TKA・UKA 人工膝関節置換術パーフェクト

出版社: 羊土社
著者:
発行日: 2021-06-05
分野: 臨床医学:外科  >  整形外科学
ISBN: 9784758118972
電子書籍版: 2021-06-05 (第1刷)
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豊富な写真や図とともにエキスパートのTKA・UKAの手技を流れで理解できる1冊.術中のコツや,術前・術後に注意すべき内容まで網羅的にフォロー.これから始める人にもステップアップしたい人にもオススメ.

目次

  • 第1章 TKA・UKAの手術までの準備
    1 適応(TKAかUKAかHTOか)
    2 多関節OAに対する戦略
    3 術前の準備
    4 併存症への対応
    5 術前評価しておくべきもの

    第2章 これからTKAを始めるために
    ◆§1.術前
    1 ICの実際
    2 インプラントの種類と構造(長所,短所,術後成績など)
    3 手術の目標:アライメント
    4 手術の目標:靱帯バランス
    5 術前計画およびその実施
    6 手術器具の正しい使い方
    ◆§2.各手術アプローチ
    1 皮切
    2 medial parapatellar approach, midvastus approach, trivector approach
    3 subvastus approach
    4 lateral parapatellar approach
    5 quadriceps snip, V-Y turn down, 脛骨粗面骨切り
    ◆§3.手術手技の実際と注意点
    1 後十字靱帯温存型TKA~medial stabilizing technique~
    2 後十字靱帯機能代償型TKA
    3 Medial Pivot型TKA
    4 両十字靱帯機能代償型TKA
    5 両十字靱帯温存型TKA
    6 kinematically aligned−TKA
    7 膝蓋骨の処置
    8 セメントテクニック
    9 セメントレステクニック(注意点を中心に)
    10 特別な症例に対する注意点
    11 可動域向上の工夫
    12 創閉鎖の工夫
    ◆§4.トラブルシューティング(予防も含めて)
    1 軟部組織バランス不良(ギャップ不足,不安定性,膝蓋骨トラッキング不良)
    2 軟部組織損傷(MCL,膝蓋腱など)
    3 術中骨折
    4 神経・血管損傷
    ◆§5.難治症例の対処
    1 屈曲拘縮
    2 高度内反変形膝
    3 外反変形膝
    4 高度不安定性への対処(PS型,condylar-constrained型,rotating-hinge型)
    5 骨欠損への対処
    ◆§6.コンピュータ支援手術
    1 ナビゲーション
    2 patient specific instrumentation(PSI)
    3 ロボット支援手術

    第3章 これからUKAを始めるために
    ◆§1.術前
    1 ICの実際
    2 UKAインプラントの種類と構造
    3 手術の目標(アライメントと靱帯バランス)と術前計画
    ◆§2.手術手技の実際
    1 内側UKA:mobile bearing型
    2 内側UKA:fixed bearing型
    3 外側UKA
    4 トラブルシューティング

    第4章 合併症対策・術後管理:より安全な手術を行うために
    1 出血対策
    2 周術期疼痛対策
    3 感染予防(手術室,手術着,抗菌薬,など)
    4 深部静脈血栓症対策
    5 腫脹,浮腫予防
    6 超高齢者への配慮
    7 術後リハビリテーション
    8 術後マネジメント(生活指導・スポーツ)
    9 術後晩期疼痛対策

