德国人的膝关节置换课件

nullnullnullGeneral remarks 总评„design and instruments of knee replacement systems are getting more and more similar“ “不同膝关节置换系统的设计和器械越来越相似”„the better the systems get, the more accurate the surgical technique has to be“ “系统越好,外科技术的精确性也应该越高”„many problems after TKR are more related to a wrong implantation technique than to material or design problems“ „TKR后的许多问题更多的是由于错误的植入技术造成, 而不是材料或设计的问题nullWhy choose the Gemini® SL ? 为何选择Gemini ® SLWhat are the special advantages united in this system in comparison to others ? 相对于其他系统,该系统有什么特殊优点?Which surgical problems can be avoided ? 能避免什么样的技术失误?nullAdvantages reflected in the surgical technique 和外科技术有关的优势 approach 入路 tibial plateau 胫骨平台 polyethylene plateau 聚乙烯垫片 femoral component and patella 股骨假体和髌骨nullApproach 入路With Gemini SL Knee system MIS is possible Gemini SL系统同时可应用于微创nullApproach 入路MISMinimal Invasiv Surgery微创Minimal Incision Surgery小切口„ skin Incision is a secondary result when we preserve soft tissues muscle and tendons ! “ 皮肤的小切口是我们保护了软组织、肌肉和肌腱的表现而已nullnullnullnullnullnullnullnullnullnullnullnullapproach no contractile elements included没有包括的收缩因素 good ventral coverage 良好的腹侧固定 incision of the different layers not one upon another 只切开同侧 „ballanced patella“髌骨的平衡nullnullnullApproach 入路unilateral tibial resection guide on the medial tibial head 单侧胫骨截骨导向器放在胫骨平台内侧small and atraumatic exposure 暴露小而无创nullnullnullnullnullnulltibial plateau 胫骨平台Shaped in accordance with the anatomy of the tibial head 解剖设计和胫骨平台良好匹配Perfect coverage of the bone contact surface 完美覆盖骨接触表面nulltibial plateau 胫骨平台You avoid oversizing and any compromising of the popliteus muscle or dorsal capsule 避免过多处理或产生掴肌或背侧关节囊的任何妥协nulltibial plateaunulltibial plateaunullpolyethylene plateau 聚乙烯垫片Dished surface provides congruency of the articulating planes 深盘状表面提供关节接触面的匹配 It stabilizes the knee joint even in absence of the PCL 即使在PCL缺如的情况下也能稳定膝关节Large area of load transmission, less wear 大的应力传导面，磨损少null0 mm4 mm8 mmpolyethylene plateau 聚乙烯垫片In increasing flexion the femoral condyles glide backwards 增加屈膝时的后滚nullpolyethylene plateau 聚乙烯垫片 surgeons manual: „ …you can combine any size of femoral component with any size of tibial baseplate…“ 医生手册：“可以将任何型号的股骨假体和任何 型号的胫骨托进行匹配uniform mechanism of fixation of the polyethylene, which must have the size of the femoral component 聚乙烯垫片的统一固定机制，需要和股骨假体型号进行匹配 nullnullpolyethylene plateau聚乙烯垫片 Restriction 限制combination of a smaler tibial baseplate to a femoral Component 胫骨托的型号不要小于股骨假体polyethylene plateau is oversized ! 等于或大于没有问题 nullpolyethylene plateau聚乙烯垫片nullpolyethylene plateaunullpolyethylene plateaunullnullfemoral component and patella 股骨假体和髌骨too much patello-femoral pressure or an incomplete tracking („snapping“) of the patella causes anterior knee pain 太大的髌骨压力或不完全髌骨轨道 („snapping“)会导致膝前痛 10 % after TKR TKR后10%nullfemoral component and patella reduction of patello-femoral pressure 减少髌股压力 thin and high patellar glide 髌骨轨道又薄又长 anatomical shaped patellar groove 髌骨滑车解剖型设计 股骨假体和髌骨nullfemoral component and patellareduction of patello-femoral pressure 减少髌-股压力 less invasive, „ballanced“ approach is possible 微创，“平衡的”入路成为可能 backward translation in flexion reduces pressure to the patellar joint 屈膝时的后滚同样降低髌股关节压力股骨假体和髌骨nullfemoral component and patellano or less resection-arthroplasty of the patella 不需要或少的髌骨成型resection of exophytic bone 截骨或植骨 股骨假体和髌骨nullnullnullnullfemoral component and patella 股骨假体和髌骨„Ballanced“ patella “平衡”髌骨nullfemoral component and patella personal opinion:个人观点 „an intact retropatellar surface (cartilage or sclerotic zone) reduces knee pain after TKR“ “原封未动的髌骨后表面（软骨或硬化区）降低TKR后的 膝关节痛 „opened cancellous bone > pain on palpation/pressure“ “开放的松质骨>触痛或压痛”股骨假体和髌骨nullnullSurgeons manual: most important steps 外科医生手册：最关键的步骤„instruments with a good alignement allow an accurate surgical technique !“ “ “器械良好的对线是手术技术精确的表现”nullnullnullfemoral component and patellanullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullnullConclusion 结论Components can be used in various combinations 能应用于不同情况 Minimal invasive technique is possible 使微创成为可能 A wide intraoperative flexibility 术中灵活性 Identical cuts used for rotating-hinge knee 同样的截骨还可应用旋转铰链假体 Endo-Model and MEGASYSTEM-C