THA-Offset重建与下肢长度---吴海山.ppt

TJR 术后体验调查 THA——下肢不等长 TKA——疼痛 下肢长度 纵向 横向 Significant correlation for HSS and both hip offest renconstrution and leg length difference. HSS和双髋偏心距（HO）及下肢长度差异显著相关 HO and leg length reconstruction demonstrated an additive effect on clinical outcome. HO和下肢长度的重建对临床结果具有叠加效应 Should aim for high accuracy in reconstruction of both 重建这两个因素时应该力求准确性 THA中 下肢长度和偏心距控制的很好，临床疗效会更佳 Implant Fixation假体固定 Kinematic Restortion 运动学重建 Max Rom 最大活动范围 Min Dislocation rate 最小几率的脱位风险 Restore center of motion 运动中心重建 Rsetore Offset 偏心距重建 Soft tissue balance 软组织与肌力平衡 Leg Length Restoration 肢体长度重建 偏心距——臀中肌力臂——臀中肌效率——股骨头压在髋臼内的稳定性 Hip offset ＆ Global offset 二者的意义和关联？ 区别在于髋臼打磨的深度？ Proper Offset=Arm of Abduction muscle 外展肌力臂 Less abductor muscle strength 所需外展肌力减小 Decreases pressure in hip 关节间压力减小 Decreases PE wear 聚乙烯磨损减少 Increased tension of soft tissue 增加软组织张力 Decrease dislocation rate 降低脱位率 Less FAI减少与髋臼撞击 Less ceramic fracture 降低陶瓷部件破裂率 Improve muscle efficifency 提高肌肉动力效率 Improve ROM 增加活动度 Insufficient Offset 不足 Trendelenburg gait Trendelenburg步态 Fatigue when walk 行走时易疲劳 Need to use crutches 需要借助拐杖 Increased pressure in hip 关节间压力增加 Increased PE weat 内衬磨损增加 Over much Offset 过大 Pain due to high tension 软组织张力高引起疼痛 Greater trochanter bursistis 大转子滑囊炎 Hip appearance 髋关节外观 Analysis of Insufficient Offset Subjective 主观 Surgeons do not understand 手术医生不理解 Objective 客观 Limited choice of prosthesis 假体选择有限 Only 40% THA restore femoral prosthesis 仅40%THA术后恢复股骨offset Increased neck length,resulting in longer limb 为了稳定而增加颈长，造成肢体延长 Factors that Affect Offset Neck shaft angle 假体颈干角 Neck length 假体头颈长 Calcar femorale 保留股骨距 Rotation center 旋转中心位置 Ncek shaft angle of Prosthesis Greatest impact on offset 对offset影响最大 Standard bilateral hip AP view 内旋15°双髋正位片 Accurate template measurement 术前模板准确测量 Risk of less neck shaft angle Prosthetic fracture at neck 假体颈部断裂风险 Increase torsion at Calar 增加假体在股骨距处扭力 I