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第1章 TKA・UKAの手術までの準備

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2) Bedard NA, et al : The John N. Insall Award : Do Intraarticular Injections Increase the Risk of Infection After TKA? Clin Orthop Relat Res, 475 : 45-52, 2017
3) Richardson SS, et al : Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am, 101 : 112-118, 2019
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5) Bannuru RR, et al : OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 27 : 1578-1589, 2019
6) Kim K, et al : Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes. J Knee Surg, 33 : 306-313, 2020
7) Doi T, et al : Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs : a randomized controlled trial. Am J Phys Med Rehabil, 87 : 258-269, 2008
8) Furu M, et al : Quadriceps strength affects patient satisfaction after total knee arthroplasty. J Orthop Sci, 21 : 38-43, 2016
9) Nishitani K, et al : A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty. Knee Surg Relat Res, 31 : 25-30, 2019
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12) Tokarski AT, et al : Dental clearance prior to elective arthroplasty may not be needed for everyone. J Arthroplasty, 29 : 1729-1732, 2014
13) Lee SH, et al : Effectiveness of iron supplementation in the perioperative management of total knee arthroplasty : a systematic review. Knee Surg Relat Res, 32 : 44, 2020
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P.25 掲載の参考文献
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5) Marchant MH Jr, et al : The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am, 91 : 1621-1629, 2009
6) Stryker LS, et al : Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. J Bone Joint Surg Am, 95 : 808-14, S1, 2013
7) Tarabichi M, et al : Determining the Threshold for HbA1c as a Predictor for Adverse Outcomes After Total Joint Arthroplasty : A Multicenter, Retrospective Study. J Arthroplasty, 32 : S263-S267.e1, 2017
8) Dhatariya K, et al : NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med, 29 : 420-433, 2012
9) Stundner O, et al : Rheumatoid arthritis vs osteoarthritis in patients receiving total knee arthroplasty : perioperative outcomes. J Arthroplasty, 29 : 308-313, 2014
10) Kobayashi S, et al : Rheumatoid Arthritis Patients Achieve Better Satisfaction but Lower Functional Activities as Compared to Osteoarthritis Patients After Total Knee Arthroplasty. J Arthroplasty, 34 : 478-482.e1, 2019
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12) Goodman SM, et al : 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. J Arthroplasty, 32 : 2628-2638, 2017
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P.30 掲載の参考文献
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第2章 これからTKAを始めるために

P.34 掲載の参考文献
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3) Christ AB, et al : Incidence and Risk Factors for Peripheral Nerve Injury After 383,000 Total Knee Arthroplasties Using a New York State Database (SPARCS). J Arthroplasty, 34 : 2473-2478, 2019
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5) Chang MJ, et al : Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis : a 128-row multidetector CT indirect venography study. BMC Musculoskelet Disord, 19 : 274, 2018
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P.45 掲載の参考文献
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2) Nakamura S, et al : Correlation Between Intraoperative Anterior Stability and Flexion Gap in Total Knee Arthroplasty. J Arthroplasty, 33 : 2480-2484, 2018
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P.50 掲載の参考文献
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3) Nishida K, et al : Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 25 : 3488-3494, 2017
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P.55 掲載の参考文献
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3) Takayama K, et al : Influence of intra-operative joint gaps on post-operative flexion angle in posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 20 : 532-537, 2012
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5) Ismailidis P, et al : Clinical outcome of increased flexion gap after total knee arthroplasty. Can controlled gap imbalance improve knee flexion? Knee Surg Sports Traumatol Arthrosc, 25 : 1705-1711, 2017
6) Minoda Y, et al : Joint Gap in Mid-Flexion Is Not a Predictor of Postoperative Flexion Angle After Total Knee Arthroplasty. J Arthroplasty, 33 : 735-739, 2018
7) Deshmane PP, et al : Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty. Orthopedics, 37 : e768-e774, 2014
8) Watanabe T, et al : Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty : assessment of well-functioning knees. Knee Surg Sports Traumatol Arthrosc, 28 : 1400-1409, 2020
9) Tanaka Y, et al : Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction. Knee Surg Sports Traumatol Arthrosc, 2020
10) Tsukiyama H, et al : Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee, 24 : 1478-1484, 2017
11) Kamenaga T, et al : Medial knee stability at flexion increases tibial internal rotation and knee flexion angle after posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon), 68 : 16-22, 2019
12) Matsuzaki T, et al : Tibial internal rotation is affected by lateral laxity in cruciate-retaining total knee arthroplasty : an intraoperative kinematic study using a navigation system and offset-type tensor. Knee Surg Sports Traumatol Arthrosc, 22 : 615-620, 2014
13) Nakano N, et al : Postoperative Knee Flexion Angle Is Affected by Lateral Laxity in Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty, 31 : 401-405, 2016
14) Kobayashi T, et al : Lateral laxity in flexion increases the postoperative flexion angle in cruciate-retaining total knee arthroplasty. J Arthroplasty, 27 : 260-265, 2012
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第3章 これからUKAを始めるために

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第4章 合併症対策・術後管理 : より安全な手術を行うために

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