全膝關(guān)節(jié)置換術(shù)不同股骨后髁偏心距對術(shù)后膝關(guān)節(jié)最大屈曲度影響的初步基礎(chǔ)研究
發(fā)布時(shí)間：2019-04-01 23:07
【摘要】：目的全膝關(guān)節(jié)置換術(shù)是治療終末期膝骨關(guān)節(jié)炎的有效方法,術(shù)后膝關(guān)節(jié)良好的屈曲度是手術(shù)成功及患者滿意的一個(gè)重要方面。影響膝關(guān)節(jié)置換術(shù)后膝關(guān)節(jié)屈曲度的因素是多方面的,其中股骨后髁偏心距(posterior condylar offset)最早由Bellemans等在2002年提出,近年來,股骨后髁偏心距對膝關(guān)節(jié)屈曲度的影響多有報(bào)道,其對膝關(guān)節(jié)屈曲度的影響具有一定爭議。理論上,股骨后髁偏心距越大,在膝關(guān)節(jié)屈曲過程中脛骨平臺(tái)后緣與股骨后側(cè)骨皮質(zhì)發(fā)生撞擊越晚,膝關(guān)節(jié)屈曲角度越大。本次初步研究應(yīng)用基礎(chǔ)實(shí)驗(yàn),探討股骨后髁偏心距與膝關(guān)節(jié)置換術(shù)后膝關(guān)節(jié)最大屈曲度的關(guān)系。方法實(shí)驗(yàn)用福爾馬林固定的人體下肢6具,長度自髖關(guān)節(jié)離斷至足(包括足),其中男性4具,女性2具,膝關(guān)節(jié)外形均未見明顯疤痕及畸形,屈伸活動(dòng)自如;實(shí)驗(yàn)用假體選用強(qiáng)生De Puy PFC SIGMA PS假體固定平臺(tái)系統(tǒng),股骨側(cè)試模選用常用型號2、2.5、3、4;脛骨側(cè)依據(jù)測量大小選用試模;半月板厚度包括8mm、10mm、12.5mm、15mm、17.5mm和1mm厚度墊片;實(shí)驗(yàn)用骨水泥選用有機(jī)膠泥替代。手術(shù)操作常規(guī)行內(nèi)側(cè)髕旁入路暴露膝關(guān)節(jié),先行股骨側(cè)截骨:股骨遠(yuǎn)端等量截骨9mm,選用前參考系統(tǒng),將股骨測量導(dǎo)板導(dǎo)針定位于股骨遠(yuǎn)端外側(cè)皮質(zhì)齊平,擰緊尺寸指示刻度,移動(dòng)鉆頭導(dǎo)向刻度,分別定位于2、2.5、3、4,外旋3°在導(dǎo)板導(dǎo)釘孔依次打入導(dǎo)釘,股骨側(cè)按實(shí)際測量大小完成斜面截骨、髁間截骨;脛骨側(cè)專用器械完成平臺(tái)截骨,8mm間隙塊測量屈伸間隙相等;安裝實(shí)際股骨側(cè)及脛骨側(cè)試模假體,選用8mm半月板,極度屈曲膝關(guān)節(jié)攝最大屈曲純側(cè)位1:1 X線片,劃線測量并記錄股骨后髁偏心距數(shù)值及最大膝關(guān)節(jié)屈曲度數(shù)值;再分別由小至大安裝其余型號股骨側(cè)截骨板對應(yīng)之導(dǎo)板釘孔標(biāo)記,分別完成斜面截骨、髁間截骨,再分別按照不同股骨髁假體測量數(shù)據(jù)a(見圖1)之間差異,選擇相應(yīng)脛骨側(cè)加截骨數(shù)值或選用加厚脛骨平臺(tái)半月板型號,保證屈曲間隙恒定為8mm,應(yīng)用不同型號膝關(guān)節(jié)股骨側(cè)假體并極度屈曲膝關(guān)節(jié)攝最大屈曲純側(cè)位1:1 X線片,測量并記錄股骨后髁偏心距、膝關(guān)節(jié)最大屈曲角度數(shù)值,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果6具標(biāo)本術(shù)前與術(shù)中采用不同型號股骨側(cè)假體股骨后髁偏心距數(shù)值和術(shù)前與術(shù)中采用不同型號股骨側(cè)假體膝關(guān)節(jié)最大屈曲度數(shù)值經(jīng)Pearson相關(guān)系數(shù)和Spearman相關(guān)系數(shù)檢驗(yàn),同一標(biāo)本不同股骨髁偏心距與術(shù)后膝關(guān)節(jié)最大屈曲度并無相關(guān)性(均P0.05,差異無統(tǒng)計(jì)學(xué)意義)。結(jié)論通過本組實(shí)驗(yàn),我們認(rèn)為全膝關(guān)節(jié)置換術(shù)股骨后髁偏心距大小與術(shù)后膝關(guān)節(jié)最大屈曲度無相關(guān)性。
[Abstract]:Objective Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthritis. The good flexion of the knee after operation is an important aspect of the success and satisfaction of the patients. There are many factors affecting knee flexion after knee replacement. The eccentricity of femoral posterior condyle (posterior condylar offset) was first proposed by Bellemans et al in 2002. In recent years, the influence of femoral posterior condylar eccentricity on knee flexion has been reported. Its influence on knee flexion is controversial. Theoretically, the greater the eccentricity of the femoral posterior condyle, the later the impact occurs between the posterior edge of the tibial plateau and the posterior femoral bone cortex, and the greater the flexion angle of the knee joint is. In this preliminary study, the relationship between femoral posterior condylar eccentricity and the maximum flexion of knee joint after knee arthroplasty was studied. Methods six lower limbs were fixed with formalin. The length was from hip joint to foot (including foot). There were 4 males and 2 females. There were no obvious scars and deformities in the knee joint, and the movement of flexion and extension was free. The fixed platform system of Johnson De Puy PFC SIGMA PS prosthesis was used in the experiment, and the femoral side test model was chosen as the usual type 2, 2.5, 3, 4. The tibial side was tested according to the measuring size. Meniscus thickness includes 8mm, 10mm, 12.5mm, 15mm, 17.5mm and 1mm thickness gasket. During the operation, the knee joint was exposed through