膝关节置换图解.docx

膝关节置换图解（1）??A 76-year-old woman presented with bilateral knee pain, left worse than right. Pre-operative radiographs of the left knee show severe, end-stage osteoarthritis. The radiographic hallmarks of osteoarthritis are: joint space narrowing, sclerosis of the subchondral bone, osteophyte formation and eventually cystic changes in the adjacent bone 患者，女，76岁，主诉双膝疼痛，左侧为重。术前X线（左侧）示：骨性关节炎，关节间隙变窄，软骨硬化，骨赘形成以及软骨下骨囊性改变。??Standing alignment views are used to determine the patients weight bearing and mechanical axis. The technical goals of Total Knee Arthroplasty include re-establishing the patients mechanical axis and restoring the joint line. Often times, patients will have developed severe varus deformity (bowed legs) or less commonly, valgus deformity (knock kneed). 站立位通常用于决定患者负重和力线，TKA技术目标包括重建患者下肢机械轴线和恢复关节功能。通常，患者都有严重内翻或外翻（少见）。?After a sterile prep, the limb is draped, landmarks are identified and the mid-line knee incision is planned unless patients have old scars which are not compatible with this standard incision 经过一系列准备以后，下肢铺单贴膜，标记前正中切口皮缘，除非患者有疤痕不宜采用标准切口。??The leg is exsanguinated and a tourniquet is used to maintain hemostasis throughout the case. 用下肢驱血带驱血，保持整个手术过程清晰。??Once the incision is made, the quadriceps tendon, the patella and the patellar tendon are identified. A medial para-patellar arthrotomy is made and the soft tissues are elevated from the tibia. Great care must be taken not to strip to much medially or laterally as this may result in disruption of the medial collateral ligament or the patellar tendon, respectfully. Both are disastrous complications. 切开皮肤，显露股四头肌腱，髌骨，髌腱。从髌骨内侧缘（保留0.5cm软组织以利用缝合）切开软组织致胫骨，注意不要向内侧或外侧剥离过多，以防损伤内侧副韧带或髌韧带，以免引起严重并发症。??The patella and patellar tendon are released from the underlying fat pad and other soft tissues so the patella may be everted laterally to expose the distal femur and proximal tibia. 分离髌骨和髌韧带下方的脂肪垫及其他软组织，以便髌骨向外翻，以显露股骨远端和胫骨近端。??After the patella and tendon are everted (under rake in photo), remaining capsular tissu