Plated knee arthrodesis

The fixation of the steel plate has the advantages of stability, firmness and reliability, reduction of external fixation time, and the ability of the patient to move early. In addition, the incision can be used for surgery such as lesion removal, tumor resection (lower femur and upper tibia), bone grafting, correction of deformity and internal fixation. Treatment of diseases: knee joint tuberculosis Indication Plate fixation knee joint fusion is suitable for: 1. Knee joint tuberculosis, articular cartilage and bone destruction. Children should be delayed until the squall line is closed and then fused. 2. Rheumatoid arthritis, young and middle-aged patients with normal cartilage surface damage, long-term severe pain, loss of working ability, and normal joints of lower limbs. 3. Young patients with septic arthritis and joint deformity. 4. Knee joint failure. 5. The lower end of the femur and the upper end of the humerus are resected, and the joint function cannot be reconstructed. 6. sequelae of polio, unstable knee joints. Contraindications 1. The ipsilateral hip or contralateral knee has been fused. 2. Those who can retain joints or improve function with other operations, such as senile osteoarthritis with varus deformity, and can achieve significant effects after correction of deformity by tibia osteotomy. 3. Elderly people who are suitable for joint replacement. 4. Kneeling >15° non-functional tonic pain. 5. Children under the age of 12. Preoperative preparation 1. Knee flexion contracture deformity is corrected by excessive bone resection in the operation, which will cause limb shortening. It should be corrected gradually by spiral expander or traction before operation. Note that correcting too fast can cause paralysis of the common peroneal nerve. 2. Those with tuberculosis sinus, it is safer to fight for sinus closure and reintegration. 3. Have a history of purulent infection, use broad-spectrum antibiotics before surgery to prevent recurrence of resting infection. 4. Matching blood 300~600ml. Surgical procedure Incision and exposure The median incision was made from the iliac crest to the tibial tuberosity. Cut the skin, subcutaneous tissue and deep fascia, cut the quadriceps aponeurosis, cut the switch sac along both sides of the humerus, expose the knee joint and remove the humerus, and preserve the bone graft. For patients with weak quadriceps muscle strength and not suitable for tendon severing, the anterior medial incision should be used, starting from the inner edge of the 10cm quadriceps tendon, and bypassing the inner edge of the humerus to the tibial tuberosity. The tendon and the medial femoral muscle are separated, and the sac of the switch is cut along the humerus, which is enlarged downward, and the tibia is pulled outward to reveal the joint. 2. Lesion removal The cruciate ligament was cut, the calf was pushed back, and the medial and lateral collateral ligaments and the joint capsule were sharply dissected to dislocate the femoral condyle. Bend the knee joint, a dry gauze strip from the femoral joint, lift the lower end of the femur, remove the meniscus, clean the lesions in the joint, remove the synovial membrane, and wash the wound. 3. Saw the femoral articular cartilage surface Remove the gauze strip and place the femoral condyle on the tibial plateau. Do not move the calf position and continue to bend the knee 90°. The femoral articular surface was sawn with an amputation saw on the incision plane of the femoral condyle (the blade and the central axis of the femur were 85°, and the upper and lower sides were inclined by 5°). 4. Saw the articular cartilage surface of the tibia The femur is displaced posteriorly behind the humerus to protect the axillary vascular nerves. At the <1cm below the tibial plateau (the saw blade is 85° from the central axis of the humerus, ie 5° front and rear), the tibia is removed to achieve a 170° extension of the knee at one time, and the upper and lower bone ends can be closely aligned. 5. Steel plate fixing For the end of the bone, select two 8-hole steel plates and screws of appropriate length, first fix the anterior femoral condyle, and then fix the anterior medial side. The healthy part of the removed humerus is bitten into the filling space of the cancellous bone fragments. 6. Suture incision Rinse the wound, relax the tourniquet, strictly stop the bleeding, suture the joint capsule and the various layers of the incision, and fix the long leg plaster.