the medial paratellar approach, and the femoral lateral osteotomy was performed first: the distal femur osteotomy was equal to 9 mm. The anterior reference system was used to locate the femoral measurement guide pin in the lateral cortex of the distal femur and tighten the size indicator scale. The guide scale of the moving bit was fixed at 2,2.5, 3,4 and external rotation 3 擄into the guide pin hole in turn, and the femoral side was osteotomy on the oblique surface and intercondylar osteotomy according to the actual size of the femur. Tibial side special instrument completed platform osteotomy, 8mm space block measurement flexion and extension gap is equal; The 8mm meniscus was used to measure the maximum flexion of knee joint at 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion of knee joint were measured and recorded. From small to large, the other types of femoral lateral osteotomy plate corresponding to the guide plate pinhole marking, respectively completed oblique osteotomy, intercondylar osteotomy, and then according to different femoral condylar prosthesis measured data a (see fig. 1), the difference between the different femoral condylar prosthesis measured data a (see fig. 1). Select the corresponding tibial side plus osteotomy value or thickened tibial plateau meniscus type to ensure a constant buckling gap of 8 mm, using different types of knee femoral prosthesis and extreme flexion of the knee joint to take the maximum flexion of the pure lateral position 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion angle of knee joint were measured and recorded for statistical analysis. Results the eccentricity of femoral posterior condyle with different types of femoral prosthesis and the maximum flexion of knee joint with different types of femoral prosthesis were tested by Pearson correlation coefficient and Spearman correlation coefficient before and after operation. There was no correlation between the eccentricity of different femoral condyles and the maximum flexion of knee joint after operation (all P 0.05, there was no significant difference between the two groups). Conclusion there is no correlation between the eccentricity of the femoral posterior condyle and the maximum flexion of the knee after total knee arthroplasty.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2451993
[Abstract]:Objective Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthritis. The good flexion of the knee after operation is an important aspect of the success and satisfaction of the patients. There are many factors affecting knee flexion after knee replacement. The eccentricity of femoral posterior condyle (posterior condylar offset) was first proposed by Bellemans et al in 2002. In recent years, the influence of femoral posterior condylar eccentricity on knee flexion has been reported. Its influence on knee flexion is controversial. Theoretically, the greater the eccentricity of the femoral posterior condyle, the later the impact occurs between the posterior edge of the tibial plateau and the posterior femoral bone cortex, and the greater the flexion angle of the knee joint is. In this preliminary study, the relationship between femoral posterior condylar eccentricity and the maximum flexion of knee joint after knee arthroplasty was studied. Methods six lower limbs were fixed with formalin. The length was from hip joint to foot (including foot). There were 4 males and 2 females. There were no obvious scars and deformities in the knee joint, and the movement of flexion and extension was free. The fixed