同濟(jì)大學(xué)附屬楊浦醫(yī)院關(guān)節(jié)外科主任，博士、主任醫(yī)師、博士生導(dǎo)師，美國(guó)田納西大學(xué)、英國(guó)牛津大學(xué)訪問(wèn)學(xué)者，《中國(guó)骨質(zhì)疏松雜志》、《生物骨科材料臨床研究雜志》編委、《中國(guó)組織工程研究》審稿專家，中國(guó)老年學(xué)會(huì)骨質(zhì)疏松委員會(huì)常委，中國(guó)醫(yī)師協(xié)會(huì)骨科醫(yī)師分會(huì)委員，中國(guó)康復(fù)醫(yī)學(xué)會(huì)骨與關(guān)節(jié)及風(fēng)濕病專業(yè)委員會(huì)專家委員，上海市中西醫(yī)結(jié)合學(xué)會(huì)創(chuàng)傷醫(yī)學(xué)委員會(huì)常務(wù)委員，上海市中西醫(yī)結(jié)合學(xué)會(huì)關(guān)節(jié)病委員會(huì)委員，上海市醫(yī)師協(xié)會(huì)骨科分會(huì)關(guān)節(jié)工作組組員，國(guó)家、上海市科技獎(jiǎng)評(píng)審專家，2017年上海市“五一勞動(dòng)獎(jiǎng)?wù)隆保瑖?guó)家發(fā)明專利5項(xiàng)、實(shí)用新型專利13項(xiàng)。
內(nèi)側(cè)、外側(cè)UKA手術(shù)適應(yīng)癥類似，包括單間室OA、骨壞死、創(chuàng)傷性關(guān)節(jié)炎 Unicompartmental arthritis, Osteonecrosis, Post-traumatic arthritis (√)
類風(fēng)濕關(guān)節(jié)炎不適合行UKA Rheumatoid arthritis (×)
另外一個(gè)間室狹窄明顯則為UKA的絕對(duì)禁忌證 Not limited to one compartment arthritis (×)
應(yīng)力位下間隙狹窄固定，無(wú)法糾正，也應(yīng)視為手術(shù)禁忌Fixed narrow deformity not corrected on stressed films (×)
超過(guò)10°的固定屈曲畸形 Fixed flexion deformity >10°(×)
非骨對(duì)骨Not bone on bone in involved compartment (×)
韌帶嚴(yán)重受損 Absent or several damaged ACL（MCL or PCL)(×)
St Georg Sled
術(shù)前動(dòng)力位檢查 Preoperative varus and valgus examination by fluoroscopy
髖關(guān)節(jié)屈曲70°Hip flexed to about 70°
切口髕骨上極至關(guān)節(jié)線下3厘米 From above the pole of the patella to a point 3cm distal to the joint line
剔除股骨髁邊緣骨贅 Moving large osteophytes from the margin of the femoral condyle and from both margins and root of the intercondylar notch
根據(jù)擬選擇試模型號(hào)標(biāo)記截骨的寬度和厚度 Marking the point of width and thickness of the osteotomy according to the proposed model number.
根據(jù)標(biāo)記截骨 Osteotomy is performed according to the markers
測(cè)試屈曲間隙和選擇脛骨假體 Measuring the flexion and chosing the tibial component with the appropriate width
標(biāo)記伸直線 Making full extension line
除去關(guān)節(jié)軟骨 Removing the femoral cartilage by oscillating blade
股骨假體定位在脛骨平臺(tái)中點(diǎn)的運(yùn)動(dòng)軌跡 Femoral prosthesis is positioned to contact in the centre of the tibial plateau
股骨假體完全覆蓋股骨髁 Drill guide cover the femoral condyle in deep flexion and extend up to but not significantly beyond the extension line
鉆固定孔 Drilling the fixation holes
試模復(fù)位 The trial sled prosthesis is placed on the prepared femoral condyle
脛骨開(kāi)槽 The bony structure is displaced, compressed by the chisel
試模復(fù)位 The tibial trial prosthesis is put into place with slight valgus loading
屈伸間隙平衡 The knee is moved through its entire range of motion to check the balance of the flexion and extension and the natural tension of the ligaments is restored
膝關(guān)節(jié)屈曲脛骨外旋有利于脛骨假體安裝 To facilitate tibial prosthesis placement, the knee is flexed and the tibia is externally rotated
股骨假體先于脛骨假體安裝 The femoral prosthesis was installed prior to the tibia prosthesis
關(guān)閉切口 Closing the incision
術(shù)后檢查 Postoperative examination by fluoroscopy
股骨髁截骨避免股骨假體過(guò)屈，避免發(fā)生髕骨撞擊 Avoid excessive flexion of the femoral component, Prevent patella impingement
股骨髁截骨避免股骨假體過(guò)伸，避免發(fā)生髕骨彈跳 Avoid excessive extending of the femoral component，Prevent patella bounce
假體置入后必須反復(fù)伸屈檢查 Repeatly test the patella movement trace
避免殘存骨贅導(dǎo)致假體撞擊 Avoid impingement
脛骨截骨 Tibial osteotomy
截骨應(yīng)比較保守Osteotomy should be conservative
脛骨垂直截骨內(nèi)旋5-10°（screw-home機(jī)制）（外側(cè)UKA） 5 to 10°internal rotation of the sagital tibial cut
截骨深度5-7mm The osteotomy depth was 5-7mm
脛骨截骨 tibial osteotomy
最佳脛骨后傾角度是5-7°optimal tibial slope is 5-7°
超過(guò)7°UKA失敗率增加 more failure when slope is beyond 7°
如何解決？How to do?
避免過(guò)度矯正冠狀面畸形 Avoid overcorrection of coronal deformity
推薦輕度矯正不足 Slight undercorrection
內(nèi)側(cè)UKA保留輕度內(nèi)翻 1 to 3°of varus
外側(cè)UKA保留輕度外翻 3 to 5°of valgus
髕股軌跡 Patellofemoral track
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