaybeevertedlaterallytoexposethedistalfemurandproximaltibia.分離髕骨和髕韌帶下方的脂肪墊及其他軟組織，以便髕骨向外翻，以顯露股骨遠(yuǎn)端和脛骨近端。??Afterthepatellaandtendonareeverted(underrakeinphoto),
7、remainingcapsulartissuesarereleased.Thepatellar-femoralligamentabovetheclampisabouttobedivided.把髕骨和髕韌帶翻向一側(cè)后，清除剩余軟組織，分離髕股韌帶（下圖彎鉗上方組織）??Onlyasinglecutismadetopreparethetibia.Anextramedullaryalignmentguideisplacedandsecuredwithpinsintheproximaltibia.Thisguideisusedtore
