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膝关节骨关节炎的外科治疗

faburiqi: 2018-10-07     yueducishu: 8144

膝关节骨关节炎是关节外科常见的慢性关节疾患,具有患病率高、病变范围广、晚期功能障碍程度重等特点。调查结果显示,在40~60 岁的人群中,骨关节炎的患病率为10%~17%; 60岁以上人群中,骨关节炎的患病率达50%;而在> 75岁人群中, 80%患有骨关节炎。

yinggaishuomuqianshangmeiyourenhezhiliaofangshikeyishiguguanjieyandebingchengnizhuanhetingzhi,guguanjieyandezhiliaomudeshihuanjietengtong,yanhuanbingbianfazhan;zaoqizhengquedezhiliaokeyimingxianxiaochuzhengzhuang,gaishanguanjiegongneng,shijibingbuyingxianghuanzhedeshenghuozhiliang;wanqiguguanjieyanhuanzhe,yingjijicaiqushoushuzhiliao,yibimianguanjieyanzhongjixingdefasheng。muqiandezhiliaozhuyaocaiyongjietiliaofa,jizaoqicaiyongfeiyaowu(huanzhejiaoyu、wulizhiliao、jirouxunlian、tizhongkongzhi、fuzhuzhijudeng)、yaowuzhiliao(gaishanzhengzhuangyaowu、gaishanjiegouyaowu),danghuanzheyoujiaoyanzhongdechixuxingtengtongjimingxiandeguanjiehuodongzhangai,baoshouzhiliaowuxiao,yingxianggongzuojishenghuoshi,zekaolvshoushuzhiliao,duiyuzao、zhongqiguguanjieyanhuanzhe,kezaiguanjiejingxiaxingguanjieqinglishu,xiaoguolianghao。wanqichuxianjixinghuochixuxingtengtongshi,kegenjuhuanzhejutiqingkuangxuanzeguanjiezhouweijiegushujirengongguanjiezhihuanshu。neimenaxiexiguanjieguguanjieyanhuanzheshiheguanjiejingshoushuni?tongchangyabotiyuxuanzetengtongshijianduan<3geyue;youniushangshi;youmingquedejixiezhengzhuangrukagan、jiaosuohuohuanxishenzhishouxian;guanjiejiye、guanjiexianyatong、mcmurrayzheng(+);neifanjixing< 10°,waifanjixing< 15°。zaishiyingzhengxuanzeheshideqingkuangxiaguanjiejingzhiliaoxiguanjieguguanjieyanhuiqudehuanjiezhengzhuang、gaishangongneng、yanhuanbingqingfazhandeliaoxiao。

rengongguanjiezhihuanshuyongyuyanzhongdeguxingguanjieyan;

shangxufuheyixiabiaozhuncaishiyijinxingrengongguanjiezhihuanshu: ①guanjiemianguheruangupohuaideyingxiangxuegaibian;②youzhongdudaozhongduchixuxingtengtong;③jingguozhishaobanniandebaoshouzhiliao,gongnenghetengtongwufagaishan。baoshouzhiliaozhishaoyingbaokuo: feizaitileikangyanyaowujiqitaleixingdezhitengyaowu、liliao、zhuxingzhuangzhi(shouzhang、guaizhangdeng)yijiyouyishidejianshaoguanjiefuhedeshenghuo、gongzuoxiguandegaibian;④huanzhenenggoujijipeiheyishengzhiliao,youlianghaodeyicongxing;

亚伯体育nianlingyifeirengongguanjiezhihuandejuedingxingyinsu。zuichu,shouxianyuzaoqiderengongguanjiejiatishejijicailiaomosunxingnengdexianzhi,yijishoushujishushangbuchengshu,yidurenweirengongguanjiezhihuanzhishiyongyu65suiyishangrenqun。 dansuizhegengduodexinxingnaimocailiaozairengongguanjiezhongguangfanyingyong,shoushujishutebieshifanxiujishudedafudutigao,gezhongfanxiujiatishejiriquwanshan,errenmenduishenghuozhiliangdeyaoqiuyebuduantigao,yuelaiyueduodegaolingrenqunhenianqingrenyinweiyanzhongdeguanjiejibingjieshourengongguanjiezhihuanshu。

亚伯体育chenggongdeyaosu(4pyaosu)

亚伯体育(1) (patient selection)bixuxuanzeheshishiyingzhengdehuanzhe

rengongguanjiezhihuanshujinguanyijinghuodehendadechenggong,danrengrannanyimanzunianqinghuanzhedahuodongliang,zhangqishiyongdeyaoqiu;duiyumouxiegaolinghuanzhe,qibansuiyouqitaqiguandeyanzhongjihuan,huozhenanyipeiheyishengjinxingzaoqideguanjiegongnengkangfu,yebushiyuguanjiezhihuan。baozhenghuanzheanquanyongyuanshirengongguanjiezhihuanshuyaokaolvdediyiweidewenti。

