tailieunhanh - Phẫu thuật đầu gối

Một kế hoạch tốt tác tiếp cận để sửa đổi đầu gối arthroplasty tổng IS rất quan trọng cho một kết quả thành công. Must Be đã đạt được tiếp xúc rộng để cho phép loại bỏ thành phần, cân bằng mô mềm, quản lý của mất xương, và reimplantation Nếu không có Làm hư hỏng các cấu trúc quan trọng. | Surgical Exposures in Revision Total Knee Arthroplasty Alastair S. E. Younger MB ChB MSc FRCSC Clive P Duncan MB ChB MSc FRCSC and Bassam A. Masri MD FRCSC Abstract A well-planned operative approach to revision total knee arthroplasty is crucial to a successful outcome. Wide exposure must be achieved to allow component removal soft-tissue balancing management of bone loss and reimplantation without damaging important structures. These structures include skin the extensor mechanism the collateral ligaments the remaining bone stock and neurovascular structures. Skin necrosis can be avoided by selecting the appropriate incision and dissecting deep to the fascia. Extensile exposure by dissection of scar quadriceps snip or turndown tibial tubercle osteotomy or medial epicondylar osteotomy should be performed early to prevent patellar tendon disruption. In certain cases the distal femur can be exposed circumferentially by using a quadriceps myocutaneous flap or femoral peel. Special care should be taken with the infected or ankylosed knee. J Am Acad Orthop Surg 1998 6 55-64 Revision total knee arthroplasty is a challenging surgical procedure. The correct surgical approach and sound knowledge of local anatomy will allow safe exposure of the joint and successful completion of the Particular risks in the surgical exposure for revision total knee arthroplasty include wound-edge necrosis and rupture of the extensor mechanism. Both are serious complications the former increasing the risk of periprosthetic infection due to the loss of the epithelial barrier the latter resulting in poor long-term function and increased risk of Both complications must be prevented by careful planning and execution of the procedure. Other structures one must avoid damaging include the collateral ligaments at the level of the joint and the neurovascular struc tures in close proximity to the posterior and lateral aspects of the knee. Patients at particular risk for .