国际热点问题探讨.ppt

* 膝关节置换国际热点问题的争论 吕厚山 北京大学人民医院关节研究诊疗中心 CCJR、AAOS、欧洲人工关节会议的热点问题 Retaining/Sacrifice/Substitution PCL Cemented or cementless fixation Mobile bearing or fixed bearing Minimal Invasive Surgery(MIS) Computer-assisted navigation systems Resurfacing patella or not Anticoagulation or not Postoperative Analgesia CCJR、AAOS、欧洲人工关节会议的热点问题 Retaining/Sacrifice/Substitution PCL 保留和不保留PCL的TKR长期随访临床效果基本无差别 保留PCL：技术难度高（保存韧带正常形态和张力） 不保留PCL：技术相对直接、方便 Jacobs WC. Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004803. Netherlands Retaining/Sacrifice/Substitution PCL PCL substitution is not essential for excellent post-op outcomes in TKR Parsley BS. J Arthroplasty. 2006 Sep;21(6 Suppl 2):127-31 USA 279 TKR (骨水泥第三代PS假体) 238 膝(85%)，平均随访48 m ( 24-72 m) KSS术前48分，术后96分 No 髌骨撞击、髌骨轨迹不佳、后脱位 No loosening or osteolysis No revisions 3例晚期感染 Fuchs R, Insall JN, et al. J Arthroplasty. 2006 Sep;21(6):821-5 Instability is an important cause of failure following total knee arthroplasty. Increasing component constraint may reduce instability, but doing so also can cause increased forces to be transmitted to fixation and implant interfaces, which may lead to premature aseptic loosening. Constraint is defined as the effect of the elements of knee implant design that provides the stability needed to counteract forces about the knee after arthroplasty in the presence of a deficient soft-tissue envelope. Determining the amount of constraint necessary can be challenging. Most primary total knee arthroplasties are performed for knees without substantial deformity or the need for difficult ligament balancing; in these cases, either a posterior-stabilized or a posterior cruciate-retaining design is appropriate. In certain situations, such as patients with prior patellectomies, rheumatoid arthritis, or substantial preoperative deformities, a p