人工髋关节置换术的发展对康复提出的新挑战.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,人,工,髋,关,节置,换,技,术,发,展,对,康,复,提,出的,新,挑,战,人,工,髋,关,节,Copyright Swedish Hip Arthroplasty Register,Primr,total,hftprotes,i,Sverige,Primary,total,hip,replacement,in,Sweden,ter,analysis,regarding,reoperations,and,revisions.,1,我,Re-reporting,国,：,21,8400/,10000,年,人,工,（,髋,）,关,节,置,换,术,Reporting,to,the,Registry,The,number,of,primary,total,hip,arthroplasties,performed,in,Swed-,examples,of,such,work.,This,year,we,publish,written,re-,手术,率,1,.68/,每,tral,problem,area,for,the,Registry,s,work.,千人,5,SWEDISH,HI,P,ARTHR,O,PLASTY,RE,GI,STE,R,2,01,0,20,世纪最,重,Most,medical,departments,要,records,的,from,report,re-operations,技,via,the,术,web,are,application.,创,sent,over,新,Copies,the,year,of,with,varying,delay.,Reviews,of,medical-record,copies,and,systemized,data,collection,centrally,are,necessary,for,Regis-,All,publications,annual,reports,and,scientific,reports,are,presented,on,our,website.,The,Hip,Arthroplasty,Registry,in,collaboration,with,the,Swedish,Knee,Arthroplasty,Reg-,istry,invites,all,departments,to,an,annual,user,meeting,at,Arlanda.,Local,activity,analysis,and,development,The,Registry,has,always,intended,that,re-reporting,should,stimulate,participating,departments,to,carry,out,local,anal-,yses,of,their,activity,and,that,this,should,lead,to,measures,for,improvement.,The,purpose,of,open,comparisons,is,that,16000,14000,8000,6000,4000,0,67,70,73,76,79,82,85,88,91,94,97,00,03,06,09,they,should,put,increased,pressure,on,this,process.,In,the,past few years we have,in each annual report,selected good en from 1967(6 operations)to (15 935 operations).,瑞典的初次全ports髋置from 换two departments：1967about 年their（analyses.6例How）to，（15935例），,stimulate,all,departments,to,carry,out,similar,work,is,a,cen-,development,of,registries,internationally,where,the,Swe-,dish,Hip,Arthroplasty,Register,has,been,a,model.,This,year,s,production,Ola Rolfson,who defended his thesis on 10 December,summarising the Registrys 10-year patient-related outcome,人工髋关节置换术（THA）的目的 解除疼痛,恢复功能,改善外观,THA康复的目的 消除或控制疼痛,恢复关节活动度,恢复肌肉强度,恢复关节平衡感觉（本体觉）,延长人工关节使用寿命,防止、治疗并发症,前,提,：,保,持,稳,定,性,Fig.,4.,失,去,功,能,Anteroposterior,radiograph,of,the,left,Fig,hip,joint,shows,a,cranially,dislocated,total,hip,arthroplasty,even,though,the,acetabular,cup,is,in,a,proper,position.,早,期,：,对合稳定,中晚期,：,界面稳定,稳,定,性,的,维,持,头臼对合,假体,-,骨界面固定,1960,Charnley,金,属,-,塑,料,全,髋,low-friction,John,Charnley,骨,水,泥,的,深,入,研,究,与,推,广,磨,损,快,脱,位,率,7%,22mm,即,刻,稳,定,早中期功能优秀,中,晚,期,松,动,率,高,金,属,-,塑,料,全,髋,骨,水,泥,固,定,界,面,固,定,骨水泥,非骨水泥,初期机械性稳定 