全膝关节置换术

intramedullary guide for femoral cuts and extramedullary guide for tibial cuts
cut surfaces are cleansed with pulsatile lavage system before cementation (no need for cementless fixation)
Pre-operative (therapists) baseline assessment by physiotherapist & occupational
therapist assess range & quadriceps power, measure
circumferences at knee joint, 10 cm. above it and 10 cm. below it teach post-op. exercises e.g. active knee mobilization, static quadriceps, straight-leg-raising, bridging 术前准备(治疗师) 由物理治疗师和职业治疗师进行基本状况评估 膝关节活动范围及股四头肌肌力评估﹐在距离膝关节上下各 10厘米处测量大腿及小腿的周径 指导术后的操练﹐例如膝关节的主动活动﹐股四头肌静力收 缩﹐直腿高举以及伸腰弯弓动作的练习
confirm the presence of all prostheses and special instruments that may be needed with OT staff
make sure that allograft is available if that is part of the surgical plan 术前准备(医生) 填写全膝关节置换术记录表 与手术室同事确认所需的假体和特殊器械均已到位 手术方案中若需植骨﹐则事先确认有合适的异体骨 可供选用
no bulking drape around foot and ankle
surgical approach (Insall) with periosteum elevated from medial third of the patella is adopted
patella is replaced routinely in rheumatoidห้องสมุดไป่ตู้arthritis, but not osteoarthritis
3 、关节肿大 手部关节肿大变形明显， 部分膝关节因骨赘形成或关节积液也会造 成关节肿大。
4 、骨摩擦音(感) 由于关节软骨破坏、 关节面不平，关节活动时出现骨摩擦音(感)， 多见于膝关节。
5、关节无力、活动障碍 关节疼痛、 活动度下降、肌肉萎缩、软组织挛缩可引 起关节无力，行走时软腿或关节绞锁，不 能完全伸直或活动障碍。
什么是骨性关节炎
骨关节炎是一种发生在 滑膜关节、发展缓慢，以局 部关节软骨破坏，并伴有相 邻软骨下骨板骨质增生或骨 唇形成为特征，由机械性、 代谢、炎症和免疫等因素作 用而造成的关节疾病。
病理特点
病理特点为关 节软骨变性破坏、 软骨下骨硬化或囊 性变、关节边缘骨 质增生、滑膜增生、 关节囊挛缩、韧带 松弛或挛缩、肌肉 萎缩无力等。
Operative
supine position, apply foot positioner before draping (so that the knee can be locked in full flexion)
thigh tourniquet is applied but is only inflated after draping (tourniquet only used for cementation after 2001)
临床表现
1 、关节疼痛及压痛 初期为轻度或中 度间断性隐痛，休息时好转，活动后加重， 疼痛常与天气变化有关。晚期可出现持续 性疼痛或夜间痛。关节局部有压痛，在伴 有关节肿胀时尤为明显。
2 、关节僵硬 在早晨起床时关节僵硬 及发紧感，也称之晨僵，活动后可缓解。 关节僵硬在气压降低或空气湿度增加时加 重，持续时间一般较短，常为几分钟至十 几分钟，很少超过30分钟。
all three components are inserted with one pack of Endurance cement mixed in partial vacuum; if exposure is sub-optimal, cement the patellar button and tibial tray first, and then insert the femoral component with another pack of cement (cement gun after 2001)
trace all previous X-rays and find the previous operation records (for revision cases)
consider knee aspiration and bone (Indium111) scan if sepsis is suspected (for revision cases)
术前准备 拍摄双侧下肢全长X光片 (站立位、髌骨向前、双
足并拢) 回顾所有以前拍摄过的X光片并找出以往手术记录
(对于翻修病例) 如果怀疑感染﹐可考虑行膝关节穿刺和铟111同位
素骨扫描 (对于翻修病例)
Pre-operative (medical)
fill in the total knee replacement arthroplasty documentation form
辅助检查
OA的X线表现可有：关节间歇狭窄、关节软 骨下骨质硬化、边缘骨质增生、关节鼠形成 及软骨下囊性变。
Work-up
take long films of both lower limbs (standing, patellae facing forward, feet together)