亚伯体育huanzhebixujubeimanzushoushuyaoqiudequanshenzhuangkuangjilianghaodejingshenzhuangtai,tongshiyaoduirengongguanjiezhihuanshuyouhelideyuqi。

亚伯体育(2) (procedure)shoushucaozuojishu

rengongguanjiezhihuanshuduiyishengdeshoushucaozuojishuyaoqiuhengao。

shouxianrengongguanjiezhihuanshuzhongchuleyaoduiguanjiedebingzaojinxingqiechuyiwai,xuyaoshenkelijieguanjiedeyundongxueyuanli,jiangrengongguanjiedejiatianzhuangzaizhunquedeweizhi,jinengshijiatihuodelianghaodewendingxing,younenghuifuguanjiedezhengchangyundong。

qici,rengongguanjiezhihuanshuzhongyaoshiyongdaodaliangdegongjuqixie。yishengbixuzhangwogongjuqixiedeshejiyuanli,shuxishiyongfangfa,zheijiuxuyaodaliangdelilunxuexihelinchuangshijian。zaiyabotiyuguo,haiyouyigetedian,jiduoshuhuanzhezaixunqiuguanjiezhihuanshi,guanjiejibingyizhiwanqi,cunzaiyanzhongdeguanjiejixingheguquesundengqingkuang。zheigengxuyaoyishengyouzhashidelilunjichujifengfudelinchuangjingyan,cainenglinghuodechulishoushuzhongchuxiandefuzaqingkuang。guowaiyouyanjiubiaoming,nianshoushuliangxiaoyu30lideyishengzhiliaodehuanzhegengrongyichuxianbingfazheng。

(3) (prosthesis selection)jiatixuanze

亚伯体育xuduohuanzhejiandandelijieweirengongguanjiejiati“yueguiyuehao,yuexinyuehao”。

qishiburan,shouxian,rengongguanjiejiatixuyaozairentineizhangqifahuixiaoneng,erxindejiatiwangwangjinzaishiyanshineijingguomoniceshi。jinguanshiyanshujubiaomingkeyishiyongjiaozhangshijian,danyouyurentihuanjingjiqifuza,guanjiejiatinengfouzairentineifahuizhangqixiaonengzecunzaiyiwen,xuyaoshijianjianyan。

亚伯体育qici,rengongguanjiejiatizhongleifanduo,qishejidejiepouxueshujulaiziyubutongzhongzuderenqun,chuzhongshizhenduibutongleixingjibingdehuanzhe,yinciguidejiati、xindejiatiweibishizuishihenindejiati。

亚伯体育zaize,yishengduiyujiatideshuxichengduyezaihendachengdushangjuedinglelinchuangdejieguo,yizhongxindejiati,kenengganggangjinrudaolinchuangshiyong,yishenghaiquefashijianjingyan,duiyujiatidetexingkenenghaibushuxi,fanerhuiyanzhangshoushushijian,zengjiashuhoubingfazheng。

亚伯体育yinci,gengweizhunquedelijieshi,“meiyouzuihaodejiati,zhiyouzuishihenidejiati”。

亚伯体育(4) (peri-operation management)weishoushuqiguanli

亚伯体育yilirengongguanjiezhihuanshudechenggong,shiyigetuanduigongtongnulidejieguo。shoushuyishengzaiqizhongbanyanzhuyaojiaose,ermazuishi、neikeyisheng、hushi、kangfushidengtongyangzhongyaoerbukehuoque。xifangfadaguojiaderengongguanjiezhihuanshuyijingfeichangchengshu,yincizairengongguanjiezhihuandeyiliaozhongxinxingchengleyigewendingdetuandui,duiyuxuyaojinxingrengongguanjiezhihuandehuanzhecaiyongbiaozhunhuadechuliliucheng。zheidadatigaoleshoushudeanquanxinghechenggonglv,yesuoduanlehuanzhedezhuyuanshijianjijiangdilehuanzhedeyiliaozhichu。

亚伯体育weishoushuqiguanlishejihuanzheshuqianquanshenzhuangkuangdepinggu,mazuipinggujicaozuo,shuzhongshoushuyishengjiqixiehushideshulianpeihe,shuhouzhiteng,kangganran,kangfudengzhuduofangmian。

亚伯体育chenggongderengongguanjiezhihuanshuyishangsigeyaosuqueyibuke。


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