中远期生物性稳定,假体形状,（力学分布,）,表面处理,对,合,稳,定,金属,-,聚乙烯,陶瓷,磨损率大大减少，减少松动,金属,-,金属,股,骨,头,直,径,123,evant,designs,and,component,orientations,to,further,clarify,our,understanding,of,dislocation,risk.,We,therefore,evaluated:,(1),the,three-dimensional,sta-,bility,of,four,different,component,designs;,(2),whether,various,clinically,relevant,positions,of,abduction,and,Fig.,1,This,is,a,schematic,diagram,illustrative,of,traditional,jump,distance,measurements,at,45,(left),and,0,(right).,稳定性提高,关节活动范围增大 脱位率减少,磨损率减少,远近,端分,别,准备,，获,得最,大填充,多角度调整前,倾角、偏距、长度,组,配,型,假,体,获得远,端固定,、为近,端移植,骨愈合,提供保证,组,配,型,假,体,直,前后倾,8,前后倾,15,内翻外翻,现,代,人,工,髋,关,节,更稳定,更大的活动范围,更耐磨,？,手,术,适,应,证,最,初,6075,岁,疼痛无法缓和的关节炎（解除疼痛）改善功能为次要目的,年龄,疾病,In,1994,，,THR,is,an,option,for nearly,all patients with diseases of the hip,that,cause,chronic,discomfort,and,significant,functional,impairment,手,术,适,应,证,无痛、有功能和稳定的髋关节，并且符合：发育成熟,髋关节疾病发展到了比较严重的程度 疼痛或功能障碍影响生活和工作 没有其他更好的治疗措施,易,脱,位,挑,战,：,高,龄,心肺功能差,卧床时间长,肌肉力量差,协调能力弱,术后神经系统失调多见,血栓,交流困难,挑战：年轻患者 追求生活质量、规定高 活动量大,活动范围大,依从性不确定,大,量,复,杂,病,例,高度脱位髋关节疾病,髋关节巨大骨溶解缺损,翻修,髋关节畸形,融合性髋关节,髋臼内陷征,关节僵硬,挛缩,髋周肌肉萎缩 协调性差 同步伴脊柱僵硬 驼背畸形,巨大骨溶解,个,体,化,定,制,型,假,体,多次手术史,创伤大,卧床时间长,易脱位,数字化原型重建,个性化假体设计,假体制作,手术治疗,儿,时,病,变,先,天,性,髋,关,节,脱,位,7cm,神经最易受牵拉损伤,Anteversion,(),P0.05,70.0,60.0,DDH,股,骨,前,倾,角,变,异,45.0,40.0,50.0,40.0,30.0,20.0,10.0,21.4,15.4,42.3,35.6,35.0,30.0,25.0,20.0,15.0,10.0,17.4,23.9,27.1,27.0,15.4,0.0,DDH,Normal,DDH,Normal,P0.05,中国DDH成人股骨前倾角变异较大，随脱位程度的增大 而增大，与国外的报道存在明显不一样,分次手术,真臼位置重建,股骨近端截骨,内收肌切断,取髋屈膝保护神经,Wilcox,and,Ha,髋关节屈曲,The,sig,Fig.,1.,The,drawing,of,axis,change,postoperatively.,膝关节屈曲,Of,22,(13.3,3.4;,range,5.6-23.0),who,had,preoperative,patient,膝关节外翻,the,pa,(range,膝前疼痛,secondary,coxarthrosis,owing,to,Crowe,type,III,an,postope,lengthening,was,18.2,7.2,mm,(range,2.3-37.4,mm).,scores,w,35.8,to,13.7),and,the,femoral,offset,increased,by,1.6,4.4,mm,(range,7.7,to,16.4,mm).,The,Insall-,knee,sc,period,1.24;,Table,3,).,after,the,operation.,improv,improv,committee,and,informed,consent,was,obtained,from,(,P,b,.00,下肢旋转力线变化 髂胫束张力增高,268 The Journal of Arthroplasty Vol.27 No.2 February,膝关节压力增高,Fig.,3.,The,graph,depicting,changes,in,lateral,patellar,tilt.,Asterisk,denotes,a,significant,difference,(,P,b,.0001),(mean,SD).,Numer,minimu,were,re,To,dete,variable,change,MM,an,Fig.,2.,The,angle,of,anteversion,of,the,femoral,neck,was,analysis,of,variance,Fig.,3,1A,and,1B).,The,increase,disappeared,3,months,after,the,operation,(10.7,2.3;,range,5.0-17.0;,Fig.,3,and,1C).,Lateral,patellar,tilt,was,numeri,increased,in,all,the,patients,with,knee,pain,to,16.2,3.5,lation,t,(range,11.0-22.0),from,preoperative,values,of,9.7,2.6,(range,4.9-15.7),and,this,was,significantly,larger,compared,to,that,seen,in,patients,without,knee,pain,strain,i,hips,to,assess,the,value,of,leg,lengthening,at,knee,early,jo,p,values,of,9.8,2.3,(range,6.2-16.5;,Table,2,and,).,Significant,to,analyze,whether,these,alterations,have,any,valgum,e,correlation,was,found,between,the,magnitude,on,of,clinical,change,scores.,was,sta,in,lateral,patellar,tilt,and,the,presence,of,anterior,knee,of,the,pain,(,P,b,.0001).,Materials,and,Methods,16.1,m,The,leg,length,inequality,was,18.4,7.7,mm,A,total,(range,of,126,hips,of,104,patients,were,operated,w,1.5-39,mm),before,surgery,and,0.3,1.5,mm,THA,(,4.9,and,to,subtrochanteric,shortening,osteotomy,(,P,b,.00,5.4,mm),after,surgery,and,the,average,amount,of,leg,Impro,hip dysplasia,between and.The indicat.001).,Femoral,anteversion,decreased,by,7.1,3.9,(range,for,surgery,were,patients,having,extreme,limitatio,.001),(,motion,during,daily,activities,and,pain,at,night,scores,(,Salvati,ratio,was,1.06,0.062,(range,0.84-1.24),responding,after,to,at,least,6,months,of,conserva,operation,and,showed,no,change,when,treatment.,compared,Patients,who,had,a,history,of,surgery,postope,with,preoperative,values,(1.06,0.065;,range,trauma,Fig.,0.84-,3.,in,The,the,measurement,ipsilateral,of,the,Q,knee,angle,of,primary,patient,the,day,or,second,wherea,osteoarthritis,of,the,knee,joint,patellofemoral,arthr,intra-articular,study,was,approved,or,extraarticular,by,the,institutional,ligament,research,ethics,lesions,reducti,in,physical,examination,Q,angle,greater,than,the,ph,each,patient.,The,i,ologic,values,or,pathologic,genu,varum,and,valg,挑,战,关节置换,+,截,骨内固定,保护神经功能,保持关节稳定性,保证截骨愈合,髋关节康复,膝关节康复,对侧存在先天性脱位,脱位,并,发,症,多,样,深静脉血栓,异位骨化,Fig.,4.,Anteroposterior,radiograph,of,the,left,hip,joint,shows,a,cranially,dislocated,total,hip,arthroplasty,even,though,the,acetabular,cup,is,in,a,proper,position.,Fig.,5.,The,Hohmann,antiluxation,bandage,(Brillinger,GmbH,&,Co.,Tbingen,Germany),with,their,integrated,lateral,splints,limits,external,rotation,and,adduction,in,cases,of,an,“instable,hip,joint,”.,Color,figure,can,be,viewed,in,the,online,issue,which,is,available,at,www.aott.org.tr,假体周围骨折,肢体不等长,人,工,髋,关,节,置,换,术,的,发,展,假体设计,、,制造工艺提高,对疾病认识和手术技术提高,使更数年龄层患者受益,更多更复杂疾病,多种并发症,对康复医生提出新挑战,人工关节置换术治疗团体 手术医师,护理,康复医师,病人、家眷,医,患,沟,通,疾病的严重性,关节置换术的目的-改善生活质量 不一样类型关节置换术的优缺陷 关节置换术的术前准备,关节置换术的术后康复过程,重要性,时间,艰难的,/,痛苦的,病,人,教,育,病人教育,理解病情,简介手术基本知识,树立康复信心,病人家眷教育,家庭康复的执行,积极参与康复治疗,后期康复要点,医,护,沟,通,医生,理解手术状况,关,注,术后注意事项,及,时,反馈术后问题,康,复,医,师,理解疾病,理解THA进展,理解手术状况,最佳参与术前讨论和术后总结 协助评估康复效果,与医生及时沟通，反馈康复反应,人,工,关,节,置,换,术,的,康,复,治,疗,康复治疗始于术前,康复方案因人、因病、因时而异（个体化）康复治疗需要团体协作,