Zimmer MIS Multi-Reference, Хирургическая техника, Страница: 14 / 48

Zimmer MIS Multi-Reference 4-in-1 Femoral Instrumentation Surgical Technique
12
Step Two
Cut the Distal Femur
While the Adjustable IM Alignment
Guide is being inserted by the surgeon,
the scrub nurse should attach the Mini
Distal Femoral Cutting Guide to the 0°
Distal Placement Guide (Fig. 2a).
Ensure that the attachment screw
is tight. Insert the Distal Placement
Guide with the cutting guide into the
Adjustable IM Alignment Guide until
the cutting guide rests on the anterior
femoral cortex (Fig. 2b). The Mini Distal
Femoral Cutting Guide is designed to
help avoid soft tissue impingement.
Optional Technique: The 3° Distal
Placement Guide can be used to place
the Mini Distal Femoral Cutting Guide
in 3° of flexion to protect the anterior
cortex from notching.
Using the 3.2mm drill bit, drill holes
through the two standard pin holes
marked “0” in the anterior surface of
the Mini Distal Femoral Cutting Guide,
and place Headless Holding Pins
through the holes (Fig. 2c).
Additional 2mm adjustments may be
made by using the sets of holes marked
-4, -2, +2, and +4. The markings on the
cutting guide indicate, in millimeters,
the amount of bone resection each
will yield relative to the standard distal
resection set by the Adjustable IM
Alignment Guide and Standard
Cut Plate.
If more fixation is needed, use two
3.2mm Headed Screws or predrill and
insert two Hex-head Holding Pins in the
small oblique holes on the Mini Distal
Femoral Cutting Guide, or Silver Spring
Pins may be used in the large oblique
holes (Fig. 2d).
The IM guide can be left in place during
resection of the distal condyle, taking
care to avoid hitting the IM rod when
using the oscillating saw.
Fig. 2a
Fig. 2c
Fig. 2b
Fig. 2d
Completely loosen the attachment
screw (Fig. 2e) in the Distal Placement
Guide. Then use the Slaphammer
Extractor to remove the IM guide and
the Distal Placement Guide (Fig. 2f).
Cut the distal femur through the
cutting slot in the cutting guide using
a 1.27mm (0.050-in.) oscillating saw
blade (Fig. 2g). Then remove the
cutting guide.
Check the flatness of the distal femoral
cut with a flat surface. If necessary,
modify the distal femoral surface
so that it is completely flat. This is
extremely important for the placement
of subsequent guides and for proper
fit of the implant.
If you prefer to complete tibial cuts
prior to completing the femur, refer
to page 22.
Fig. 2e
Fig. 2f
Fig. 2g