platform system of Johnson De Puy PFC SIGMA PS prosthesis was used in the experiment, and the femoral side test model was chosen as the usual type 2, 2.5, 3, 4. The tibial side was tested according to the measuring size. Meniscus thickness includes 8mm, 10mm, 12.5mm, 15mm, 17.5mm and 1mm thickness gasket. During the operation, the knee joint was exposed through the medial paratellar approach, and the femoral lateral osteotomy was performed first: the distal femur osteotomy was equal to 9 mm. The anterior reference system was used to locate the femoral measurement guide pin in the lateral cortex of the distal femur and tighten the size indicator scale. The guide scale of the moving bit was fixed at 2,2.5, 3,4 and external rotation 3 擄into the guide pin hole in turn, and the femoral side was osteotomy on the oblique surface and intercondylar osteotomy according to the actual size of the femur. Tibial side special instrument completed platform osteotomy, 8mm space block measurement flexion and extension gap is equal; The 8mm meniscus was used to measure the maximum flexion of knee joint at 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion of knee joint were measured and recorded. From small to large, the other types of femoral lateral osteotomy plate corresponding to the guide plate pinhole marking, respectively completed oblique osteotomy, intercondylar osteotomy, and then according to different femoral condylar prosthesis measured data a (see fig. 1), the difference between the different femoral condylar prosthesis measured data a (see fig. 1). Select the corresponding tibial side plus osteotomy value or thickened tibial plateau meniscus type to ensure a constant buckling gap of 8 mm, using different types of knee femoral prosthesis and extreme flexion of the knee joint to take the maximum flexion of the pure lateral position 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion angle of knee joint were measured and recorded for statistical analysis. Results the eccentricity of femoral posterior condyle with different types of femoral prosthesis and the maximum flexion of knee joint with different types of femoral prosthesis were tested by Pearson correlation coefficient and Spearman correlation coefficient before and after operation. There was no correlation between the eccentricity of different femoral condyles and the maximum flexion of knee joint after operation (all P 0.05, there was no significant difference between the two groups). Conclusion there is no correlation between the eccentricity of the femoral posterior condyle and the maximum flexion of the knee after total knee arthroplasty.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【共引文獻(xiàn)】
相關(guān)期刊論文 前6條
1 冉學(xué)軍;覃勇志;蒲川成;周勇;蘇琴;吳貴亮;;人工關(guān)節(jié)置換術(shù)后早期感染的治療措施[J];臨床骨科雜志;2015年01期
2 田潤;王丹;沈旭慧;;雙膝晚期骨性關(guān)節(jié)炎患者手術(shù)治療與康復(fù)護(hù)理進(jìn)展[J];湖州師范學(xué)院學(xué)報(bào);2015年04期
3 冉學(xué)軍;蒲川成;胡敏;覃勇志;周勇;蘇琴;吳貴亮;;保留修復(fù)后方關(guān)節(jié)囊及韌帶對防止人工髖關(guān)節(jié)置換術(shù)后脫位的作用[J];臨床骨科雜志;2015年03期
4 陳巧玲;黃雙英;封蕾;朱旭霞;沈宋炎;;穴位按壓聯(lián)合溫灸干預(yù)全膝關(guān)節(jié)置換術(shù)后下肢腫脹臨床觀察[J];上海針灸雜志;2015年10期
5 王波;季衛(wèi)平;;人工髖關(guān)節(jié)置換術(shù)下肢長度控制方法的研究進(jìn)展[J];中國中醫(yī)骨傷科雜志;2014年08期
6 王利;陸琳松;殷劍;袁宏;;聯(lián)合檢測降鈣素原、血沉、C-反應(yīng)蛋白在膝關(guān)節(jié)置換術(shù)后感染的臨床意義[J];中華關(guān)節(jié)外科雜志(電子版);2014年05期
相關(guān)碩士學(xué)位論文 前2條
1 蔡f+;丹參注射液對人工髖關(guān)節(jié)置換術(shù)后隱性出血影響的初步臨床觀察[D];湖南中醫(yī)藥大學(xué);2014年
2 方遠(yuǎn);采用超大生物型臼杯行髖關(guān)節(jié)翻修術(shù)的療效觀察[D];蘇州大學(xué);2014年
，本文編號：2451993
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2451993.html
最近更新
教材專著
